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
UNIFIED MEDICARE BENEFITS
For all Members and Dependents under the National Health Insurance
Program
BENEFITS
HOSPITAL CATEGORY
PRIMARY
SECONDARY
TERTIARY
ROOM AND BOARD
200
300
400
Not exceeding 45 days for each member & another 45 days to be
shared by his dependents
DRUGS & MEDICINES
1,500
2,500
0
1,700
4,000
8,000
3,000
9,000
16,000
Per single period of confinement
a. Ordinary
b. Intensive
c. Catastrophic
X-RAY, LAB, ETC.
350
700
0
850
2,000
4,000
1,700
4,000
14,000
Per single period of confinement
a. Ordinary
b. Intensive
c. Catastrophic
PROFESSIONAL FEES
P 150/day for General Practitioner
P 250/day for Specialist
Per single period of confinement shall not exceed:
a. Ordinary
General Practitioner
Specialist
600
1,000
600
1,000
600
1,000
b. Intensive
General Practitioner
Specialist
900
1,500
900
1,500
900
1,500
b. Catastrophic
General Practitioner
Specialist
900
1,500
900
1,500
900
2,500
OTHERS
385
0
0
670
1,140
2,160
1,060
1,350
3,490
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
Anesthesiologist
Maximum of 5,000
Compensable Outpatient Services:
Ambulatory surgeries and procedures including dialysis,
radiotherapy and chemotherapy