PhilHealth expands dialysis coverage to 144 sessions

FILE A COVID-19 patient on a mechanical respirator is wheeled out by health personnel to another room for dialysis treatment in UP-Philippine General Hospital, Manila. INQUIRER PHOTO / LYN RILLON

MANILA, Philippines — The Philippine Health Insurance Corp. (PhilHealth) has expanded its coverage of dialysis sessions from the previous 90 to 144 sessions for 2021.

Based on Circular No. 2021-0009 published on Friday, the policy applies to PhilHealth members and their dependents with Chronic Kidney Disease Stage 5 (CKD 5) who are currently enrolled in the PhilHealth Dialysis Database.

“This policy covers for all hemodialysis beyond the 90 to a maximum of 144 sessions for CY (Calendar Year) 2021,” the state insurer said.

According to PhilHealth, the 91st to 144th additional sessions shall be exclusively used for outpatient dialysis. Any unused sessions will not be carried over to CY 2022.

The circular takes effect immediately upon publication in a newspaper of general circulation or the Official Gazette.

“Prior to the publication of this PhilHealth Circular, qualified CKD 5 patients who already used their 91st to 144th hemodialysis sessions and whose hemodialysis benefits have not yet been deducted from their medical bill, may directly file with PhilHealth Regional/Branch Office or Local Health Insurance Office based on existing guidelines for directly filed claims,” the circular read.

PhilHealth said that upon publication of the circular, claims on covered hemodialysis sessions shall be deducted from the final medical bill and filed by the healthcare provider.

There shall also be no co-payment for PhilHealth members and dependents who are classified as indirect contributors, the state insurer added.

“If the delay in the filing of claims is due to natural calamities or other fortuitous events, the existing guidelines of the Corporation on the provisions of special privileges to those affected by fortuitous events shall apply,” PhilHealth said.

EDV