Pursuant to Proclamation No. 1218, series of 2021, the period of the State of Calamity throughout the country is extended due to Coronavirus disease (Covid). PhilHealth is relaying this information to all members and their legal dependents, partner health care providers and other stakeholders of the continuing grant of special privileges due to a fortuitous event, according to a media release from the agency’s Central Visayas office.
Without fortuitous events, claims for reimbursement or payment for services rendered shall be filed within 60 calendar days from the date of discharge of the patient from the health care provider, as stated in Section 46 of the Implementing Rules and Regulations of the National Health Insurance Act or Republic Act (RA) 7875, as amended by RA 9241 and RA 10606.
On the other hand, a member is entitled to a maximum of 45 days confinement per calendar year while his/her qualified or legal dependents shall share a separate 45-day benefit per calendar year.
Furthermore, the Single Period of Confinement Rule means that admissions and re-admissions due to same illness or procedure within a 90-calendar day period shall only be compensated with one case rate benefit.
As provided for in PhilHealth Circular No. 2020-007, the privileges during fortuitous events include submission of claims up to 120 calendar days from the date of discharge, and exemption from the 45-day benefit limit and the single period of confinement rule.
Through its Advisory No. 2021-040 entitled “Extension of Special Privileges under the Fortuitous Events until September 12, 2022,” PhilHealth reiterates that privileges will remain in effect until the said date unless earlier terminated or extended through an official issuance.
