QuestionsQuestions (PHIC PHILHEALTH CIRCULAR NO. 77-a)
It announces a new, upgraded unified benefit schedule for indigent sector members so that all members of the National Health Insurance Program (NHIP) receive the same Medicare benefit package level as government and private sector members and dependents.
Government indigent and private sector members, including OWWA and individually paying members, and their dependents.
It means indigent sector members’ benefits were equalized/raised to the same level as those of government and private sector employees and dependents under the unified schedule.
Room and Board: Primary = 120, Secondary = 220, Tertiary = 345 (with not exceeding 45 days for each member and another 45 days to be shared by dependents).
Not exceeding 45 days for each member, plus another 45 days to be shared by his/her dependents.
Drugs & Medicines (Ordinary): Primary = 1,165; Secondary = 1,595; Tertiary = 2,670.
Drugs & Medicines (Intensive): Primary = 2,430; Secondary = 3,280; Tertiary = 7,660.
Drugs & Medicines (Catastrophic): Primary = 0; Secondary = 6,575; Tertiary = 11,885.
X-ray/Lab/Etc. (Ordinary): Primary = 305; Secondary = 760; Tertiary = 1,625.
X-ray/Lab/Etc. (Catastrophic): Primary = 0; Secondary = 3,405; Tertiary = 9,810.
It states professional fees shall not exceed: P105/day for a General Practitioner and P150/day for a Specialist (with the benefit tiered amounts shown for ordinary and intensive/catastrophic as applicable).
Ordinary Professional Fees: General Practitioner = 540 (for all PRIMARY/SECONDARY/TERTIARY); Specialist = 810 (for all PRIMARY/SECONDARY/TERTIARY).
Intensive/Catastrophic Professional Fees: General Practitioner = 810 (for all PRIMARY/SECONDARY/TERTIARY); Specialist = 1,350 (for all PRIMARY/SECONDARY/TERTIARY).
For Hospital (OR): (a) RUV 5 & Below = Primary 385, Secondary 670, Tertiary 1,060; (b) RUV 1.5 to 10 = Primary 0, Secondary 1,140, Tertiary 1,350; (c) RUV Above 10 = Primary 0, Secondary 2,160, Tertiary 3,490.
Surgeon: Maximum of 15,390 @ 420/Relative Unit Value; Anesthesiologist: Maximum of 4,785 @ 420/Relative Unit Value.
Chemotherapy, Radiotherapy, Hemodialysis, Cataract extraction, and Minor surgical procedure.
Surgical family planning: Vasectomy = 900 (same for PRIMARY/SECONDARY/TERTIARY); Tubal Ligation = 1,125 (same for PRIMARY/SECONDARY/TERTIARY).