By: Sophia Pacheco
?The Philippine Health Insurance Corporation (PhilHealth) announced its coverage to include all outpatient emergency cases treated in accredited Level 1 to 3 hospitals nationwide, effective Feb. 14, 2025.
Under the new policy, these cases are covered by PhilHealth's Facility-Based Emergency (FBE) benefit, as outlined in the Outpatient Emergency Care Benefit (OECB) package introduced last year through PhilHealth Circular 2024-0033.
The OECB package covers emergency services, with a focus on facility-based treatment and pre-hospital benefits.
PhilHealth also stated that hospitals do not require additional certification to provide FBE benefits, as this is already covered in their existing hospital accreditation.
“However, those with extension facilities must submit to their respective PhilHealth Regional Offices a certification stating the name of affiliated extension facility and its complete address,” it added.
A total of 342 outpatient emergency services, medicines, and supplies are covered under a fixed fee schedule.
Key reimbursements include:
Consultations: P707 for emergent cases, P260 for urgent cases
Diagnostic tests: P1,326 for arterial blood gas tests, P423 for ECGs
Emergency bed use: P650 per instance
Medical equipment: Includes defibrillators, ventilators, oxygen, infusion pumps, intubation kits, and nebulizers
Imaging services:
CT scans: P3,211–P18,554 per use, depending on the area examined
MRIs, ultrasounds, and X-rays are also covered
While the FBE benefit expands hospital-based emergency care coverage, PhilHealth has yet to announce ambulance coverage through the Prehospital Emergency (PHE) benefit.
President Ferdinand Marcos Jr. ordered Department of Health Secretary Teodoro Herbosa to 'make sure that PhilHealth services remain unhampered,' emphasizing that the agency's zero percent government funding this year 'should not impede the delivery of healthcare services.'