PhilHealth increases coverage for maternity cases

MANILA, Nov. 4 (PNA) — The Philippine Health Insurance Corporation (PhilHealth) has increased its benefits for normal spontaneous deliveries done in all accredited hospitals and lying-in clinics in the country effective this month.

Rey B. Aquino, PhilHealth President and CEO, said they have increased maternity coverage from P4,500 to P6,500 through Circular No. 39 series of 2009 and in compliance to its Board’s directive Resolution No. 1282 series of 2009.

“The said mark up in benefits shall apply to the first four low-risk normal spontaneous deliveries of members and their qualified dependents. The enhancement is being made to substantially cover the attendant hospital charges, professional fees and costs of prenatal care,” Aquino said.

Under the new compensation rate, PhilHealth will pay up to P2,500 each to the hospital and the professional while P1,500 covers prenatal care services if giving birth in hospital facilities. In non-hospital settings such as lying-in centers and birthing homes, P5,000 goes to the facility while P1,500 goes to prenatal care.

According to Aquino, payment for the facility covers room and board; drugs and medicines; laboratories; supplies; ancillary procedures like labor, delivery and recovery rooms; and other medically necessary charges for delivery and postpartum care.

He also said that attending physicians shall be paid for the actual delivery, immediate postpartum care and counseling for reproductive health, breastfeeding and newborn care.

Aquino added the enhancement now enables PhilHealth to reimburse the necessary prenatal care for members giving birth in hospital facilities, a feature that used to be enjoyed only by those seeking deliveries in accredited maternity and lying-in clinics.

Members should only present valid official receipts to refund part of their prenatal expenses that should include consultations.

To avail of the benefit, Individually Paying Members (IPMs) should have at least nine months of paid premiums within the immediate 12 months prior to the month of availment while employed members and IPMs enrolled under the KASAPI (“Kalusugang Sigurado at Abot-kaya sa PhilHealth Insurance”) shall be required at least three months of paid contributions within the immediate six months prior to actual availment.

On the other hand, Sponsored and Overseas Worker-members can avail themselves of the package within the validity period of their coverage as stated in their Family Health Cards and Member Data Records, respectively.
Lifetime members and their qualified dependents just need to present their PhilHealth ID when availing of these benefits. (PNA)