PhilHealth assures PLHIV of health insurance coverage

The Philippine Health Insurance Corporation (PhilHealth) offers a means for people living with human immunodeficiency virus (PLHIV) to have financial access to effective health care by covering outpatient HIV/AIDS treatment.

PhilHealth initially came up with the Outpatient HIV/AIDS Treatment (OHAT) package in 2010 in support of the United Nations Millennium Development Goal Number 6 to halt or reverse the incidence of HIV or Acquired Immune Deficiency Virus (AIDS), with the aim of increasing the access to effective HIV/AIDs treatment and patient education measures.

As the Department of Health (DOH) expanded and decentralized the provision of outpatient HIV services to primary care facilities, PhilHealth issued Circular 2018-0004 providing guidelines for accreditation of stand-alone treatment and satellite hubs to bring in
more health facilities for PLHIV to choose from for their treatment and care.

Annual Coverage under this package is set at P30,000 (P7,000 as a quarterly payment) and released to the PhilHealth-accredited facility where the member or patient availed of treatment in accordance with the guidelines set by DOH on antiretroviral therapy.

With the changes in HIV treatment guidelines and the increasing number of health facilities providing HIV care, PhilHealth released its revised OHAT package guidelines in December 2021 through Circular No. 2021-0025. Only HIV/AIDS cases confirmed by the Research Institute for Topical Medicine (RITM), San Lazaro Hospital Reference Laboratory/STD AIDS Central Cooperative Laboratory, Certified Rapid HIV Diagnostic Algorithm (rHIVda) Confirmatory Laboratory or DOH-licensed laboratories with rHIVda services shall be
covered under the OHAT package.

PhilHealth Regional Office VII’s benefit payout on OHAT package has increased in the past years – from P3.8 million in 2018 to P10.8 million in 2019, which further increased to P12.4 million in 2020 and doubled to P24.7 in 2021.

To protect patients’ rights to confidentiality, PhilHealth requires accredited treatment hubs to file all claims enclosed in a sealed envelope, marked “confidential” and submitted to the PhilHealth Regional Office.

Only three pre-identified PhilHealth employees of the regional office are directly involved in the processing of claims for HIV/AIDS and they are required by the Corporation to sign a confidentiality agreement to further ensure confidentiality.

In Central Visayas, the OHAT package may be availed in the following designated treatment hubs by the DOH and are accredited with PhilHealth: Gov. Celestino Gallares Memorial Medical Center (Tagbilaran City, Bohol), Negros Oriental Provincial Hospital (Dumaguete City, Negros Oriental), Cebu City Social Hygiene Clinic, Cebu Provincial Hospital in Balamban and in Carcar City, Cebu South Medical Center (Talisay City), Chong Hua Hospital Mandaue, Danao City Social Hygiene Clinic, Eversley Childs Sanitarium
and General Hospital (Mandaue City), Mandaue City Social Hygiene Clinic, Talisay City Social Hygiene Clinic, Vicente Sotto Memorial Medical Center, and Visayas Med-Cebu.   /PR with rcg