QuestionsQuestions (PHIC PHILHEALTH CIRCULAR NO. 19. S. 2010)
To support UN Millennium Development Goal No. 6 by enabling eligible members to access effective outpatient HIV/AIDS treatment and patient education, through coverage of approved anti-retroviral therapy services and related tests.
Paid through a case payment scheme. Annual reimbursement is set at ₱30,000 per year.
Only confirmed HIV/AIDS cases requiring treatment are covered by the package.
Treatment hubs in accredited facilities must base the package on DOH guidelines on anti-retroviral therapy among adults and adolescents with HIV infection.
Drugs and medicines, laboratory examinations (including CD4 level determination and monitoring tests for ARV toxicity), and professional fees of providers.
Released in four quarterly payments; each sub-package is ₱7,500, and a maximum of four (4) sub-packages per year may be claimed by the treatment hub.
Each quarterly claim is covered by the rule on single period of confinement computed from the date of consultation. Any additional claims filed within the same period for the same reason will be denied.
The hub may only claim reimbursement for the specific quarters in which OHAT services were actually provided within the year.
Each quarterly claim shall be charged one (1) day against the 45-day annual limit (or a sum of four (4) days per year).
Reimbursement continues if: (a) the receiving facility is also PhilHealth-accredited, (b) a referral letter from the referring facility is accomplished, and (c) PhilHealth reimburses the facility prior to transfer.
Only confirmed cases by STD/AIDS Central Cooperative Laboratory (SACCL) or Research Institute for Tropical Medicine (RITM) are payable.
Excluded are: (1) HIV/AIDS diagnosis without laboratory confirmation, (2) HIV/AIDS cases with no indication for anti-retroviral therapy, (3) management of HIV/AIDS patients with pulmonary TB co-infection (handled under TB-DOTS package in accredited TB-DOTS facilities, though a member may avail of both simultaneously), and (4) opportunistic infections secondary to HIV/AIDS requiring hospitalization (covered under regular inpatient benefit).
Claims must be submitted within sixty (60) days from the first day of treatment.
They shall be returned to the facility for completion.
All claims for the OHAT Package must be enclosed in a sealed envelope marked “CONFIDENTIAL” and submitted to the PhilHealth Regional Office.
Only DOH-designated treatment hubs in accredited facilities may file for reimbursement. There is no separate accreditation for hubs as long as the hospital is currently PhilHealth-accredited; if there are gaps in facility accreditation, claims for the sub-package will not be paid.