Manila: The Philippine Health Insurance Corporation (PhilHealth) has announced a significant policy change, now allowing its members to claim benefits for readmissions due to the same illness within a 90-day period. This move comes as PhilHealth lifts its Single Period of Confinement (SPC) policy, which previously restricted compensation to only one claim for admissions and readmissions related to the same illness or procedure within a 90-calendar day timeframe. According to Philippines News Agency, PhilHealth Chief Emmanuel Ledesma emphasized that the decision to lift the SPC rule was made after extensive evaluation. "After extensive evaluation, we have lifted the rule of Single Period of Confinement to ensure continuous coverage for patients with recurring conditions," Ledesma stated in a news release on Thursday. This policy change aims to improve continuous healthcare access for members, particularly those with recurring health issues. The previous SPC policy had resulted in the denial of 26,750 claims in 2023, affecting patients with conditions such as community-acquired pneumonia, acute gastroenteritis, urinary tract infection, and chronic kidney disease. The updated policy will apply to medical conditions and surgical procedures under the All Case Rate payment scheme, expanding the scope of coverage for PhilHealth members. Ledesma further highlighted the organization's commitment to healthcare as a fundamental right. "We understand that health is not just a privilege but an essential right for every Filipino. In these challenging times, we stand with them, and always make sure to deliver all the benefits they deserve," he said. The SPC policy was originally introduced under the Philippine Medical Care Act of 1969 to prevent fraudulent claims. However, Health Secretary Teodoro Herbosa pointed out that modern technologies offer better fraud prevention, and the Universal Health Care Act of 2019 supports a shift towards more accessible and affordable healthcare services for Filipinos. In addition to the p olicy change, Ledesma reminded PhilHealth members and their qualified dependents about their entitlement to a maximum of 45 days of coverage for room and board per year. However, this does not apply to the hemodialysis benefits package, which has a separate allocation of 156 sessions per year.
PhilHealth Lifts SPC Policy, Allowing Readmission Coverage for Same Illness Within 90 Days.
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