HIV/AIDS Treatment Now Compensable with Philhealth

Press Release
November 27, 2010
HIV/AIDS Treatment Now Compensable with PHilhealth

In support to the United Nation’s Millenium Development Goal to halt or reverse incidence of Human Immuno-deficiency Virus (HIV) / Acquired Immune Deficiency Syndrome (AIDS) by 2015, Philhealth covers confirmed HIV/ AIDS cases effective October 1, 2010.

Confirmed cases by the DOH-designated treatment hubs may avail of Php30,000 reimbursement for drugs and medicines, laboratory examinations including Cluster Difference 4 (CD4) level determination test and test for monitoring of anti-retreviral drugs (ARV) toxicity and doctor’s fee.

The Php30,000 annual reimbursement will be paid through a case payment scheme at Php 7,500 per quarter based on the Department of Health (DOH) guidelines on anti-retroviral therapy.

Each quarterly claim is covered by the rule on single period of confinement computed from the date of consultation.

Diagnosis of HIV/AIDS with no laboratory confirmation and cases with no indication for anti- retroviral therapy are excluded from the availment of the outpatient benefit package.

Management of patients with pulmonary tuberculosis co-infection are also excluded but a separate package for TB-DOTS may be reimbursed from accredited TB-DOTS facilities and the member may avail of both the outpatient HIV/AIDS and TB-DOTS package simultaneously.

HIV/AIDS cases requiring confinement may not avail of the same outpatient benefit but are covered under the regular inpatient care services.

Retirees and pensioners shall be entitled to avail of the package upon presentation of their Philhealth ID.

For members under the Sponsored and Overseas Worker Program, treatment should be within the validity of their membership.

Employed, Individually Paying and KASAPI members must have paid at least three (3) months within the immediate six (6) months prior to availment.

Members are required to submit updated member data record, proof of payment and duly accomplished Claim Form 1 for the processing of claim and must be complied within 60 days from the first day of treatment.

“Incomplete documents shall be returned to the facility for completion and hospitals must submitall documents in sealed envelopes labeled “confidential” as stated in the guideline,” Philhealth XII RVP Ramon F. Aristoza, Jr. said.


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