Question & AnswerQ&A (PHIC PHILHEALTH CIRCULAR NO. 15, S. 2003)
The New PhilHealth Maternity Care Package for NSD is effective for all discharges starting May 1, 2003.
It uses a case payment scheme in claims reimbursement.
No, the RVU assigned for these procedures shall no longer apply.
The package is limited to the first two (2) normal deliveries per member.
A case rate of 4,500 pesos is paid regardless of hospital category and length of hospital stay.
2,000 pesos is for the health professional and 2,500 pesos is for the health facility.
The health facility’s share covers room and board, drugs and medicines, diagnostics, operating room, and all other medically necessary care except professional fees.
The IPP member should have sufficient regularity of premium contributions with at least nine (9) months or three (3) quarters paid within the immediate twelve (12) months prior to delivery.
Yes, IPP members enrolled as a group or through the IPP-OWWA program and all other types of membership need not satisfy the sufficient regularity rule and are governed by current eligibility requirements.
The new PhilHealth Package Claim Form No. 4 must be used. Until it is distributed, Claim Form No. 2 may be used without itemizing charges.
No, only the total actual charges and PhilHealth benefit claimed are to be indicated in Box No. 12 of Part I.
No payment for anesthesiologist’s professional fee shall be paid for NSD.
Official receipts must be submitted. The total amount paid for these items is deducted from the case rate and made payable to the member.
Hospitals may seek reimbursement based on the case classification of the condition and must list all reimbursable items for claims processing.
385 pesos for primary hospitals, 1,140 pesos for secondary hospitals, and 1,350 pesos for tertiary hospitals.
Health professionals are reimbursed 2,000 pesos plus additional reimbursements for necessary surgeries, procedures, and daily consultations for co-managed care.
No, hospitals shall submit only one claim application for complicated normal deliveries.
Yes, all medically necessary care including professional services, medicines, and laboratory exams is covered and classified as an ordinary medical case.
No, unless the newborn is admitted for other medical indications.
No, infant formula is not reimbursable.