PhilHealth expands outpatient benefits


Philhealth recently made changes in the implementation of its outpatient benefit package (OPB) — now Primary Care Benefit 1 (PCB1) package — for sponsored members, consistent with the health care reform objectives of Universal Health Care.

The old OPB package covers specific primary preventive care and diagnostic services in health centers for a particular period, which PhilHealth pays through per capita payment scheme. The amount of coverage per capita is P300 and the basis for payment depends on the number of sponsored members in a local government unit.

The PCB1 package covers primary preventive care and diagnostic services. But covered diagnostic services now include tests for lipid profile and fasting blood sugar, and drugs and medicines for outpatient treatment of asthma, upper respiratory tract infection or low risk pneumonia, acute gastroenteritis with no or mild dehydration and urinary tract infection.

Under the primary preventive care, three services are now considered under the package – clinical breast exam, visual inspection with acetic acid and blood pressure measurement. PCB1 still covers sponsored members under the National Household Targeting System for Poverty Reduction (NHTS-PR) and sponsored members subsidized by legislative, local government and private sponsors. But this time, coverage now extends to PhilHealth members under the overseas workers program (OFW) and organized group (OG).

PhilHealth encouraged all sponsored, OFW and OG members and qualified dependents to approach the health center near them and enlist on or before June 30 so they can be profiled and apprised of their entitlements under the package.

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