Philhealth Circular No. 52 (1999)
INCREASE IN MEDICARE BENEFIT AMOUNTS UNDER THE NATIONAL HEALTH INSURANCE PROGRAM
(NAR) VOL. 14 NOS. 3-4 / OCTOBER - DECEMBER 2003
[ PHILHEALTH CIRCULAR NO. 52, S. 1999, May 10, 1999 ]
INCREASE IN MEDICARE BENEFIT AMOUNTS UNDER THE NATIONAL HEALTH INSURANCE PROGRAM
Effective immediately, the maximum benefit amounts for medical care services under the National Health Insurance Program (NHIP) are hereby increased to make the Program more responsive to the health care needs of its members. The new benefit schedule are as follows: For Private Sector Members (including Overseas Filipino Workers) and their Dependents: Benefit Item PrimarySecondary Tertiary Hospital Hospital Hospital ROOM & BOARD 120 220 345 DRUGS & MEDICINES 1. Ordinary Case 1,165 1,595 2,670 2. Intensive Case 2,430 3,280 7,660 3. Catastrophic Case 0 6,575 11,885 X-RAY, LAB. ETC.
1. Ordinary Case 305 760 1,625 2. Intensive Case 500 1,680 3,405 3. Catastrophic Case 0 3,405 9,810 DOCTOR'S FEES 1. Ordinary Case a. Gen. Practitioner 540 540 540 b. Specialist 810 810 810 2. Intensive/Catastrophic a. Gen. Practitioner 810 810 810 b. Specialist 1,350 1,350 1,350OTHERS 1. Hospital (OR) a. RUV 5 & below 385 670 1,060 b. RUV 5.1 to 10 -- 1,140 1,350 c. RUV above 10 -- 2,160 3,490 2. Doctor a. Surgeon Maximum of P15,390, RUV = 420 b. Anaesthesiologist Maximum of P4,785 SURGICAL FAMILY PLANNING 1. Vasectomy 900 660 660 2. Tubal Ligation 1,125 825 825 For Government Sector and Indigent Program Members and their Dependents Benefit Item PrimarySecondary Tertiary Hospital Hospital Hospital ROOM & BOARD 90 170 255 DRUGS & MEDICINES 1. Ordinary Case 1,095 1,550 1,955 2. Intensive Case 2,050 2,650 5,610 3. Catastrophic Case 0 5,745 8,750 X-RAY, LAB. ETC.
1. Ordinary Case 230 590 1,295 2. Intensive Case 495 1,360 2,650 3. Catastrophic Case 0 2,550 8,520 DOCTOR'S FEES 1. Ordinary Case a. Gen. Practitioner 425 425 425 b. Specialist 600 600 600 2. Intensive/Catastrophic a. Gen. Practitioner 600 600 600 b. Specialist 990 990 990OTHERS 1. Hospital (OR) a. RUV 5 & below 235 405 645 b. RUV 5.1 to 10 ---- 885 1,050 c. RUV above 10 ---- 2,020 2,710 2. Doctor a. Surgeon Maximum of P10,620, RUV = 420 b. Anaesthesiologist Maximum of P3,185 SURGICAL FAMILY PLANNING 1. Vasectomy 660 660 660 2. Tubal Ligation 825 825 825 These increased benefits may be availed of by NHIP members in the government and private sectors, including their dependents, who were discharged from PhilHealth-accredited hospitals starting June 1. All accredited health care providers are advised to use the new benefits schedules in granting Medicare benefits to qualified NHIP members. Please be guided accordingly. Thank you. Adopted: 10 May 1999
(SGD.) ENRIQUE M. ZALAMEA President and CEO