BAGUIO CITY (PIA) — The Philippine Health Insurance Corporation (PhilHealth) has made significant updates to its hospitalization benefits, including the removal of the previous 45-day limit on confinement, ensuring better protection for members requiring hospital care.
Baguio Local Health Insurance Officer Janet Palaez highlighted this in a recent interview, where she said what every PhilHealth member needs to know regarding hospital confinement.
Unlimited Confinement Days
One of the most welcomed changes is the removal of the old regulation that limited coverage to only 45 days per calendar year.
“Before, once you used up your 45 days, succeeding confinement was no longer covered. Now, there is no limit. You can be confined multiple times, even for the same illness or different ones, and PhilHealth will cover you every time,” Palaez said.
This update, effective April 4, 2025, ensures that members with chronic or recurring illnesses no longer have to worry about exhausting their coverage within a calendar year.
Philhealth coverage includes hospital room and board, medicines, laboratory exam, operating room use, and professional fees of attending physicians. The amount is based on case rates Philheath pays directly to the public or an accredited private hospital.
24-Hour Rule with Emergency Exception
To qualify for confinement benefits, patients generally must be officially admitted and complete a full 24-hour hospital stay.
“If you check in and check out before completing 24 hours, you forfeit the benefit,” Palaez said.
However, PhilHealth has removed the 24-hour requirement for life-threatening medical emergencies, allowing patients treated and released immediately to still qualify for outpatient emergency care benefits.
“For cases requiring admission, observation, or surgery, the 24-hour period must be completed to claim the benefit, unless it’s a life-threatening emergency,” she said.
Palaez clarified that employed and self-paying members are required to pay their monthly premium contribution.
“Unlike preventive services, when you are confined, we check your payment history,” Palaez said. She noted that many members only remember to pay their contributions when they are already in the hospital.
She added that unpaid contributions do not incur penalties, but settling dues is necessary to maximize benefits during confinement.
“We encourage everyone to pay regularly so you are secured and eligible when the need arises,” Palaez advised.
“It is better to have it and not need it than to need it and not have it. Health is wealth; without it, all savings can easily be spent on treatment,” she said, inviting the public to visit the nearest PhilHealth office or health center for further inquiries and clarification.
All hospitals in Baguio City are fully accredited PhilHealth providers, ensuring members have access to quality healthcare facilities. **JDP/MAWC-PIA-CAR
