News
BCG Vaccine Now Included in PhilHealth's Newborn Care Package - February 4, 2008
The basic, most important vaccine against childhood tuberculosis is now covered by the Philippine Health Insurance Corporation (PhilHealth).
Through Resolution No. 1060, series of 2007, the PhilHealth Board of Directors approved the inclusion of the Bacillus Calmette-Guérin (BCG) vaccine in the Newborn Care Package (NCP) effective January 1 hospital admissions. Effective BCG vaccine provides protection against the more severe types of tuberculosis such as miliary TB and TB meningitis which are most common in young children.
Lorna O. Fajardo, Acting PhilHealth President and CEO said that the enhanced NCP which now also includes resuscitation of the newborn, covers all eligible newborn-dependents delivered in accredited health care facilities including non-hospital maternity health care providers. The amount of the NCP package remains at P1,000.00.
"We are ensuring that newborn-dependents of members will be able to avail themselves of this benefit regardless of the eligibility of the mother to claim for the Maternity Care Package," Fajardo said. She also called on accredited health care providers to provide all the required services under the NCP, adding that PhilHealth will not pay for the NCP benefits if the complete services included in the package are not given the newborn.
The NCP also includes umbilical cord care, eye prophylaxis, Vitamin K, thermal care, first dose of Hepatitis B immunization and newborn screening test (NBS). The NBS is ideally performed after 24 hours of life but not later than three (3) days from complete delivery of the newborn to identify at least five (5) diseases that a newborn may be predisposed to, and therefore aid in preventing its onset later in life. Claims for NCP within the said period will be compensated.
"For newborns placed in Intensive Care to ensure survival, premature and sick newborns, may be exempted from the three-day requirement, but they should be tested within seven (7) days of age," Fajardo said. Official Receipts (OR/s) for NBS dated within the same period (even after discharge of patient/newborn) will also be covered by the package.
"We hope that through this new addition into the NCP, PhilHealth is able to contribute its share in preventing child mortality through the compensability of the BCG vaccine," she said.
To ensure availment of the NBS under the NCP, health care facilities must have Newborn Screening Facility (NSF) certificates issued by the Department of Health (DOH) or by the Newborn Screening Reference Center (NSRC) starting January 1, 2008, otherwise, claims will not be compensated. Facilities that are not NSF-certified may refer patients for NBS to other facilities with NSF certification. In these cases, reimbursement directly to the member is allowed by PhilHealth provided that the original official receipt issued by the certified facility is attached to the claim documents. To date, out of the 1,600 PhilHealth-accredited health care facilities, 600 are NSF-certified by the DOH.
To avail of the package, members must submit a duly accomplished PhilHealth Claim Form 1, a clear copy of the Member Data Record (MDR) and the proof of premium payment.