Under 24-hour hospital stay covered – PhilHealth

MANILA, Philippines — The Philippine Health Insurance Corp. (PhilHealth) is expanding its benefit packages to cover inpatient admissions of less than 24 hours beginning on Sept. 18, provided they meet the prescribed qualifications and requirements.

In line with Republic Act No. 11223 (Universal Health Care Act) and PhilHealth Circular No. 2026-0013 dated Sept. 11, members and their dependents may file reimbursement claims even if they are admitted for less than 24 hours.

But the benefit will apply only to patients with “serious, severe, and life-threatening” medical conditions. PhilHealth will determine eligibility based on the “medical necessity, appropriateness and medical justification of the admission,” as supported by the patient’s medical records.

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“Even the admission has qualifiers; it must be medically necessitated. Even with this policy, it includes how to deter the abuse of claims,” said Christine Mae Magno, PhilHealth’s acting senior manager of corporate communication management.

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READ: PhilHealth urged to scrap 24-hour confinement rule

The coverage also applies to patients who require continued care in another hospital or die while confined. Those who are admitted but leave the hospital within 24 hours, whether upon their physician’s advice or by personal choice, may also qualify.

Counted by the hour

Patients declared dead on arrival or whose conditions can be treated through outpatient, emergency department, ambulatory, or primary care services are not covered.

PhilHealth spokesperson Alfred Philip de Dios said the 24-hour period is counted strictly by the hour, starting from the time the patient is formally admitted.

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“Twenty-four hours is 24 hours. The clock starts ticking once an admit order was given to the patient even if they are at the emergency room. We start counting from there. If it goes beyond that, other inpatient claims will be availed,” he explained.

According to Magno, the new policy aims to address gaps in PhilHealth’s previous benefit packages, which previously required members to meet a minimum period for admission before they could avail themselves of inpatient coverage.

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“Usually, for admissions and our inpatient claims in the past, there was a required number of days of admission based on medical guidelines. Now, what we’re saying is that if you need to be admitted, but within 24 hours the doctor says, ‘Okay, you don’t have to stay longer,’ in the past, PhilHealth would no longer cover it because there was a minimum number of hours required. Now, what we’re saying in the circular is that we will pay based on the services rendered,” Magno told the Inquirer.

The policy change came after a viral social media post in June involving Maria Sulit, whose husband, a PhilHealth member, died less than 24 hours after hospital confinement. According to the post, the family was denied PhilHealth benefits because the husband did not meet the state insurer’s 24-hour confinement requirement.

Magno hinted that public sentiment gathered by PhilHealth was among the factors considered in developing and expanding the policy.

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“Based on those sentiments that we gather, that’s when the policy officers respond,” she added. /cb