PhilHealth Lifts 45-Day Benefit Limit for Members

In a landmark move, the Philippine Health Insurance Corporation (PhilHealth) has lifted the 45-day benefit limit for all its members and their qualified dependents. This significant policy change, detailed in PhilHealth Circular No. 2025-0007, aims to enhance healthcare accessibility for Filipinos, in line with the Universal Health Care Act.

Previously, PhilHealth benefits were capped at 45 days for members and another 45 days shared among their dependents. This rule was a cost-containment measure to prevent the overutilization of health services. However, recognizing the evolving healthcare needs of the nation, PhilHealth has discontinued this limitation to ensure that access to critical services is not hampered.

The new policy applies to medical conditions and surgical procedures covered under the All Case Rates (ACR) and other special packages that were previously subject to the 45-day limit. This means members can now avail of PhilHealth benefits for confinements exceeding 45 days, provided that the services are appropriate, necessary, and adhere to established standards of care.

To safeguard the program's integrity, PhilHealth will closely monitor admissions and benefit utilization for patients with prolonged confinements. Health facilities are also tasked with conducting their own reviews of such cases to ensure quality assurance. It is important to note that this policy change does not extend to hemodialysis benefits and other services that were not previously subject to the 45-day limit.

This new development marks a significant step towards providing more comprehensive financial risk protection and equitable access to quality healthcare for all Filipinos.



Reference: PC2025-0007