The Philippine Health Insurance Corporation (PhilHealth) has announced an expansion of its coverage to include all outpatient emergency services in accredited Level 1, 2, and 3 hospitals. This initiative is part of the Facility-Based Emergency (FBE) benefit under the outpatient emergency care benefit package, aiming to provide comprehensive healthcare access to Filipinos.
In its recent advisory, PhilHealth clarified that hospitals are not required to seek separate accreditation to offer FBE services, as this provision is encompassed within their existing hospital accreditation. However, extension facilities providing FBE services must submit a certification detailing their name and address to the nearest PhilHealth regional office for record updating.
Earlier this month, PhilHealth emphasized the necessity for more accredited medical facilities to broaden its health coverage, targeting the inclusion of millions of Filipinos. The corporation is also working towards incorporating ambulance services into the pre-hospital emergency benefit, enhancing the scope of emergency medical assistance available to members.
In January, a lawmaker called on PhilHealth to revise its policies and streamline requirements in claims processing. This appeal was made to address the significant number of denied and return-to-hospital (RTH) claims, which have been a source of concern for both patients and healthcare providers. Simplifying the claims process is anticipated to improve the efficiency of service delivery and reduce administrative burdens.
President Ferdinand Marcos Jr. has directed the Department of Health to ensure the continuous provision of PhilHealth benefits. This directive comes in response to the bicameral conference committee’s decision to remove government subsidies for the state health insurer in the 2025 national budget. The President’s intervention underscores the administration’s commitment to maintaining accessible healthcare services for all citizens, despite budgetary constraints.
PhilHealth’s expansion of outpatient emergency services coverage reflects its dedication to enhancing the country’s healthcare system. By eliminating the need for separate accreditations and working to include ambulance services, the corporation is taking significant steps to ensure that emergency medical care is readily available and accessible. These efforts, coupled with the push for more accredited facilities and streamlined claims processing, aim to provide a more efficient and inclusive healthcare experience for Filipinos nationwide.
As the healthcare landscape continues to evolve, PhilHealth’s proactive measures are poised to address the immediate needs of the population. Ensuring uninterrupted delivery of benefits, even amidst financial challenges, highlights the organization’s resilience and commitment to public health. Members are encouraged to stay informed about these developments and understand how they can benefit from the expanded services now available under PhilHealth’s coverage.