PHILHEALTH CIRCULAR NO. 52, S. 1999, May 10, 1999

[ PHILHEALTH CIRCULAR NO. 52, S. 1999, May 10, 1999 ]

INCREASE IN MEDICARE BENEFIT AMOUNTS UNDER THE NATIONAL HEALTH INSURANCE PROGRAM

Effective immediately, the maximum benefit amounts for medical care services under the National Health Insurance Program (NHIP) are hereby increased to make the Program more responsive to the health care needs of its members. The new benefit schedule are as follows:

For Private Sector Members (including Overseas Filipino Workers) and their Dependents:

Benefit Item Primary Hospital

Secondary Hospital

Tertiary Hospital

ROOM & BOARD 120

220

345

DRUGS & MEDICINES

1. Ordinary Case 1,165

1,595

2,670

2. Intensive Case 2,430

3,280

7,660

3. Catastrophic Case 0

6,575

11,885

X-RAY, LAB. ETC.

1. Ordinary Case 305

760

1,625

2. Intensive Case 500

1,680

3,405

3. Catastrophic Case 0

3,405

9,810

DOCTOR'S FEES

1. Ordinary Case

a. Gen. Practitioner 540

540

540

b. Specialist 810

810

810

2. Intensive/Catastrophic

a. Gen. Practitioner 810

810

810

b. Specialist 1,350

1,350

1,350

OTHERS

1. Hospital (OR)

a. RUV 5 & below 385

670

1,060

b. RUV 5.1 to 10 --

1,140

1,350

c. RUV above 10 --

2,160

3,490

2. Doctor

a. Surgeon Maximum of P15,390, RUV = 420

b. Anaesthesiologist Maximum of P4,785

SURGICAL FAMILY PLANNING

1. Vasectomy 900

660

660

2. Tubal Ligation 1,125

825

825

For Government Sector and Indigent Program Members and their Dependents

Benefit Item Primary Hospital

Secondary Hospital

Tertiary Hospital

ROOM & BOARD 90

170

255

DRUGS & MEDICINES

1. Ordinary Case 1,095

1,550

1,955

2. Intensive Case 2,050

2,650

5,610

3. Catastrophic Case 0

5,745

8,750

X-RAY, LAB. ETC.

1. Ordinary Case 230

590

1,295

2. Intensive Case 495

1,360

2,650

3. Catastrophic Case 0

2,550

8,520

DOCTOR'S FEES

1. Ordinary Case

a. Gen. Practitioner 425

425

425

b. Specialist 600

600

600

2. Intensive/Catastrophic

a. Gen. Practitioner 600

600

600

b. Specialist 990

990

990

OTHERS

1. Hospital (OR)

a. RUV 5 & below 235

405

645

b. RUV 5.1 to 10 ----

885

1,050

c. RUV above 10 ----

2,020

2,710

2. Doctor

a. Surgeon Maximum of P10,620, RUV = 420

b. Anaesthesiologist Maximum of P3,185

SURGICAL FAMILY PLANNING

1. Vasectomy 660

660

660

2. Tubal Ligation 825

825

825

These increased benefits may be availed of by NHIP members in the government and private sectors, including their dependents, who were discharged from PhilHealth-accredited hospitals starting June 1.

All accredited health care providers are advised to use the new benefits schedules in granting Medicare benefits to qualified NHIP members.

Please be guided accordingly. Thank you.

Adopted: 10 May 1999

(SGD.) ENRIQUE M. ZALAMEA President and CEO