Question & AnswerQ&A (MMDA REGULATION NO. 98-003)
The purpose is to implement an outpatient blood transfusion benefit for PhilHealth members and dependents who require blood transfusion without the need for confinement.
Only PhilHealth accredited hospitals Levels 1, 2, 3, and 4 are qualified facilities for this outpatient benefit.
Payment is based on a fee-for-service scheme, with benefits calculated using a Relative Value Unit (RVU) system analogous to therapeutic aphaeresis procedures.
The RVU assigned is 10 for one or more units transfused.
The maximum benefit amounts are 9,000 PHP for Level 1, 11,200 PHP for Level 2, and 14,000 PHP for Level 3 and 4 hospitals.
Patients with repeat procedures within less than 90 days in a calendar year will not receive a new benefit allowance but may use unused benefits from the previous one. This applies to drugs & medicine, laboratory, and supplies.
No, room and board charges are not covered by this benefit; however, one day is deducted from the 45-day confinement allowance for each day of benefit availed.
No, there will be no additional professional fee for blood transfusions done during confinement or other PhilHealth-covered procedures such as hemodialysis.
Required documents include PhilHealth Claim Form 1, Claim Form 2, official receipts and statement of account, Member Data Record, proof of premium payment (MI-5), and PhilHealth ID.
Employed and Individually Paying Program members (including KASAPI) must have at least three months of contributions within the last six months prior to the month of availment. Sponsored and Overseas Workers must have a valid membership at the date of availment, and lifetime members can avail of the benefit with their PhilHealth ID.