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  • This Is How Much PhilHealth Will Pay If You Get Tested, Hospitalized Due To COVID-19

    Recovered patients who already paid for their own treatments can also apply for reimbursements.
    by Rachel Perez .
This Is How Much PhilHealth Will Pay If You Get Tested, Hospitalized Due To COVID-19
PHOTO BY iStock
  • No one wants to get infected with COVID-19, a fast-spreading, and potentially fatal disease. If unfortunately, a person gets infected, it would be great to not have to spend millions getting treated.

    The Philippine Health Insurance Corporation (PhilHealth) announced via an advisory released on April 3, 2020, that it will "shoulder the full cost of treatment for all COVID-19 patients," which was a relief. But only until April 14, 2020. Starting yesterday, April 15, 2020, the government-owned health insurance company would only be paying for partial costs of treatment.

    The window for PhilHealth's full-cost coverage of COVID-19 treatment gave it and doctors time to know "more about the behavior of the disease" and set treatment protocols. It allowed PhilHealth to create "an appropriate case rate that will provide adequacy and sustainability to the anti-COVID-19 campaign."

    All Filipinos, even those who are not registered with PhilHealth, will be automatically covered as long as they complete member registration before being discharged from the hospital.

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    How much will PhilHealth shoulder for COVID-19 treatments?

    PhilHealth will shoulder all medical expenses of all health workers who get infected with COVID-19 even beyond the April 14, 2020 cut-off date. For non-health worker COVID-19 patients, whether probable or confirmed cases, admitted in hospital facilities on April 15 onwards, the state-run insurance agency's COVID-19 benefits package will shoulder the following amounts, based on the severity of pneumonia:

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    • Mild pneumonia = Php43,997
    • Moderate pneumonia = Php143,267
    • Severe pneumonia = Php333,319
    • Critical pneumonia = Php786,384
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    For critical pneumonia, additional necessary medical procedures will also be covered by PhilHealth:

    • Acute respiratory distress syndrome (ARDS)
    • Septic shock
    • Requiring invasive ventilation
    • Requiring extracorporeal membrane oxygenation (ECMO)
    • Requiring renal replacement therapy

    According to PhilHealth Circular No. 2020-0009, mandatory healthcare services such as hospital accommodation, disease management and monitoring of illness, laboratory and diagnostics test including imaging, medicines included in the Department of Health (DOH) guidelines and protocols, and supplies and equipment, including personal protective equipment (PPE), are also included in PhilHealth's benefits package.

    PhilHealth also has a community isolation benefit package for expenses incurred within 14 days of self-isolation in DOH-certified, public or privately-owned hospital facilities. These are facilities that are set-up in coordination with or by the national government or local government units (LGUs). To qualify for quarantine support, the isolation facilities should also be accredited by the state-run insurance agency.

    According to PhilHealth's Circular No. 2020-0012, COVID-19 patients, whether probable or confirmed cases, in community isolation can avail of PhilHealth's benefits package amounting to Php22,449. This applies to individuals under community isolation since February 1, 2020.

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    How much PhilHealth will shoulder for COVID-19 testing?

    PhilHealth Advisory No. 2020-0010 states that it will shoulder expenses for all Filipinos who need to get tested for COVID-19 according to DOH guidelines, as well as patients that require repeat testing. It only covers testing in the Research Institute for Tropical Medicine-Department of Health (RITM-DOH) and all its certified testing laboratories.

    For COVID-19 tests conducted since February 1, 2020, PhilHealth's testing benefits package includes screening or clinical assessment, diagnostic workup, specimen collection and transport, test kit, running the RT-PCR testing, and analysis and reporting of the result. It will shoulder the following amounts:

    • All components are covered by the testing laboratory: Php8,150
    • Test kits are donated: Php5,450
    • Test kits are donated; bundled with the cost of running the test: P2,170
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    Request for additional assistance and reimbursement

    According to President and CEO Ricardo Morales, the new COVID-19 benefits packages are based on the average expenses incurred by patients in four tiers of the severity of the disease. He is confident that the packages allow for sustainability since they are also paying for other illnesses.

    "We don’t know how long this pandemic is going to last. That’s why we’re configuring for the long term," he told ABS-CBN News.

    PhilHealth Vice President for Corporate Affairs and spokesperson Dr. Shirley Domingo added that they have a mechanism in place to cover indigent patients. Patients can also apply for additional assistance.

    "Kung lalampas siya sa case rate, kasi malaki-laki rin naman ang mga case rate natin, ay puwede naman siya mag-request ng assistance doon sa balance of the bill," Domingo told GMA News. Morales added that requesting additional assistance will help them reevaluate their package rates if needed.

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    Recovered patients who already paid for their own treatments can also apply for reimbursements.

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