PhilHealth now covers readmission for same illness within 90 days

By Ma. Teresa Montemayor, Philippine News Agency

FILE: BUSINESS UNUSUAL. Philippine Health Insurance Corp. transactions go through the manual process, like in this branch in Mother Ignacia Avenue, Quezon City, on Tuesday (Sept. 26, 2023), four days after its system was attacked by the Medusa ransomware. (PNA photo by Joan Bondoc)

MANILA – The Philippine Health Insurance Corporation (PhilHealth) has lifted its single period of confinement (SPC) policy, allowing members readmitted due to the same illness in 90 days to claim benefits.

“After extensive evaluation, we have lifted the rule of Single Period of Confinement to ensure continuous coverage for patients with recurring conditions,” PhilHealth Chief Emmanuel Ledesma said in a news release Thursday.

The SPC rule imposed that admissions and readmissions due to the same illness or procedure within a 90-calendar day period should only be compensated once.

In 2023, it resulted in the denial of 26,750 claims including community-acquired pneumonia, acute gastroenteritis, urinary tract infection, and chronic kidney disease.

Ledesma noted that the initiative applies to medical conditions and surgical procedures under the All Case Rate payment scheme.

“We understand that health is not just a privilege but an essential right for every Filipino. In these challenging times, we stand with them, and always make sure to deliver all the benefits they deserve,” he said.

Last month, Health Secretary Teodoro Herbosa said the SPC was developed during the time of Philippine Medical Care Act of 1969 to avoid fraudulent benefit claims.

Herbosa said current technologies against fraud are better and that the Universal Health Care Act of 2019 ushers an era of affordable and accessible healthcare services for all Filipinos.

Ledesma reminded members and qualified dependents that they are entitled to a maximum of 45 days coverage for room and board per year.

However, this does not apply to the hemodialysis benefits package as it has a separate 156 sessions allocated per year.