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Effective December
1999, PhilHealth implemented a unified benefit package for all
PhilHealth members.
This benefit package includes the following categories of personal
health services:
Inpatient hospital care:
- Room and board;
- Services of health care professionals;
- Diagnostic, laboratory, and other medical examination services;
- Use of surgical or medical equipment and facilities;
- Prescription drugs and biologicals, subject to the limitations
stated in Section 37 of RA 7875; and
- Inpatient education packages.
Outpatient care:
- Services of health care professionals;
- Diagnostic, laboratory, and other medical examination services;
- Personal preventive services;
- Prescription drugs and biologicals, subject to the limitations
described in Section 37 of RA 7875; and
- Emergency and transfer services
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UNIFIED MEDICARE BENEFITS
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For all Members and Dependents under the National Health Insurance
Program
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BENEFITS
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HOSPITAL CATEGORY
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PRIMARY
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SECONDARY
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TERTIARY
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| ROOM AND BOARD |
200
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300
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400
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Not exceeding 45 days for each member & another 45 days to be
shared by his dependents
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| DRUGS & MEDICINES |
2,500
0
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4,000
8,000
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9,000
16,000
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| Per single period of confinement |
a. Ordinary
b. Intensive
c. Catastrophic |
| X-RAY, LAB, ETC. |
700
0
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2,000
4,000
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4,000
14,000
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| Per single period of confinement |
a. Ordinary
b. Intensive
c. Catastrophic |
| PROFESSIONAL FEES |
P 150/day for General Practitioner
P 250/day for Specialist
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| Per single period of confinement shall not exceed: |
a. Ordinary
General Practitioner
Specialist |
600
1,000
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1,000
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600
1,000
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b. Intensive
General Practitioner
Specialist |
900
1,500
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1,500
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900
1,500
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b. Catastrophic
General Practitioner
Specialist |
900
1,500
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1,500
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900
2,500
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| OTHERS |
0
0
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1,140
2,160
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1,350
3,490
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| Operating Room |
a. RVU of 30 and below
b. RVU of 31 to 80
c. RVU of 81 and above |
| Surgeon |
Maximum of 16,000
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| Anesthesiologist |
Maximum of 5,000
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Compensable Outpatient Services:
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