PhilHealth says benefits package for under-24-hour hospital stays available

Members who are confined for less than 24 hours are eligible for a benefit package, the Philippine Health Insurance Corporation (PhilHealth) said Tuesday.

In an interview on “UH On Record,” PhilHealth said that a 2023 policy revision provides specific benefits for stroke patients who die during a hospital stay of less than 24 hours.

“Sa kaso na ito na ang pasyente daw po ay namatay nang dahil sa stroke, meron po tayong revision na policy noong 2023 pagdating sa stroke,” PhilHealth spokesperson Dr. Israel Pargas said.

“Nakasaad din na may pakete na ibibigay kung ang pasyente ay namatay nang less than 24 hours,” he added.

(In this case, where the patient reportedly died due to a stroke, we have a revised policy from 2023 when it comes to strokes. It is also stated that a package will be provided if the patient dies in less than 24 hours.)

According to Pargas, the 24-hour confinement policy had previously been an issue, even facing scrutiny in the Senate.

In a viral social media post on Friday, a deceased member’s wife shared that her husband was deemed ineligible for PhilHealth benefits because he had been confined for less than 24 hours.

“What is the purpose of #PhilHealth if the people who have contributed for decades cannot access the benefits when they need them most?” Maria Lourdes Sulit said in her post.

Sulit said that her husband was a PhilHealth contributor for more than 25 years.

PhilHealth said that they are already communicating with the bereaved family and the concerned hospitals.

Pargas said PhilHealth is assessing what kind of in-patient benefit package/s they can give the family, considering that the patient was confined.

“Pero kailangan din natin tingnan kasi ito po ay, I mean, sa kasamaang palad ay namatay so titingnan din natin kung meron po bang mga ginawang hakbang like resuscitation kasi binabayadan din po natin ‘yan,” Pargas said.

(But we also need to look into it because, unfortunately, the patient passed away, so we will check if steps like resuscitation were performed, as we also pay for those.)

In her post, Sulit said that they were also denied the Resuscitation Package.

“Even the #ResuscitationPackage was denied because it was claimed that we did not authorize resuscitation (ambubag was present in the bill), but how could resuscitation save him when the surgery he urgently needed was never performed?” she said.

In the interview, Pargas promised that the Sulit family would receive the due benefits and would not be left with nothing.

“Ang mangyayari po nito ay magiging reimbursement na or diretso na sa pasyente kung merong benepisyong na ibabayad,” Pargas said.

(What will happen is that it will either be a reimbursement or go directly to the patient if there are benefits to be paid.)

Benefits for stroke patients

PhilHealth members with stroke are eligible for medical treatment, which has two packages, according to Pargas.

The first stroke medical treatment package is for members who have had an infarct or blockage, which provides around P76,000.

Meanwhile, if similar to the case of Sulit’s husband, who had bleeding, the assistance is around P80,000, according to Pargas.

“Kung halimbawa naman po, ito ay magiging surgical treatment ‘yung, kung magiging gamutan o kailangang operahan, meron po tayo na pakete na umaabot sa P108,000 depende po sa procedure na gagawin,” he added.

(For example, if it becomes a surgical treatment or requires an operation, we have a package that reaches up to ₱108,000, depending on the procedure that needs to be done.)

Under PhilHealth’s Benefit Plan for 2026, Pargas said that a review of the benefit packages for stroke surgical treatment is scheduled to be implemented this year.

Possible violation

Sulit also said that her husband was advised to undergo surgery. However, the hospital had required them to make a P1-million deposit before her husband’s admission.

In a statement, Senator JV Ejercito flagged this as a violation of the Batas Pambansa 702, amending the Republic Act 10932, the Anti-Hospital Deposit Law.

Pargas did not confirm if the hospital will be held liable for the violation, but said that the problem needs a “whole of society approach” by the concerned agencies in the healthcare system.

“Hindi lang po PhilHealth yung naging issue, but meron nga rin kung naging issue doon sa anti-deposit law, which is being run by different agencies,” Pargas said.

(“It wasn’t just PhilHealth that became an issue, but there was also an issue regarding the anti-deposit law, which is run by different agencies.)

“So hindi lang po PhilHealth yung kinakailangang gumalaw, but rather kasama po yung mga ibang ahensya through a whole-of-society approach,” he added.

(So it is not just PhilHealth that needs to take action, but rather other agencies as well, through a whole-of-society approach.)

According to Pargas, the regulation of hospital operations and licenses is under the Department of Health, including the implementation of the Anti-Deposit Law.

“Isang tingin ko dito na kailangan matignan is the shared responsibility,” Pargas said.

(One thing that I think needs to be looked into is the shared responsibility.)

The spokesperson clarified that under the Universal Healthcare Law or Republic Act 11223, all Filipinos are granted automatic PhilHealth memberships and shall be immediately eligible to all the benefits of the insurance agency.

“Actually, kung hindi kayo rehistrado at tayo ay na-ospital, pwede, at the point of service may register po at makakakuha pa rin ng serbisyo at benepisyo, Pargas added.

(Actually, if you are not registered and you get hospitalized, it is possible to register at the point of service and still get the services and benefits.) — BM, GMA News