Philhealth sets new conditions for benefit claims

THE Philippine Health Insurance Corp. (Philhealth) has added conditions for entitlement of benefits among its members.

Two new conditions have been set under Philhealth circular no. 31. First is the status of hospital’s accreditation with Philhealth during a member’s confinement.

The circular states that if the hospital’s accreditation expires within the member’s confinement period, the member is still entitled to Philhealth benefits for drugs and medicines, X-ray, laboratory procedures and others, including coverage for operating room and professional fees.

“However, the benefit for room and board charges of the patient will only cover the days that fall within the validity period of the hospital’s accreditation. The patient will not be covered for room and board during the days after that,” said Marites Que, officer in charge of Philhealth Negros Oriental.

The second condition dictates that if the dependent parent of a member reaches 60 years old in the middle of hospital confinement, the patient would be entitled to the same benefits for drugs and medicines, X-ray, laboratory procedures, operating room and professional fee charges for the full confinement period, except for the room and board.

“Again, Philhealth will only cover the room and board charges at the time the patient becomes eligible as dependent parent of the member,” said Que.

She added that the new conditions will not apply for members under the sponsored program, OFWs and lifetime members.