PhilHealth now covers outpatient emergency services in accredited hospitals

The Philippine Health Insurance Corporation (PhilHealth) has announced that all outpatient emergency cases in accredited Level 1, 2, and 3 hospitals nationwide are now covered.

According to PhilHealth Advisory No. 2025-0009, published on February 18, 2025, the coverage took effect on February 14 under the Facility-Based Emergency (FBE) benefit in accordance with the Outpatient Emergency Care Benefit (OECB) package introduced late last year through PhilHealth Circular 2024-0033.

A total of 342 outpatient emergency services, medicines and supplies are covered under a fixed fee schedule.

To qualify, patients must not require hospital admission or must be discharged within 24 hours of entering the emergency department.

PhilHealth reminded hospitals that they do not need separate accreditation to provide FBE benefits, as this is already included 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.

The coverage for ambulance services for Prehospital Emergency (PHE) benefit is currently undergoing a cost study and will be announced at a later date.

President Ferdinand Marcos Jr. ordered Department of Health Secretary Teodoro Herbosa to "make sure that services of PhilHealth remain unhampered," stressing that the agency's zero government subsidy for this year "should not affect the delivery of healthcare services."