Question & AnswerQ&A (PHIC PHILHEALTH CIRCULAR NO. 77-a)
The purpose of PhilHealth Circular No. 77-a, s. 2000 is to upgrade the benefit schedule for indigent sector members to the same level as government and private sector employees, ensuring that all members of the National Health Insurance Program enjoy a unified Medicare benefit package.
The unified benefit schedule covers government indigent and private sector members, including Overseas Workers Welfare Administration (OWWA) and Individually Paying Members and their dependents.
Room and board benefits are covered not exceeding 45 days for each member, plus another 45 days to be shared by his/her dependents.
The coverage for drugs and medicines is divided into three categories: Ordinary, Intensive, and Catastrophic.
Professional fees shall not exceed P105/day for a General Practitioner and P150/day for a Specialist.
During Ordinary confinement, the maximum professional fees are P540 for a General Practitioner and P810 for a Specialist per single period of confinement.
The maximum surgeon's fee is P15,390 at the rate of P420 per Relative Unit Value.
Surgical family planning procedures included are Vasectomy with a benefit of P900 and Tubal Ligation with a benefit of P1,125.
Yes, outpatient benefits are covered and include chemotherapy, radiotherapy, hemodialysis, cataract extraction, and minor surgical procedures.
Benefits for drugs, X-ray, laboratory, and other services are categorized into Ordinary, Intensive, and Catastrophic levels depending on the severity and cost of treatment.