PhilHealth now covers outpatient emergency cases
Metro Manila, Philippines - Outpatient emergency cases in accredited hospitals are now covered by government health insurance, the Philippine Health Insurance Corp. (PhilHealth) announced.
Included in the 27 cases covered by the outpatient emergency benefit package are dizziness, persistent vomiting, diarrhea, nontraumatic bleeding, elevated blood pressure, seizures, severe headache, and mental health and sexual assault.
The facility-based emergency benefit that began on Feb. 14 covers “all essential health services and commodities provided in the ED (emergency department) and its extension facilities identified by PhilHealth for coverage,” according to PhilHealth Circular 2024-0033.
The facility-based emergency benefit was one of the two components of the new policy.
“This includes associated fees in the ED and its extension facilities, diagnostic and imaging services, laboratory work-up, including routine and blood chemistry, and therapeutics, including drugs and medicines,” read the circular.
In an advisory published Tuesday, Feb. 18, PhilHealth said ambulance services coverage for the prehospital emergency benefit, another component of the package, was “still undergoing cost study and shall be announced on a succeeding PhilHealth Advisory for implementation.”
Prehospital emergency services refer to the emergency medical care provided to patients prior to arrival or during transport to a hospital, including ambulance services, and on-site basic and advanced life support, among others.
PhilHealth said it advised hospitals that they do not need separate accreditation to provide facility-based emergency benefits as it was “already part of their accreditation as a hospital.”
“However, should hospitals have extension facilities for FBE, a certification stating the name of affiliated extension facility and its complete address must be submitted to their respective PhilHealth regional offices, for updating,” it added.
Previously, emergency cases that did not warrant confinement were only covered by the “all case rate” benefit package if they were for surgical procedures.
