Philippine Health Insurance Corporation (PhilHealth) manually process their members’ transactions at PhilHealth National Capital Region Central Branch in Quezon City on Tuesday, September 28, following the shutdown of their online system due to a cyberattack last week. Maria Tan, ABS-CBN News
MANILA — Patients admitted to a hospital as inpatients may still be covered by PhilHealth even if they stay for less than 24 hours, the state health insurer said Wednesday.
The policy means eligible members and their qualified dependents may have PhilHealth cover medically necessary hospital services and resources used during a short inpatient stay, reducing their out-of-pocket expenses.
Dr. Adeline Mesina of PhilHealth’s Benefits Development and Research Department clarified, however, that this is not a new benefit package with a separate benefit rate. It is also distinct from PhilHealth coverage for emergency room services.
“For example, merong na stroke na patient. Siyempre, i-re-refer natin sa emergency room. And then, the attending physician decided to admit the patient and nagbigay sila ng medical services because the patient is undergoing stroke,” she explained.
“But then na-realize nila na the patient kailangan ng further management at i-refer sa higher facility. Whatever ang resources na nagamit for the patient in Hospital A, babayaran to ng PhilHealth.”
Under PhilHealth Circular No. 2026-0013, the policy covers members and qualified dependents who are formally admitted as inpatients and receive medically necessary diagnostic, therapeutic, monitoring, stabilizing or other covered health care and hospital services.
Coverage may apply when the confinement lasts less than 24 hours because the patient needs to be transferred to another hospital or facility for continuity of care or if the patient expires.
Health proxy to be included soon in PhilHealth membership form
It’s important to note, however, that the circular is limited to medically necessary inpatient admissions as supported by clinical findings, diagnostic procedures, monitoring requirements and stabilization measures among others.
PhilHealth said the policy was issued because existing reimbursement mechanisms may not fully address cases in which a patient is admitted but cannot complete a 24-hour hospital stay because a transfer to another facility becomes necessary.
PhilHealth spokesperson Dr. Alfred Philip De Dios said the 24-hour period is counted from the time the patient is issued an admission order.
He also stressed that transfers between hospitals are subject to protocols intended to ensure that patients are stable enough to be transported.
“Ang hospitals, hindi yan magtatransfer ng unstable patient. Kung may chance na mamatay during transit, hindi yan paalisin ng ospital,” De Dios said.
The policy takes effect Friday, September 18, 2026.
PhilHealth’s Yakap program to go to schools, workplaces to encourage public to register
RELATED VIDEO: