Wednesday, January 03, 2007 Philhealth rolls out package
THE Philippine Health Insurance Corp. (PhilHealth) is rolling out its Newborn Care Benefit Package, covering claims with admission dates beginning Dec. 1.
The PhilHealth Board approved Resolution 925, series of 2006 providing for the new benefit package.
PhilHealth Circular 34 sets the guidelines for its implementation, using a case payment scheme for reimbursement of P1,000 to the accredited health care provider.
The newborn care services covered under the package include umbilical cord care, eye prophylaxis, administration of Vitamin K, thermal care, first dose of Hepatitis B immunization and newborn screening tests, as recommended by the Department of Health.
The accredited health care providers must be able to give the services in order to be reimbursed.
The case rates are P250 for eye prophylaxis, umbilical cord care, Vitamin K administration and thermal care; P250 for the first dose of Hepatitis B immunization; and P500 for the newborn screening test.
Confinement
If newborns are confined in the hospital due to other conditions or illnesses, they can avail themselves of other benefits, including room and board fee, based on the type of their illness or diagnosis.
The claim should include the newborn care services in the package and should not be considered a separate benefit.
The Newborn Care Benefit Package is available to newborns whose mothers are qualified to avail themselves of pregnancy-related benefits.
Mothers, as members or dependents, are eligible for pregnancy-related benefits if the contribution requirement for members is satisfied.
For employed members, a contribution of at least three months within the immediate six months before the month of delivery is required.
Contribution
For individually paying members, the contribution requirement is at least nine months within the immediate 12 months before the month of delivery.
Sponsored members and Overseas Workers’ Program members can avail themselves of pregnancy-related benefits within the one-year validity period of their coverage.
If the delivery is normal, a pregnancy-related benefit is available only for the first three normal deliveries.
An additional requirement for mothers delivering in accredited non-hospital facilities (such as lying-in clinics, midwife-managed clinics, birthing homes, rural health units, ambulatory surgical clinics and others), is that they must undergo prenatal care services and the first visit must be made before the four months age of gestation lapses.
