Philhealth Releases Revised Guidelines on the Provision of Special Privileges to Those Affected by Fortuitous Events

The Philippine Health Insurance Corporation (PhilHealth) is releasing an initial P30 billion to accredited hospitals to ensure their liquidity and financial viability to adequately respond to the COVID-19 pandemic. As such, accredited Health Care Institutions (HCI) may apply for an interim reimbursement mechanism (IRM) fund under Circular No. 2020-0007 equivalent to three months' worth of claims based on historical data, which will be charged to their future claims.

While geared toward responding to the COVID-19 crisis, the Circular restates certain privileges in previous circulars for patients and HCIs affected by fortuitous events in general. Both PhilHealth members and non-members, for example, can avail themselves under the policy of PhilHealth benefits even if confined in non-accredited facilities.

Among other special privileges are admission to accredited or non-accredited facilities as long as they are DOH-licensed or DOH-certified and treatment and management by accredited or non-accredited health care professionals who are duly licensed by the Professional Regulations Commission (PRC).

The Circular also covers claims for medical treatment done as an outpatient or inpatient relative to the direct and indirect effects of the fortuitous event within the HCI, or in an improvised/satellite facility; and patient transfers from or managed by health care personnel from accredited facilities in an evacuation area, or in improvised health care facilities.

The policy also extends additional privileges such as exemption from the 45 days annual benefit limit, Single Period of Confinement, and the less than 24 hour confinement policies; extension of payment of premium contributions and extension of period of coverage; reimbursement for both referring and receiving health care institutions; priority in the processing of claims, extension of the deadline for submission of health care facility reports, and extension of accreditation of providers, as applicable.

Click here to read the entire text of Philhealth Circular No. 2020 – 0007.