Question & AnswerQ&A (PHIC PHILHEALTH CIRCULAR NO. 26, S. 2003)
The circular provides special benefit packages for health workers and all members who contract Severe Acute Respiratory Syndrome (SARS) as per PhilHealth Board Resolutions No. 563 and 564.
Qualified PhilHealth members and their dependents who are DOH-identified probable SARS cases admitted in a Department of Health (DOH)-designated hospital for SARS cases are covered.
The maximum amount payable is P50,000 per case.
It covers professional health services; drugs and medicines; radiographic services; laboratory examinations; supplies; transfer services from referring hospital to DOH-designated hospital for SARS; use of the operating room complex; and all other medically necessary care, subject to limits on room rate, professional fees, and a 45-day room and board allowance.
Health workers are entitled to a maximum amount of P100,000 per case if they contracted SARS due to caring for a suspected SARS patient in a DOH-designated SARS hospital.
Yes, there are no specific benefit limits except for the room rate and professional fees benefit limits, and the application of the 45-day room and board allowance.
Members should have at least paid three months of premium in the last six months prior to availment to be eligible.
No, claims for SARS benefits shall be paid directly to the DOH-designated hospital. Members cannot file claims directly.
The ICD 10 code for probable SARS cases is J12.8 and B97.2.
The documentary requirements include PhilHealth Claim Form 1, PhilHealth Claim Form 2 (itemization of parts III and IV not required), hospital documentation from DOH confirming the hospital is designated for SARS and the patient is a probable SARS case, and for health workers, a certification from the hospital chief or DOH authorized officer attesting the worker contracted SARS in the performance of duties.
The SARS benefits cover all eligible cases discharged from designated SARS hospitals starting May 8, 2003.