Provision of Newborn Screening, Immunization, and Claim Filing Procedures
- Newborn screening test, BCG, and Hepatitis B immunization may be administered on an outpatient basis.
- Services are considered incomplete if immunization is done in private clinics or screening tests are done in different facilities; members may need to file claims directly with PhilHealth in such cases.
- Claims for NCP should be submitted only after completion of all required services if these are provided in Rural Health Units (RHUs).
Newborn Resuscitation Criteria and Claim Inclusion
- Resuscitation includes medical procedures such as suctioning and oxygen administration to normalize vital signs in newborns.
- Only newborns with abnormal breathing one minute after delivery or Apgar scores below 7 require resuscitation.
- Resuscitation procedures should be indicated in the specific section (Part IV c item No. 3) of the PhilHealth Claim Form 2.
- Normal newborns requiring no resuscitation are not eligible for this claim inclusion.
Administrative and Coverage Conditions
- NCP claims are exempt from submitting a Statement of Accounts.
- Home deliveries are not covered under NSD, MCP, or NCP; members are encouraged to deliver in PhilHealth-accredited facilities.
- Rural Health Units and Health Centers are encouraged to apply for accreditation as maternity care package providers to claim reimbursement for MCP and NCP expenses.
Normal Spontaneous Delivery and Maternity Care Package Benefits
- NSD Package covers normal deliveries for the first four births in accredited hospitals.
- MCP covers the first four births in accredited non-hospital facilities like lying-in clinics, birthing homes, and midwife-managed clinics.
- Case rate for both NSD and MCP is fixed at Php 4,500 per case, inclusive of Php 2,000 professional fee for accredited hospitals.
- MCP includes prenatal care, delivery, postpartum care, and family planning.
- Newborn care services previously included in MCP are now covered separately under NCP.
Erratum on Relative Value Unit for Incomplete Abortion Treatment
- The Relative Value Unit (RVU) for surgical treatment of incomplete abortions (RVS Code 59812) remains at 40, not 60 as incorrectly stated in a previous circular.
Continuity and Effectivity
- Previous circulars and Office Orders not inconsistent with this clarification remain in effect.
- Circular was adopted on February 10, 2009, under the authority of PhilHealth President and CEO Dr. Rey B. Aquino.