Question & AnswerQ&A (PHIC PHILHEALTH CIRCULAR NO. 16, S. 2003)
Lying-in Clinics, Midwife-managed Clinics, Birthing Homes, Rural Health Units (RHU), Ambulatory Surgical Clinics (ASC), and any other analogous Health facilities accredited by PhilHealth.
Effective to maternity care services initiated on May 1, 2003.
A total case rate of 4,500 pesos is paid to accredited health care providers.
The package includes prenatal care, delivery, newborn care, postnatal services, room and board, drugs and medicines, diagnostics, operating room, professional fees, and all other medically necessary care including services for maternal complications during delivery.
The payment is divided into two: P3,650.00 after delivery covering prenatal care and normal delivery (1st payment), and P850.00 after postnatal consultation covering postnatal care and family planning services (2nd payment).
The package is limited to the first two (2) normal deliveries as per PhilHealth Board Resolution No. 501.
They must comply with sufficient regularity of premium contributions, having at least nine (9) months or three (3) quarters of premium payments in the immediate twelve (12) months prior to delivery, and the first prenatal visit must not exceed four (4) months age of gestation.
Indigents under the Individual Paying Program (IPP) enrolled as a group or through IPP-OWWA program and all other types of membership exempt from this rule and are governed by current eligibility requirements.
Exclusions include: maternal age under 19 or 35 and older for elderly primies, multiple pregnancy, ovarian abnormalities, uterine abnormalities, placental abnormalities, abnormal fetal presentation, history of three or fewer miscarriages or one stillbirth, previous major obstetric/gynecologic surgery, certain medical conditions (e.g. hypertension, diabetes, epilepsy), and other pregnancy risk factors requiring referral.
Duly accomplished PhilHealth Claims Form 4 is required, or Claims Form No. 2 until Form 4 is distributed.
Claims for prenatal, delivery, and newborn care must be filed within sixty (60) days from the date of discharge; claims for postnatal and family planning services must be filed within ninety (90) days from the date of discharge.
Availment of the Maternity Care Package shall be charged as one day to the member's annual 45-day benefit limit.
The Corporation shall not reimburse claims with incomplete provision of services.