How many times can we use PhilHealth in a year?

Last Updated on 01/27/2021 by FilipiKnow

PhilHealth members are entitled to a maximum of 45 days confinement per calendar year1. The qualified dependents of the member share another set of 45 days benefit per calendar year. However, the 45 days allowance shall be shared among them. 

A patient should be confined for at least 24 hours in a PhilHealth-accredited hospital to be able to claim the PhilHealth compensation.

When approving claims, PhilHealth also follows the Single Period of Confinement (SPC) Rule. It states that admissions and readmissions due to the same illness or procedure within a 90- calendar day period shall only be compensated with one (1) case rate benefit.

In other words, more than 90 days must lapse between your first and subsequent admission for the same illness or procedure before you can be qualified for a new benefit.

*Note: Certain conditions requiring multiple treatment sessions (e.g. hemodialysis) in the hospital are entitled to more than 45 days of confinement per calendar year. Make sure to properly check the package to be availed to stay informed of the allowable limit. 

Go back to the main article: How to Compute PhilHealth Contribution: A Complete Guide to Contribution Table and Payment

 

Reference.

  1. PhilHealth Circular No. 2020-007 (Guidelines on the Provisions of Special Privileges to those Affected by a Fortuitous Event). (2020). [PDF]. Retrieved from https://www.philhealth.gov.ph/circulars/2020/circ2020-0007.pdf