PhilHealth lifts 45-day benefit limit, expands coverage

The Philippine Health Insurance Corporation (PhilHealth) has lifted its 45-day benefit limit for members, enhancing healthcare coverage and ensuring continued access to services.

This decision by PhilHealth president Edwin Mercado is part of ongoing reforms aimed at improving the government's social health insurance program, as the previous limit was deemed an outdated cost-containment strategy no longer aligned with current healthcare needs.

PhilHealth announced on Wednesday that it will process over P8 billion in denied claims and lift the 45-day cap on hospital admissions, readmissions, and benefit utilization per year, effective around April 4.

Mercado emphasized that unpredictable medical needs often require more than 45 days of coverage and thanked the PhilHealth Board for approving this policy update.

PhilHealth will closely monitor patient admissions, readmissions, and benefit utilization exceeding 45 days to ensure responsible implementation while also assessing health facility compliance with clinical standards through the Health Care Providers Performance Assessment System (HCPPAS).

The policy change does not affect hemodialysis benefits or other services not subject to the 45-day rule.

This update aligns with the Universal Health Care Act, which mandates PhilHealth to fund individual-based services.