The Philippine Health Insurance Corp. (PhilHealth) has rolled out a wider coverage for Covid-19 cases, given the high hospitalization costs incurred amid the pandemic.

In its previous covid package under PhilHealth Circular 2020-0009, benefits were only limited to hospitalized individuals. It didn’t consider individuals who are asymptomatic and isolating in their homes.  The initial benefits rolled out by Philhealth are straightforward and practical, to say the least, but didn’t consider cases outside the confines of our hospitals.

1. Philhealth’s new COVID-19 hospitalization coverage.

Below is the chart showing the amount of benefit provided is based on the severity of the patient’s pneumonia.

2. No co-payment and no balance billing

This PhilHealth benefit is for all COVID-19 patients who are admitted to any basic or ward accommodation. With this policy, patients no longer have to pay their excess fees upon discharge. However, this is only applicable to public hospitals and facilities contracted with Philhealth. For patients in private hospitals, only the hospitalization coverage for COVID-19 is applicable. 

How to file your claims for Philhealth’s COVID-19 benefits

As mentioned in their circular, no claims shall be filed directly to Philhealth as the benefits will be reimbursed directly to the hospital or facility. The submission procedure follows their regular SOPs, all claimants must apply for it through the facility where they are admitted and should do so upon their discharge order and when their final billing is issued. 

To apply for these benefits, the following must be submitted to the hospital or facility’s billing office. 

• A copy of the patient’s COVID-19 tests results
• Duly signed and accomplished PhilHealth Claim Signature Form, PhilHealth Claim Forms 1, 2, and 4.
• Hospital bill or statement of account
• For non-PhilHealth members: a fully accomplished Philhealth Membership Registration Form.

In the enhanced coverage of Philhealth, additional measures were implemented and followed to adapt to the changing healthcare landscape.

1. COVID-19 home isolation benefits package (CHIBP)

Individuals who meet social and clinical criteria for home quarantine and are capable of receiving health support directly from their house. 

According to Philhealth Circular 2021-014, this shall apply to all claims for home isolation services filed by accredited PhilHealth isolation facilities, infirmaries, hospitals, and Konsulta providers who have accomplished the necessary documentary requirements to provide the CHIBP.  

What services can you avail of from the home isolation package?

Under this package, qualified patients who are able to do home quarantine will be entitled to the following:

Mandatory services

• Minimum of 10-day isolation consultations. At least twice in the 10 day isolation period with the first one as face-to-face, and the succeeding through phone (teleconsultation).
• 24/7 daily monitoring of clinical and supportive care by a nurse. This can be done through teleconsultation.
• Provision of home isolation kit UPON INITIAL CONSULTATION. This kit contains the following: 1 70% isopropyl alcohol, 5 pieces face mask, 1 thermometer, 1 pulse oximeter medicines (18 pieces Paracetamol, 12 pieces Lagundi tablets or equivalent, 6 sachets of oral rehydration salts, 10 pieces Ascorbic Acid, 10 pieces Vitamin D and zinc), consent form.

Other services

• Patient education on how to use a pulse oximeter, signs and symptoms to watch out for, waste disposal, proper dose and when to take medicines, and others as needed.
• Patient referral to a higher level facility and supporter if and when needed to be transferred. 

Who is eligible for the home isolation benefits package? 

• All Filipinos are registered under the National Health Insurance Program (NHIP).
• Filipinos who are not yet registered under the program shall automatically be covered, provided that they complete and submit an accomplished PhilHealth Member Registration Form (PMRF) for the issuance of the PIN upon vailing of the benefits package. 
• The beneficiary shall be assessed by their Barangay Health Emergency Response Team (BHERT) based on Philhealth’s Assessment Checklist of Clinical and Social Criteria for COVID-19 Home Isolation Benefit Package. Only beneficiaries who passed both the clinical and social criteria shall be eligible for this package.  

2. Emergency room coverage

Due to the lack of hospital beds during the surge of covid cases, Philhealth has made sure that patients who are stuck in the ER and admission tents due to the unavailability of hospital beds will receive full benefits under the condition that they’ve been in the facility for at least 24 hours. 

Do you need to be a Philhealth member to be eligible for these benefits?

Regardless of whether or not you’re an active member with up-to-date Philhealth contribution or you’re not even registered at all, you will be entitled to the benefits for COVID-19 coverage by Philhealth. 

For registered members with or without up-to-date Philhealth contributions, you are automatically covered. For those who are not registered yet, you will only be required to submit a fully accomplished Philhealth Membership Form (PMRF) which you can directly download from Philhealth’s website. You can also register on their website through Philhealth Online.

Sources 1,2, 3,4

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