What does this mean for PhilHealth members?

Effective October 1, 2024, the Philippine Health Insurance Corporation (PhilHealth) officially canceled the single isolation period policywhich impacts how members can access benefits when hospitalized for the same condition.

Here’s what this change means for PhilHealth members and healthcare providers.

What was the policy for a single isolation period?

The uniform period of confinement policy was introduced during the Philippine Medicare era. It provided that if a patient was hospitalized and readmitted for the same disease or surgical procedure within 90 days, PhilHealth would reimburse only one hospitalization.

These policies often made patients financially responsible for additional hospital stays, since claims for subsequent hospitalizations during that period could be denied.

Key changes associated with the repeal of the policy

Readmission Coverage: With the policy lifted, PhilHealth members who are readmitted for the same condition within 90 days can now access benefits for each hospitalization.

Applies in all cases: PhilHealth President and CEO Emmanuel Ledesma explained that this change is not limited to specific diseases; this applies to all cases under the all-case payment schemes.

This means members can now take advantage of benefits for any illness or surgical procedure that requires readmission to the hospital.

Rationale for change

Ledesma said this policy review is part of PhilHealth’s ongoing assessment of its policies to ensure continued coverage of patients, especially those with recurring health problems.

He said PhilHealth is committed to supporting its members during difficult times by providing them with the benefits they deserve.

Implications for participants and health care providers

Financial assistance for patients: Policy waivers provide significant financial relief to members who require multiple hospitalizations for the same condition, ensuring that they are not burdened with the full cost of hospitalization.

Claims processing: Accredited medical facilities and health care providers should adjust their claims procedures accordingly, as policy cancellation allows for multiple claims to be filed within a 90-day period for the same condition. (SunStar Philippines)