revised inpatient care benefits

The following are the maximum allowances or ceilings to be applied per single period of confinement** effective April 5, 2009 admissions onwards.

Level 1 Hospitals (Primary)
Benefit Item Case Type
A B
Room and Board
(maximum of 45 days per year)
300 300
Drugs and Medicine
(per single period of confinement)
2,700 9,000
X-ray, Laboratory and Others
(per single period of confinement)
1,600 5,000
Operating Room 500 500
Professional Fees
a. Daily Visits
General Practitioner (Groups 1, 5, & 6)
Per Day 300 400
Maximum per confinement 1,200 2,400
Specialist (Groups 2, 3, & 4)
Per Day 500 600
Maximum per confinement 2,000 3,600
b. Surgery (for Case Type A and B)
Surgeon Anesthesiologist
General Practitioner
1st Tier (Group 1)
RVU x PCF 40=PF1 40% of surgeon's fee (PF1)
With Training
2nd Tier (Group 5 and 6)
RVU x PCF 48=PF2 48% of surgeon's fee (PF1)
Diplomate/Fellow
3rd Tier (Group 2, 3 and 4)
RVU x PCF 56=PF3 56% of surgeon's fee (PF1)
Maximum of 2,000 per confinement Maximum fee computed as percentage of 2,000

* Not to exceed 45 days for each calendar year.
** Refers to a confinement or series of confinements of the same illness not separated from each other by 90 days within a calendar year. In this case, a member or beneficiary is not entitled to another set of benefits until after 90 days. They can only avail of the unused portion of the benefits and the room and board fees until the 45 days allowance is exhausted.

However, a member can avail of new set of benefits if succeeding confinements are of different illness or condition.