Manila: The Philippine Health Insurance Corporation (PhilHealth) on Thursday reminded healthcare facilities that the implementation of the lifting of the 45-day benefit limit will start on Friday. In a Bagong Pilipinas Ngayon interview, PhilHealth Senior Vice President for Health and Finance Policy Sector Israel Francis Pargas stated that the move allows members to use their benefits for the entire year without the previous 45-day coverage restriction.

According to Philippines News Agency, this change aligns with the Universal Healthcare Act, which mandates that every Filipino should receive immediate healthcare services. It also adheres to President Ferdinand R. Marcos Jr.’s directive for the national health insurance program to meet the comprehensive healthcare needs of its members. Last month, PhilHealth President and Chief Executive Officer Edwin Mercado described the 45-day benefit limit as an outdated cost-containment strategy, emphasizing that certain health conditions require more than 45 days of treatment.

Healthcare facilities are advised to adhere to the standards of care, treatment protocols, and clinical or pathological guidelines. Pargas highlighted the potential for misuse of benefits since there is no longer a limit, urging hospitals to strictly follow necessity and treatment guidelines to prevent abuse.

The state insurer employs a healthcare provider assessment system to monitor hospital performance, issuing warning letters to facilities or providers violating care standards after due process. A healthcare facility may receive up to three warning letters. “After the third due process of warning letters, we will file appropriate action as a violation for their performance commitment during accreditation,” Pargas added.

He also noted that patients may submit complaints against non-compliant healthcare facilities via email to [email protected]. Additionally, they can contact the 24/7 hotline at 0286222588 or consult PhilHealth employees stationed in hospitals.