QuestionsQuestions (PHIC PHILHEALTH CIRCULAR NO. 26, S. 2003)
The circular is issued pursuant to PhilHealth Board Resolutions No. 563 and 564, which provide special benefit packages for health workers and members who contract Severe Acute Respiratory Syndrome (SARS).
Qualified PhilHealth members and their dependents may avail, provided the patient is a DOH-identified probable SARS case admitted in a DOH-designated SARS hospital.
The case must (1) be identified by the DOH as a probable SARS case, and (2) be admitted in a DOH-designated hospital for SARS cases.
Up to a maximum of PHP 50,000 per case.
Up to a maximum of PHP 100,000 per case, for those at the forefront with peculiarly high risk who contacted the SARS-causing organism from caring for a SARS-suspected patient in a DOH-designated SARS hospital.
Payment of professional health services; drugs and medicines; radiographics services; laboratory examinations; supplies and transfer services from referring hospital to the DOH-designated hospital; use of the operating room complex; and all other medically necessary care.
No specific benefit limits are stated, except for the room rate and professional fees benefit limits. However, the 45-day room and board allowance applies.
It limits/sets the duration for room and board allowance to 45 days, and it applies to both members/dependents and health workers.
They must have at least paid three months of premium in the last six months prior to availment.
No. As a special benefit, SARS benefits are paid directly to the DOH-designated hospital with no direct filing by members allowed.
J12.8, B97.2.
PhilHealth Claim Form 1; PhilHealth Claim Form 2 (itemization of Parts III and IV is not required); and hospital documentation from DOH that the hospital is a designated SARS hospital and the patient is a DOH-identified probable SARS case.
A certification signed by the Hospital Chief/Administrator that the patient is a health care worker who contacted the disease in the course of duties in a DOH-designated SARS hospital, or any other document attesting to that fact signed by an authorized DOH officer.
It covers all eligible cases discharged from designated SARS hospitals starting May 8, 2003, even though the circular was adopted on August 1, 2003.
No. Qualification requires admission in a DOH-designated SARS hospital and identification as a DOH-identified probable SARS case.
Yes. Coverage is limited to DOH-identified probable SARS cases.
No. Both conditions are required: DOH designation of the hospital and DOH identification of the patient as a probable SARS case.