Special PhilHealth privileges no longer in effect: Ledesma

MANILA -- The Philippine Health Insurance Corporation, Inc. (PhilHealth) on Thursday reiterated its reminder to the public that special privileges under fortuitous events were no longer in effect as of Jan. 1, 2023 following the lifting of the nationwide state of calamity due to Covid-19.

In PhilHealth Advisory 2023-0012, Acting President and Chief Executive Officer Emmanuel R. Ledesma Jr. said that with the cessation of the special privileges, the deadline of submission of claims shall return to 60 calendar days from the date of discharge.

The rules on 45-day benefit limit and single period confinement shall apply for all claims with admission date starting Jan. 1, 2023, he added.

“This means that a member is entitled to a maximum of 45 days confinement per calendar year while their qualified or legal dependents shall share a separate 45-day benefit per calendar year,” Ledesma said.

“Meanwhile, the single period of confinement rule means that admissions and re-admissions due to the same illness or procedure within a 90-calendar day period shall only be compensated with one case rate benefit,” he further said.

Among the special privileges during fortuitous events granted during the state of calamity, as provided for in PhilHealth Circular No. 2020-007, was the extension of the submission of claims for up to 120 calendar days from the date of discharge and exemption from the 45-day benefit limit and the single period of confinement rule.

Ledesma further said the public may call the PhilHealth Callback Channel at 0917-898-PHIC (7442) or any of the PhilHealth Regional and Local Health Insurance Offices for any questions or concerns.

PhilHealth usually extends special privileges to its members and health facilities that are affected by “fortuitous events,” which include “acts of God such as floods, typhoons, and natural disasters, and “acts of man” such as rebellions, insurgencies, and wars. (PNA)