PhilHealth now covers same case readmission

Metro Manila, Philippines — The Philippine Health Insurance Corporation (PhilHealth) has scrapped a policy against disallowing coverage of readmission cases.

The single period of confinement policy has denied thousands of claims for medical facility readmission for similar cases.

“Last Sept. 27, the PhilHealth board decided to lift finally the rule on single period of confinement,” Eli Santos, PhilHealth executive vice president, told a Senate panel on Wednesday, Oct. 2, complying with an earlier commitment.

“This will take effect Oct. 1, 2024… and the policy will be published on Oct. 7, 2024. This will have a retroactive effect effective Oct. 1, 2024,” he added.

According to the state health insurer, the single period of confinement rule means “admissions and readmissions due to the same illness or procedure within a 90-calendar day period shall only be compensated with one case rate benefit.”

“Therefore, availment of benefit for the same illness or procedure that is not separated from each other by more than 90 calendar days will not be provided with a new benefit, until after the 90-calendar day period reckoned from the date of admission,” the PhilHealth Circular No. 0035, s. 2013 read.

The Department of Health said the policy denied 26,750 claims in 2023 covering diseases including community acquired pneumonia, acute gastroenteritis, urinary tract infection, and chronic kidney disease.

The benefits committee of the PhilHealth board recommended removing the single period of confinement rule on Sept. 24.