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Monday, December 06, 2021

PhilHealth explains hemodialysis coverage

THE Philippine Health Insurance Corp. (PhilHealth) explainED that its health insurance coverage for hemodialysis is at a rate of P2,600 per session.

Members are covered by the health insurance company for a maximum of 45 days of admission or confinement per year.

Each admission (outpatient) or each day of confinement (inpatient) will be deducted from this 45-day limit.

This applies to all cases covered by PhilHealth, including hemodialysis.

Health insurance coverage is extended to qualified dependents (if any) at no added premium, also up to a maximum of 45 days per year. But these additional 45 days are to be shared by all qualified dependents.

Members and dependents who have already used up their 45-day allowances are no longer entitled to PhilHealth coverage for the year, except when the reason for admission is outpatient hemodialysis.

PhilHealth allows members to use the 45-day allowance intended for dependents (or what is left of it, if any) as additional health insurance coverage exclusively for outpatient hemodialysis.

In the same way, dependents can use the 45-day allowance of the member (or what is left of it, if any) for outpatient hemodialysis. Members and dependents can only do so once their first 45 days of coverage has been used up.

The same policy applies to members without qualified dependents.

PhilHealth covers their admissions or hospitalizations for a maximum of 45 days per year.

If these 45 days have been exhausted, the member is no longer entitled to insurance coverage, except when the reason for admission is outpatient hemodialysis.

In which case, PhilHealth covers the member’s outpatient hemodialysis for another 45 days.

If dialysis patients use their 45-day allowance solely for outpatient hemodialysis (no other hospitalization) and they are able to maximize the 45 days intended for dependents, at a case rate of P2,600 per session for a total of 90 sessions, hemodialysis patients can avail of a maximum of P234,000 per year as health insurance coverage from PhilHealth.
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