PhilHealth to cover expenses of COVID-19 patients with unpaid contributions

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Metro Manila (CNN Philippines, April 2) — The Philippine Health Insurance Corporation will shoulder the medical expenses of COVID-19 patients who have no contribution payments, the agency president said Thursday.

PhilHealth chief Ricardo Morales said they will be lifting conditions for members’ availment of benefits, particularly the required contributions. He stressed that public health crisis demands that those who contracted the viral disease have access to health services.

“Universal healthcare na tayo ngayon at under pandemic condition, lifted muna ‘yung mga gano’ng delayed contributions,” said Morales in an interview on CNN Philippines. “Saka na tayo magbilangan. Ang importante mabigyan muna ng tulong.”

[Translation: We are now carrying out universal health coverage, and under pandemic condition, stipulations regarding delayed contributions will be lifted for now. Let's do the computations later. What's important is that COVID-19 patients are given assistance.]

He clarified that infected PhilHealth members will still be required to pay for their missed premium contributions. However, their coronavirus-related medical expenses will be covered by the agency.

“‘Yung mga hindi nila nabayaran sa premium, hahabulin na lang nila ‘yon," Morales said. "Pero hindi ‘yung mga ginastos nila sa ospital."

[Translation: They will have to pay for their missed contributions later, but not their hospital expenses.]

PhilHealth will also shoulder medications for pre-existing health conditions of COVID-19 patients, such as hypertension or diabetes, he said.

He added that PhilHealth will pay for medical examinations of suspected COVID-19 patients, as long as it is done by a health professional and administered in a hospital accredited by the agency.

In case there are no PhilHealth-accredited hospitals in the areas, Morales said members should have the supervising physician sign forms for the services administered, and PhilHeath will also take care of the expenses.

No balance billing policy

The agency chief reiterated that COVID-19 patients will not have to pay for treatment costs, as the Bayanihan Law mandates the implementation of a ‘No Balance Billing’ policy.

This means that all medical expenses, including medicines and doctor’s fee, will be shouldered by the state health insurer. Morales said PhilHealth has prepared a P30-billion fund for the health crisis.

“Nag-issue kami ng guidelines today [April 2] sa hospitals na sasagutin ng PhilHealth lahat ng gastusin sa mga pasyenteng tatamaan ng COVID-19,” Morales said. “Alam ng ospital ‘yan. Walang dapat ilabas na pera yung pasyente.”

[Translation: We issued guidelines to hospitals today, saying that PhilHealth will cover all expenses of COVID-19 patients. The hospitals know that. Patients won't have to pay for anything.]

Different case rate after April 14

According to Morales, PhilHealth will be implementing a different set of packages for COVID-19 cases by the end of the enhanced community quarantine, which is set to expire on April 14.

“May bago na tayong case rate na puwede i-apply sa mild, moderate, severe, and critical cases," he said. "‘Yung ang gagamitin natin."

[Translation: We now have a new case rate that we can apply for mild, moderate, severe, and critical cases. That's what we'll use.]

In the event that the insurance offered would not suffice, patients may apply for additional funding—which will come from the Philippine Charity Sweepstakes Office, and it will be a case-by-case basis, he added.

“Pero hopefully kasi napag-aralan na natin nang husto ‘to, hopefully magkakasya naman ang ating case rate para sa critical cases after April 14,” Morales said.

[Translation: But hopefully, since we've been able to thoroughly assess the situation, hopefully our case rates will be enough to shoulder critical cases after April 14.]

Earlier, the PCSO was asked to transfer over ₱420 million of its fund to PhilHealth to cover COVID-19 related packages.

As of April 2, the health department has recorded 2,633 COVID-19 cases in the country. The death toll stands at 107, while 51 patients have recovered.