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Republic of the Philippines

PHILIPPINE HEALTH INSURANCE CORPORATION
!L41Phi1Health
p 1iwrPnriiU!rinllealth Q Citystate Centre, 709 Shaw Boulevard, Paslg City
1;. (02) 8441·7442 I!J)www.phllhealth.gov.ph
D PhiiHealthOfficial ll'teamphilhealth

PHILHEALTH CIRCoror
No. flO
fL3 · CBD

TO ACCREDITED HEALTH FACILITIES, HEALTH CARE

PROVIDERS, PHILHEALTH MEMBERS,
PHILHEALTH REGIONAL OFFICES, AND ALL
OTHERS CONCERNED

SUBJECT Institutionalization of 156 Hemodialysis Sessions

I. RATIONALE

Republic Act (RA) No. 11223, or the Universal Health Care (UHC) Act, Sections 37(a),
(b), and (c) state that portions of the funds from the Philippine Amusement and Gaming
Corporation (PAGCOR) income, and Philippine Charity Sweepstakes Office (PCSO)
charity fund shall be transferred to PhilHealth for the improvement of benefits
packages, which includes the benefits package for hemodialysis (HD). As part of
benefits improvement, Phi!Health, through Board Resolution No. 2776, s.2023 1 shall
institutionalize the expansion of the HD benefits package from 90 to 156 HD sessions
that is according to current standards for adequate HD of three times per week HD
sessions for 52 weeks or 156 HD sessions for the whole year.

II. OBJECTIVES

This Phi! Health Circular aims to establish the policy for availing of the 156 HD sessions
benefits package.

III. SCOPE

This Phi!Health Circular shall apply to Phi!Health members and their dependents
diagnosed with chronic kidney disease stage 5 (CKDs) who are registered in the
Phi!Health Dialysis Database (PDD).

--~~- DEFINITION OF TERMS

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A. Chronic Kidney Disease Stage 5 (CKD5) refers to end stage renal disease
(ESRD) or an advanced stage of kidney disease resulting to irreversible loss of

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nearly all ability to remove toxic by-products from the blood.

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alp R No. 2776, s.2023 Resolution Approving The Institutionalization Of The Increase In The Number Of
·~'"····-·rteJ'mbursable Hemodialysis Sessions From 90 To 156 Sessions For Cy 2023 And The Years Thereafter
Page 1 of3
 B. Hemodialysis (HD) refers to the medical procedure of removing fluid and waste
products from the blood, and correCting electrolyte imbalances. This is
accomplished using a synthetic membrane or dialyzer, which is also referred to as
an "artificial kidney".

C. PhilHealth Dialysis Database (PDD) refers to a system that collects data on

members and dependents diagnosed with CKD5 (previously known as ESRD) who
are prescribed with HD, peritoneal dialysis (PD), or kidney transplantation (KT). 2

V. POLICY STATEMENTS

A. Patients diagnosed with CKD5 on hemodialysis treatment shall be allowed to avail

of 156 HD treatment sessions per year based on the prescription of their
nephrologists.

B. All patients diagnosed with CKD5 shall be registered in the PDD in accordance with
PC No. 2016- 0007, titled: "PhilHealth Dialysis Database (PDD)".

C. The package rate for HD treatment is Php2,6oo per HD session, divided between
health facility (HF) and professional.

Package Rate HFFee Professional Fee

Php2,6oo Php 2,250 Php350
Table 1: Package rate for HD treatment

D. The HD benefits package includes the use of facility and dialysis machine, PNF
drugs as needed, IV solutions, supplies, dialyzer, and professional fees.

E. The 45-day annual benefit limit shall not apply to the 156 HD benefits package. In
the event that the CKD5 patient on HD needs hospital confinement, the HD session
shall be filed separately and shall not overlap with the inpatient claim.

F. Unused HD treatment sessions of the current year shall not be carried over to the
succeeding year.

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G. The No Balance Billing (NEB) Policy, as stipulated under PC No. 2017- 0017, shall
·· "·~·~· r. apply to health care services contemplated by this Circular.
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~ i H. Accredited health facility providing services for HD shall be subject to the current
r::a::: ;;j performance monitoring policy of PhilHealth.
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Accredited health facility shall comply with all the provisions in their Performance
Commitment and other rules and regulations governing Phi!Health accreditation.
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J. In case of delays in the filing of claims due to natural calamity or other fortuitous
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events, the existing guidelines of PhilHealth on providing special privileges to those
0 affected by fortuitous events shall apply.

K. In order to educate the general public and increase their awareness of this benefits
package and to promote informed decision-making and participation among

'PC 2016-ooo7 "Phi!Health Dialysis Database (PDD)"

Page 2 of3
 patients, healthcare professionals, and health facility, and other stakeholders,
marketing and promotional activities shall be undertaken following the integrated
marketing and communication plan of PhilHealth.

L. The monitoring of benefits delivery and performance of health facility shall be

anchored on PhilHealth's monitoring framework. Random post-audits shall be
conducted upon implementation of this Circular to monitor, evaluate, and revise
this policy, as necessary.

In consultation and collaboration with relevant stakeholders, experts, and technical

staff representing the Corporation, Phi!Health shall conduct the policy review of
this benefit package as necessary.

VI. PENALTY CLAUSE

Any violation of this PhilHealth Circular shall be dealt with and penalized in accordance
with pertinent provisions of Republic Act No. 7875, as amended by Republic Act Nos.
9241 and 10606, and their respective Implementing Rules and Regulations.

VII. SEPARABILITY CLAUSE

In the event that any part or proVIsiOn of this PhilHealth Circular is declared
unauthorized or rendered invalid by any court of law or competent authority, those
provisions not affected by such declaration shall remain valid and effective.

VIII. REPEALING CLAUSE

This Policy repeals PC No. 24-2015 "New PhilHealth Dialysis Package (Revision 1)".

IX. DATE OF EFFECTIVITY

This Phi!Health Circular shall take effect immediately upon publication in any
newspaper of general circulation or in the Official Gazette. A copy of this PhilHealth
Circular shall thereafter be deposited at the Office of the National Administrative
Register (ONAR) of the University of the Philippines Law Center.

Date signed: _ _s-1-j_.l..Ljw_'l--_;_______

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