Sunday, September 10, 2006
PhilHealth expands maternity package coverage
THE Philippine Health Insurance Corporation (PhilHealth) will reimburse uncomplicated deliveries of the first three births in accredited hospitals and lying-in clinics starting October 1, 2006 following the expansion of the agency's Normal Spontaneous Delivery (NSD) package.
PhilHealth Board Resolution No. 923 provides for the expansion of NSD.
A case rate of P4,500 will be paid to accredited providers of NSD and maternity care package. For hospitals, payment for accredited health professionals is set at P2,000 and P2,500 for the facilities.
In lying-in clinics and analogous facilities, the first payment of P3,650 is paid after delivery and the second payment of P850 is paid after the post-natal consultations and family planning services.
Normal birth is characterized by spontaneous onset of labor's low risk at the start of labor, throughout labor and delivery, fetus in vertex position, and 37-42 weeks of completed pregnancy.
An additional requirement to avail of the benefit in lying-in clinics is the first prenatal visit for the patient that must not exceed the four-month age or 16-week age, of gestation.
The following conditions remain to be excluded from coverage when giving birth in PhilHealth-accredited lying-in clinics: maternal age under 19 years old; first pregnancy of patients aged 35 years and older; multiple pregnancy; ovarian cyst; myoma uteri; placenta previa; breech presentation; history of three or more miscarriages; history of one stillbirth; history of major obstetric and/or gynecologic operation (caesarean section, uterine myomectomy); history of medical conditions (e.g. hypertension, pre-eclampsia, eclampsia, heart disease, diabetes, thyroid disorder, morbid obesity, moderate to severe asthma, epilepsy, renal disease, bleeding disorders); and other risk factors that may arise during pregnancy (e.g. premature contractions, vaginal bleeding) that would necessitate a referral for further management.
Contributions requirement
Members in the employed sector or their dependents availing of the NSD package are required to have made three months of payments within the immediate six months prior to delivery.
Individually paying members or their dependents are required to have made nine months of premium payments within the immediate 12 months prior to delivery.
Members under the Overseas Workers Program or their dependents may avail of this benefit within the validity period stated in the Enhanced Members Data Record, PhilHealth Certificate of Eligibility, or the Medicare Eligibility Certificate.
Sponsored members may avail of this benefit within the validity period stated in their PhilHealth Family Health Cards or Form CE1. Ligaya U. Barcenas, PhilHealth Regional Office VII.
(September 10, 2006 issue)
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