PhilHealth is about giving access to health services. In 2003, PhilHealth expanded its benefit package to cover services most needed by the members and would redound to better health services. As a result, PhilHealth’s benefit payments reached P10.9 billion in 2003.

A number of benefit enhancements were made in 2003 and these contributed to the phenomenal growth in benefit payments.

Increase in Room and Board Rates

PhilHealth started the year with an increase in room and board rates. Effective admissions on April 1, 2003, room and board rates for primary hospitals were increased from P150 to P200, secondary hospitals from P220 to P300 and tertiary hospitals to P400 per day of hospitalization.

TB Package

The Philippines has one of the highest incidence of tuberculosis in the world. In response to this, PhilHealth developed the TB-defined package which was made available starting April 1, 2003. The package follows the anti-TB treatment known as Directly-Observed Treatment Short-Course or DOTS which is reported to have a cure rate of as much 96%.

Normal Spontaneous Deliveries

Since Medicare started, normal deliveries were not being reimbursed. In a historic first, PhilHealth started to reimburse the first two Normal Spontaneous Deliveries (NSD) done in lying-in clinics, midwife-managed clinics, birthing homes, and rural health units (RHUs) effective May 1, 2003. The package which is paid with a case payment rate of P4,500 covers prenatal care, delivery care, newborn care and postpartum care to PhilHealth members and benificiaries.

Dialysis in Free Standing Clinics

Dialysis has long been reimbursed by PhilHealth but availment of such services are limited to hospital facilities. With the setting up of free standing dialysis centers offering services comparable to hospital- based facilities, PhilHealth saw the opportunity to expand PhilHealth services by reimbursing dialysis clinics effective April 1, 2003.

SARS Package

The global community grappled with a mysterious public health menace in 2003, the Severe Acute Respiratory Syndrome or SARS.

Members and their qualified dependents are given a maximum of P50,000 per case. This covers the payment for professional health services, drugs and medicines, radiographic services from the referring hospital to the DOH-designated hospital to the DOH-designated hospital for SARS. With our health workers facing greater risk of contracting the disease, their SARS benefit package was pegged at P100,000.

What You Need to Submit to Enjoy Your Benefits:

Fully-accomplished PhilHealth Claim Form I, Form II and Form III.