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PhilHealth Expands Coverage with New Outpatient Emergency Care Benefit and Lifts 45-Day Confinement Limit
The Philippine Health Insurance Corporation (PhilHealth) has announced a significant expansion of its services, allowing all members and their legal dependents to access the Outpatient Emergency Care Benefit (OECB) Package at any PhilHealth-accredited Level 1 to Level 3 hospitals nationwide. This move is aimed at improving access to emergency healthcare for a broader range of patients.
In a recent advisory, PhilHealth clarified that no additional accreditation is required for hospitals to offer the OECB Package. The benefit is now part of the services covered by hospitals that have already received PhilHealth accreditation. This initiative is designed to streamline the process for both patients and healthcare providers, ensuring that emergency care services are more widely accessible.
PhilHealth also provided guidance for patients who may have been admitted to hospital emergency departments since February 14, 2025, and were unable to utilize the OECB Package at the time of their treatment. These patients will still be able to file a claim under PhilHealth's policies.
In addition, the advisory includes updates on important aspects of emergency care, such as coverage for "Urgent Care" and "Emergent Care," as well as detailed information on the Essential Emergency Care List (EECL) Summary Form, mandatory discounts, claims monitoring, and other related policies.
For members seeking to avail of the OECB Package, PhilHealth urged them to coordinate directly with the hospital where they received treatment. Hospitals will assist in preparing and submitting the required documents, which include Claim Form 1 (for member and patient information), Claim Form 2 (for provider details), Claim Form 4 (for clinical summaries), itemized billing, lab results, and other necessary paperwork.
PhilHealth also announced the removal of the longstanding 45-day benefit limit, which previously restricted members’ confinement days to a maximum of 45 days per calendar year. This cap applied separately to qualified dependents, in accordance with the National Health Insurance Act (Republic Act 7875). The removal of this limit is seen as part of PhilHealth’s ongoing efforts to expand coverage and improve healthcare access. This follows a previous decision to increase the number of hemodialysis sessions covered by PhilHealth from 90 to 156 per year.
While the 45-day limit has been lifted, PhilHealth stressed that benefit availment will still be guided by medical necessity and adherence to established clinical standards. The corporation emphasized that it will monitor hospital admissions, readmissions, and any instances where patients exceed the previous confinement limit to ensure the policy is implemented effectively.
PhilHealth’s updates aim to enhance the overall healthcare experience for its members, ensuring that emergency services are accessible, and that the quality of care is maintained.
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