Applicability of Benefits by Hospital Level
- From September 1, 2009, benefits for H1N1 treatment are differentiated by hospital level.
- Level 3 and 4 (Tertiary) hospitals continue to apply the benefit payment as set out in PhilHealth Circular No. 25, s. 2009.
- Level 1 (Primary) and Level 2 (Secondary) hospitals follow a revised payment schedule with specific benefit amounts.
Specific Benefit Items and Payment Limits for Level 1 and Level 2 Hospitals
- Room and Board:
- Level 1: Php 500 per day, maximum Php 10,000 for Members/Dependents; Php 500 per day, maximum Php 20,000 for Healthcare Workers (HCW).
- Level 2: Php 700 per day, maximum Php 10,000 for Members/Dependents; Php 700 per day, maximum Php 20,000 for HCWs.
- Drugs and Medicines: Covered, but exact amounts not specified in this amendment.
- X-ray, Laboratory, and Other Supplies including Personal Protective Equipment (PPE), transfer services (ambulance), and operating room fees are included.
- Operating Room Fee:
- Php 50,000 for Members/Dependents;
- Php 100,000 for HCWs.
- Professional Fee:
- Level 1: Php 500 per day, max Php 15,000 for Members/Dependents; Php 500 per day, max Php 30,000 for HCWs.
- Level 2: Php 700 per day, max Php 15,000 for Members/Dependents; Php 700 per day, max Php 30,000 for HCWs.
- Total maximum benefit per case: Php 75,000 for Members/Dependents and Php 150,000 for HCWs at Levels 1 and 2.
Continuing Effect of Previous Provisions
- All provisions from previous PhilHealth issuances remain effective unless they conflict with the provisions of this Circular.
- This ensures a consistent legal framework for H1N1 coverage apart from the stated amendments.
Authority and Date of Effectivity
- Circular issued and adopted on September 1, 2009.
- Signed by Dr. Rey B. Aquino, President and CEO of PhilHealth, indicating official policy endorsement.