PhilHealth to reimburse first 3 uncomplicated deliveries of members

The Philippine Health Insurance Corporation will reimburse members who give uncomplicated deliveries of the first three births in accredited hospitals and lying-in clinics starting next month.

The expansion of the Normal Spontaneous Delivery package was provided by PhilHealth Board Resolution No. 923, series of 2006.

A case rate of P4,500 will be paid to providers of the NSD and maternity care package. For hospitals, payment for accredited health professionals is set at P2,000 while P2,500 is for the facilities.

In lying-in clinics and analogous facilities, the first payment of P3,650 is paid after delivery and the second payment of P850 is paid after the post-natal consultations and family planning services.

Normal birth is characterized by spontaneous onset of labor; low risk at the start of labor, throughout labor and delivery, fetus in vertex position and 37-42 weeks of completed pregnancy.

An additional requirement for the availment of benefit in lying-in clinics is the first prenatal visit for the patient and must not exceed the four-month age of gestation.

Some conditions remain excluded from coverage when giving birth in PhilHealth accredited lying in clinics such as maternal age under 19 years old, first pregnancy of patient aged 35 years and older and multiple pregnancy.

Excluded as well are ovarian cyst, myoma uteri, placenta previa, breech presentation, history of three or more miscarriages, history of one stillbirth, history of major obstetric and or gynecologicoperation, history of medical conditions such as preeclampsia, hypertension, heart disease, diabetes, thyroid disorder, morbid obesity, moderate to severe asthma, epilepsy, renal disease and bleeding disorders.

Members in the employees sector or the dependents availing of the NSD package are required to have made nine months of premium payments within the immediate six months prior to delivery.

Individually paying members or their dependents are required to have made nine months of premium payments within the immediate 12 months prior to the delivery.

Members under the Overseas Workers Program or their dependents may avail of this benefit within the validity period stated in the members enhanced data record, PhilHealth certificate of eligibility or the Medicare Eligibility Certificate. - Jasmin R. Uy/BRP