OUTPATIENT EMERGENCY SERVICES NOW COVERED BY PHILHEALTH

THE Philippine Health Insurance Corporation (PhilHealth) announced that is now covering all outpatient emergency services in accredited Levels 1, 2, and 3 hospitals nationwide.

The state health insurer said that starting February 14, 2025, outpatient emergency services would be covered under the facility-based emergency (FBE) benefit in line with the outpatient emergency care benefit package.

This applies to services rendered in the emergency departments of accredited hospitals and their extensions.

According to PhilHealth, the facility-based emergency benefit covers services such as imaging, laboratory tests, routine blood work and therapeutics.

The benefit package, stated in PhilHealth Circular 2024-0033, sets reimbursement limits for outpatient emergency services not covered under existing case rates or benefit packages. 

It includes costs for medical services, essential medicines, and supplies needed to manage urgent or emergent conditions, including diagnostic and laboratory procedures.

PhilHealth reminded hospitals that a separate accreditation to provide FBE benefits is not required as it is already included in their hospital accreditation.

However, extension facilities that offer FBE services should submit a certification with its name and address to the nearest PhilHealth regional offices for updating.

Earlier this month, PhilHealth said it needed more accredited medical facilities to expand its health coverage to millions of Filipinos.

The state-owned firm added that it was working on covering ambulance services for the pre-hospital emergency benefit.

President Ferdinand Marcos Jr. has directed the Department of Health (DOH) to ensure the uninterrupted delivery of PhilHealth benefits.

The directive was issued amid lawmakers stripping of government subsidy for the state health insurer in the 2025 national budget at the Bicameral Conference Committee.