How many days is the limit for PhilHealth coverage?
PhilHealth members have a maximum of 45 days of confinement per calendar year. The qualified dependents of the member have another set of 45 days of coverage per calendar year. However, the 45-day allowance shall be shared among them.
This amounts to a total of 90 days for a PhilHealth member and their dependents is 90 days. However, it is essential to note that certain conditions require multiple treatment sessions in the hospital. As such, they may have more than 45 days of confinement per calendar year.
What conditions can have more than 45 days of PhilHealth coverage?
According to PhilHealth’s benefits, the maximum number of days of confinement per calendar year is 45 days. However, there are conditions that will require more days in the hospital. Hence, the agency grants more than 45 days of confinement per calendar year.
These conditions include hemodialysis, which PhilHealth covers up to 156 sessions per year for hemodialysis treatment. Ultimately, the number of days of confinement for these conditions may vary. It will depend on the severity of the illness and the treatment required.
Can I use PhilHealth twice in a year?
Yes, a PhilHealth member can use their benefits twice a year. This applies as long as the total confinement days do not exceed 45 days per calendar year. The qualified dependents of the member have the shared 45 days of coverage per calendar year.
The number of times a member can use PhilHealth in a year may depend on the type of medical treatment or procedure they need. Moreover, it depends on the number of days required for their confinement.
What are the limitations of PhilHealth?
PhilHealth is a social health insurance program in the Philippines that provides financial protection to its members against the high cost of medical care. However, there are limitations to the coverage provided by PhilHealth, which include:
- Benefit limits: PhilHealth members have a maximum of 45 days of confinement per calendar year. Moreover, PhilHealth may not cover the entirety of your hospital bills, so you still need to cash out.
- Limited financial protection: The level of financial protection provided by PhilHealth is limited since it has wide population coverage.
- Admissible cases: Only admissible cases shall be reimbursed by PhilHealth.
- Subject to rules and regulations: All funds under the management and control of the Corporation and members must meet requirements to avail of its benefits.
Ultimately, PhilHealth is not intended to cover all medical expenses, and members should not solely rely on it for their healthcare needs.
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