PhilHealth expands coverage to all outpatient emergency cases

PhilHealth has expanded its coverage to include all outpatient emergency cases in accredited hospitals nationwide starting February 14, as part of the new Outpatient Emergency Care Benefit (OECB) package.

The Facility-Based Emergency (FBE) benefit covers services such as imaging, laboratory tests, routine blood work, and therapeutics in accredited hospitals, provided patients do not require admission or are discharged within 24 hours.

The benefit package sets reimbursement limits for outpatient emergency services not covered under existing case rates or benefit packages.

Hospitals do not need separate accreditation for this benefit, as it is included in their hospital accreditation, but extension facilities offering FBE services must submit a certification to their nearest PhilHealth regional offices.

Coverage for ambulance services under the Prehospital Emergency (PHE) benefit will be announced at a later date.

PhilHealth's premium contributions in 2024 reached over P167 billion, with P139.558 billion paid by direct contributors.