Acting President and CEO Dr. Edwin M. Mercado demonstrates once more PhilHealth’s commitment to follow through on the directive of President Ferdinand “Bongbong” R. Marcos Jr. of making sure “services of PhilHealth remain unhampered” through the lifting of the 45-day benefit limit.
“The 45-day benefit limit is an outdated cost-containment strategy. Naiintindihan natin kung bakit ito inilagay noon, ngunit, sa pagbabago ng ating payment mechanism, napapanahon na rin talagang repormahin ito. We cannot always predict or schedule our medical needs. Marami ring mga serbisyo ang kinakailangan ng higit sa 45 days na coverage. Kaya naman nagpapasalamat tayo sa PhilHealth Board for approving this policy update,” explained Dr. Mercado.
PhilHealth has previously recognized the need to cover for more than 45 days for certain conditions. Hence, the extension of the number of sessions covered by our hemodialysis packages – from the initial 90 to the current 156 sessions. The social health insurance is now extending this realization with the lifting of the 45-day benefit limit.
“Nais natin na ang mga Pilipinong may malulubhang sakit, chronic conditions, o di kaya’y nangangailangan ng mahaba-habang pagpapaospital ay patuloy na makatanggap ng serbisyong pangkalusugan nang hindi pa nag-aalala kung sila ba ay mababaon sa utang,” added Dr. Mercado.
PhilHealth reminds that the availment of benefits must be based on proper medical indication, necessity, and alignment with the patient’s treatment plan, and must adhere to widely-accepted standards of care, Department of Health (DOH)-approved Clinical Practice Guidelines (CPGs), and/or PhilHealth Circulars on quality standards.
To ensure the responsible and effective implementation of this policy, PhilHealth will closely monitor patient admissions, readmissions, and benefit utilization exceeding 45 days. Health facility compliance with clinical standards and reimbursement rules will be rigorously assessed through the Health Care Providers Performance Assessment System (HCPPAS).
Health facilities are also enjoined to implement comprehensive organization-wide policies focused on quality and performance improvement. This will be critical in PhilHealth’s focus to incentivize services that lead to the best outcomes.
“Layon natin na ang bawat serbisyong sinusuportahan ng PhilHealth ay tunay na nagdudulot ng katiwasayan sa myembro. Ginagawa naman na ito ng ating mga ospital — ako rin, bilang hospital administrator noon, ay pinagtuunan namin ng pansin ang pag-momonitor ng outcomes. Ngunit, ang gusto natin ngayon ay unti-unti mag-transition ang PhilHealth to value-based financing,” said Dr. Mercado.
For more details on the PhilHealth Circular 2025-0007, members may call PhilHealth’s 24/7 touch points at (02) 866-225-88 or at mobile numbers (Smart) 0998-857-2957, 0968-865-4670, (Globe) 0917-1275987 or 0917-1109812. It can also be downloaded on www.philhealth.gov.ph.
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