The Philippine Health Insurance Corporation (PhilHealth) has reminded healthcare facilities that implementation of the lifting of the 45-day benefit limit starts on Friday.
In a Bagong Pilipinas Ngayon interview, PhilHealth Senior Vice President for Health and Finance Policy Sector, Israel Francis Pargas said the move allows members to use their benefits for the whole year without a 45-day coverage limit.
This is in accordance with the Universal Healthcare Act, which states that every Filipino must receive immediate healthcare services, and the directive of President Ferdinand R. Marcos Jr. for the national health insurance program to cover healthcare needs of its members.
Last month, PhilHealth President and Chief Executive Officer Edwin Mercado said the 45-day benefit limit is an outdated cost-containment strategy, emphasizing that certain health conditions need to cover more than 45 days of treatment.
Healthcare facilities are advised to observe the standards of care, treatment protocols, and clinical or pathological guidelines. “There is a possibility for abuse because there is no benefit limit, so hopefully hospitals will ensure that they follow the necessity and treatment guidelines,” he said.
Agri Party-list Rep. Wilbert Lee meanwhile said the lifting of limit is a significant advancement toward achieving comprehensive universal healthcare.
“This development ensures that all Filipinos, regardless of their medical conditions, have continuous access to necessary health services without the fear of exceeding arbitrary limits,” Lee said in a statement.
“We want to ensure that all Filipinos, particularly those with chronic or severe health conditions, receive the necessary care without the added worry of financial constraints,” he stressed.
PhilHealth uses a healthcare provider assessment system to monitor the performance of hospitals and issues warning letters to concerned healthcare facilities or healthcare providers with violations against standards of care following a due process.
A healthcare facility may receive up to three warning letters. “After the third due process of warning letters, we will file appropriate action as for their violative performance commitment during accreditation,” he explained.
Pargas said patients may submit their complaints against violating healthcare facilities through email to actioncenter@philhealth.gov.ph. They may also contact the 24/7 hotline 0286222588 or approach the PhilHealth employees assigned in hospitals.
