The Philippine Health Insurance Corporation (PhilHealth) has implemented a new benefit package for outpatient emergency care services, effective 1 January under PhilHealth Circular No. 2024-0033. The Outpatient Emergency Care Benefit (OECB) covers a variety of services for patients treated in emergency departments (ED) of accredited facilities, including prehospital transport.
Senator Christopher “Bong” Go, a health reforms advocate, welcomed the move, which effectively abolished the 24-hour confinement policy that required patients to be admitted before accessing PhilHealth coverage. However, Go emphasized the need for continued reforms to ensure Filipinos can access comprehensive healthcare services.
“Sulit ang ating pangungulit dahil kahit papaano ay ginagawan na ng aksyon ng PhilHealth ang mga hinaing na naisiwalat sa sunud-sunod na Senate Health Committee hearings na ating pinamunuan. Ngunit hindi tayo rito titigil hanggang maisakatuparan ang mga pangakong ito na kanilang binanggit under oath,” he said.
Among the most significant changes are PhilHealth’s commitments to increase benefit packages for the top ten mortality diseases, raise case rates by up to 50%, expand coverage for dental, outpatient drug, mental health, and optometric services, and remove anti-poor policies like the 24-hour confinement rule.
“Magandang hakbang ito, pero hindi dapat dito nagtatapos ang reporma. Siguraduhin ng PhilHealth na nasusunod ang kanilang mga obligasyon at napapakinabangan talaga ng taumbayan ang mga benepisyo,” Go added.
Under the new OECB package, patients can now claim coverage for emergency services without needing hospital admission. This includes cases such as dizziness, diarrhea, persistent vomiting, elevated blood pressure, seizures, and sexual assault. Diagnostic services like X-rays, CT scans, nebulization, and blood tests are also covered. Additionally, land ambulance services are now reimbursable, with plans to expand coverage to sea and air ambulances.
While supporting the new package, Go stressed the need for transparency and efficient implementation. “Kailangang malinaw at mabilis ang proseso para sa mga pasyente. Hindi pwedeng maipit ang pondo o magkaroon ng delay sa benepisyo,” he said.
PhilHealth clarified that the OECB package applies only to accredited health facilities. Patients treated at non-accredited facilities must pay out-of-pocket or rely on private insurance. For continuity of care, discharged patients will be referred to Konsulta-accredited primary care providers for follow-up treatment, though they must first register with an accredited Konsulta provider.
Go also urged PhilHealth to expand its network of accredited providers and simplify the registration process. He also reiterated that the agency must restore public trust through effective service.