PHILHEALTH BENCOM RECOMMENDS END TO SINGLE PERIOD OF CONFINEMENT RULE

THE Benefits Committee (BenCom) of the PhilHealth Board of Directors (Board), in a special meeting held today Chaired by Health Secretary Teodoro J. Herbosa, decided to recommend to the Board _en banc_ a new policy that would remove the single period of confinement rule. The Board _en banc_ will have its next regular meeting on Friday, September 27, 2024.

PhilHealth’s All Case Rates (ACR) Policy No. 2 (PhilHealth Circular No. 0035, s. 2013) states: “Single period of confinement rule means that admissions and re-admissions due to the same illness or procedure within a 90-calendar day period shall only be compensated with one (1) case rate benefit. Therefore, availment of benefit for the same illness or procedure that is not separated from each other by more than 90 calendar days will not be provided with a new benefit, until after the 90-calendar day period reckoned from the date of admission.”

This single period of confinement rule resulted in the denial of 26,750 claims in 2023 alone. Causes typically include Community Acquired Pneumonia, Acute Gastroenteritis, Urinary Tract Infection, and Chronic Kidney Disease, among others.

“We are now in the era of the Universal Health Care Act of 2019, decades after the Philippine Medical Care Act of 1969. Technologies against fraud are also better today. Let us fix our policies to bring down the out of pocket payments of families,” said Secretary Herbosa.