PhilHealth Outpatient Emergency Care Benefit now extends coverage to outpatient emergency services in all accredited Level 1, 2, and 3 hospitals. This significant policy shift, effective January 1, 2025, is outlined in PhilHealth Circular No. 2024-0033, introducing the expanded OECB package.
Scope of the PhilHealth Outpatient Emergency Care Benefit (OECB)
The OECB package encompasses a wide range of services provided in emergency departments (ED) of accredited healthcare facilities. It covers patients who receive urgent medical care but do not require hospital admission and are discharged within 24 hours, as well as those who may unfortunately expire during emergency treatment. Covered services include diagnostic procedures, imaging tests such as X-rays and CT scans, laboratory work, and emergency treatments like nebulization or intubation. Medications administered during emergency care are also included.
Inclusion of Ambulance Services
A notable feature of the PhilHealth Outpatient Emergency Care Benefit is the inclusion of pre-hospital transport services. PhilHealth now covers land ambulance services for emergency trips to accredited facilities. There is also potential for sea and air ambulance services to be included in the future, contingent upon the establishment of supporting policies and regulations.
Accreditation and Implementation
Hospitals accredited by PhilHealth are automatically qualified to provide services under the OECB package and do not need to apply for separate accreditation. However, extension facilities offering these services must submit a certification with their name and address to the nearest PhilHealth regional office for updating.
Policy Revisions and Future Plans
This expansion of benefits comes in response to calls for PhilHealth to revise its policies and streamline claims processing to reduce the number of denied and return-to-hospital (RTH) claims. In January, a lawmaker urged the agency to address these issues to ensure more efficient delivery of services.
Additionally, PhilHealth is working on covering ambulance services for the pre-hospital emergency benefit, aiming to enhance the accessibility and affordability of emergency medical transportation for Filipinos.
Government Support and Budget Considerations
President Ferdinand Marcos Jr. has directed the Department of Health to ensure the uninterrupted delivery of PhilHealth benefits. This directive follows the bicameral conference committee’s decision to remove government subsidies for the state health insurer in the 2025 national budget, highlighting the administration’s commitment to sustaining healthcare services despite financial challenges.
For more detailed information on thePhilHealth Outpatient Emergency Care Benefit package and other PhilHealth benefits, members and healthcare providers are encouraged to visit the official PhilHealth website.
Here is a copy of PhilHealth Circular 2024-0033\
For other updates Check our what’s new page!
