(As of October 2022)
The Philippine Health Insurance Corporation (PhilHealth) will shoulder the cost of treatment for patients with COVID-19 based on a case-rate package. The state-run insurance agency has also clarified that patients may use their health insurance coverage and mandatory discounts, such as senior citizen and PWD discounts, to help substantially cover the cost of treatment.
As your partner in healthcare management, ActiveLink reached out to Maxicare on how the HMO policy will apply for the duration of the community quarantine period. For your guidance, please refer to the information below:
1. Will Maxicare cover availments for COVID-19?
Maxicare will continue to provide coverage for COVID-19 provided that the patient availed the services within the Maxicare-accredited network. HMO benefits will be deducted first before applying the PhilHealth benefits for medical expenses related to Probable and Confirmed COVID-19 cases inpatient care.
2. Will Maxicare cover RT-PCR testing costs?
Yes. Maxicare will cover COVID-19 RT-PCR testing if you are (1) symptomatic and (2) the test is availed at a Maxicare- and DOH-affiliated facility. This is following the cap limit of Php 3,360 for RT-PCR test based on DOH circular 2021-0374 net of PhilHealth, hence, PhilHealth will cover Php 2,800, while Maxicare will cover Php 560.
3. Will Maxicare cover the RT-PCR test if member is asymptomatic but was exposed to a COVID-19-positive patient?
RT-PCR testing for asymptomatic patients will not be covered, while antigen tests may be covered if required by a Maxicare Primary Care Network Physician.
4. If the treatment was done in a government hospital, will Maxicare allow reimbursement?
No. Maxicare will not cover treatment availed in government hospitals.
5. How much will PhilHealth cover for COVID-19 treatment?
For patients who were admitted starting April 15, 2020, PhilHealth will cover the admission cost based on a case rate package:
|
SEVERITY
|
PACKAGE AMOUNT (PHP)
|
HOSPITAL CATEGORY
|
|
Mild pneumonia in the elderly or with comorbidities
|
43,997
|
Levels 1-3 hospital, private room
|
|
Moderate pneumonia
|
143,267
|
Levels 1-3 hospital, private room
|
|
Severe pneumonia
|
333,519
|
Levels 2-3 hospital, private room, ICU
|
|
Critical pneumonia
|
786,384
|
Levels 2-3 hospital, private room, ICU (capable of ECMO, RRT)
|
6. I have other questions regarding COVID-19. Whom can I contact?
Should you have further concerns or clarifications; you may get in touch with:
You may also call the following COVID-19 dedicated hotlines:
Should you have other questions, please don’t hesitate to reach us.
Thank you!
ActiveLink coordinates with your HMO provider on administrative concerns regarding your HMO policy. We help you resolve your HMO concerns from start to end of your HMO policy. By using this service, you are agreeing to ActiveLink's data privacy and consent provisions. Please click this link to find out more.
