Effective October 1, the Philippine Health Insurance Corporation (PhilHealth) will no longer enforce its one-period hospitalization policy, which limits coverage for the same illness to only once in a 90-day period. This change means that beneficiaries can now get coverage for multiple admissions for the same condition without having to wait 90 days.
Israel Francis Pargas, the Senior VP and spokesperson of PhilHealth, shared the news in an interview with TeleRadyo Servisyo. He explained that patients re-admitted for the same illness—such as pneumonia, acute gastroenteritis, and urinary tract infections—will be eligible to get benefits from PhilHealth each time they are hospitalized.
In 2023, PhilHealth denied coverage for about 1,700 patients with pneumonia who were readmitted within a 90-day period. Removing this restriction ensures that members can get the care they need without worrying about being denied their benefits.
Patients undergoing hemodialysis and chemotherapy were already exempted from this policy even before it was removed. Now, all members who need to be readmitted for the same illness can get benefits from PhilHealth.
PhilHealth will introduce measures to prevent any potential abuse of the new readmission policy while ensuring quality healthcare for members. For example, those with mild to moderate pneumonia are covered up to ₱32,000, while severe cases can receive coverage that reaches ₱90,000.
Pargas also mentioned that there will be a transitory clause that will allow patients readmitted starting October 1 to apply for reimbursement, either directly or through the hospital. PhilHealth ensures that these reimbursements will be processed properly.
