MEMBERS of the Philippine Health Insurance Corporation (PhilHealth) have a maximum of 45 days' worth of allowances for hospital room and board fees in one year, while their qualified legal dependents share another set of 45 days for the same benefit item.
In a recent interview with "Dear PhilHealth" on Radio DZRH, Abigail Estrada, Social Insurance Officer III of the Benefits Development and Research Department of PhilHealth said that based on the benefit schedule, allowances for hospital room and board fees range from P300.00 per day in Level 1 hospitals to as much as P1,100.00 per day in Levels 3 and 4 hospitals nationwide.
She added that determining the allowable amount per confinement depends on the case classification of the illness and on the level of the hospital. "For instance, if a member is confined at the Philippine Heart Center which is a Level 3 hospital, and the illness is case type B, the maximum amount for room and board is P500.00 per day," Estrada said.
Estrada said that the amount of PhilHealth benefits for room and board is the same, whether a member is in ward, service, charity or suite accommodation.
In instances when members buy drugs and medicines outside of the hospital, Estrada assured them that PhilHealth will pay for these items, provided these are bought within the member's period of confinement. "These items should also be in the Philippine National Drug Formulary, a listing of drugs used to treat illnesses and approved by clinicians of the Department of Health," she said. The member has to include in his claim documents the official receipts for drugs and medicines and PhilHealth will pay for these, provided, too, that the member's allowance for drugs and medicines is not yet exhausted, Estrada emphasized.
In case the official receipts for medicines bought outside of the accredited health care facility were not included in the claim documents earlier filed with PhilHealth, the member may still request for an adjustment in the claim, provided that his allowance for drugs and medicines has not been maximized yet.
Estrada also reminded members to be responsible by making sure that their contributions are updated and to always bring with them their PhilHealth ID cards when availing themselves of the benefits. "Dapat malawak din ang ating kaalaman tungkol sa benefits para ma-maximize natin ito," she said.
'Dear PhilHealth' is PhilHealth's multi-awarded radio program which has been airing on DZRH for 14 years now. It airs Wednesdays, 5:30 - 6:00 p.m. (END)
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