* Confinement in PhilHealth-accredited hospital for
not less than 24 hours or one day, due to an illness or injury requiring
hospitalization.
Minor surgical procedures and chemotherapy, radiotherapy, hemodialysis,
cataract extraction, and a special diagnostic package (for qualified indigent
members in select areas in the Philippines) are also compensable even
on an outpatient basis.
* Confinement falls within the 45 days allowance for room and board, and
complies with the rule/policy on single period of confinement. A single
period of confinement refers to a series or successive confinements for
the same illness, injury or condition, not separated from each other by
more than 90 days within a calendar year.
Principal members are entitled to 45 days coverage each year while their
dependents also have another 45 days in a year, which they will have to
share among themselves. Any unused benefit for the given year is not cumulative
or is not carried over to the folowing year.
However, PhilHealth will not pay for the confinements in a non-accredited
hospital unless:
* Claim is based on an emergency
* Hospital/Clinic is duly licensed by the Department of Health (DOH) at
the time of the emergency
* There was physical impossibility to transfer patient to an accredited
hospital or clinic
As part of their protection, PhilHealth members are advised to seek medical
services only from PhilHealth-accredited hospitals to ensure coverage
and avail of quality services from competent physicians and complete medical
facilities.
If confined for less than 24 hours, PhilHealth shall not pay for confinement
benefits unless:
* Case is an emergency
* Patient is transferred to another hospital that is capable of giving
him/her further treatment
* Patient died during confinement
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