Legazpi City (16 November) -- Members of the Philippine Health Insurance Corporation (PhilHealth) and their dependents can now avail of higher benefits for normal deliveries in accredited facilities which has been increased to P6,500 effective November 1, this year, by virtue of the agency's Circular No. 39, s. 2009.

The circular provides that members or dependents who will give birth at PhilHealth accredited hospitals could avail of the Normal Spontaneous Delivery (NSD) package, applicable to normal deliveries of the first four births, amounting to P6,500.

The amount covers the facility fee, physician fee and prenatal care components:

a. P2,500 to cover hospital charges for: room and board, drugs and medicines, laboratory, supplies and other ancillary procedure s; labor room, delivery room and recovery room; and other medically necessary charges for delivery and post-partum care;

b. P2,500 to cover payment of professional fee of accredited professionals for delivery services, immediate post-partum care and counseling for reproductive health, breastfeeding and newborn care; and

c. P1,500 for reimbursement of members' prenatal expenses prior to confinement. This may cover any of the following prenatal expenses: drugs and medicines, laboratory tests and ancillary procedures; tetanus immunization; and, prenatal consultations as supported by official receipts.

The circular further cited that members or dependents who will give birth at accredited lying-in clinics, birthing houses or midwife-managed clinics, could avail of the Maternity Care Package (MCP), also applicable to normal deliveries of the first four births, amounting to P6,500, that is:

a. P5,000 to cover charges for: professional fee (delivery, postpartum care, and counseling for reproductive health, breastfeeding and newborn screening); room and board; drugs and medicines; laboratory, supplies and other medically necessary charges for delivery and postpartum care.

b. P1,500 for reimbursement of members' prenatal expenses prior to confinement. This may cover any of the following prenatal expenses: essential drugs and medicines; laboratory tests and ancillary procedures; tetanus immunization; and professional fee for consultations as supported by official receipts.

PhilHealth noted that members or dependents who will avail of the prenatal care component of the MCP should have at least four prenatal visits done prior to delivery.

In availing the benefit, the guidelines stipulated, payment of the prenatal care component of the MCP and NSD package is payable to PhilHealth members upon presentation of valid Official Receipts.. Official receipts should be attached in the PhilHealth Claim Forms submitted by accredited providers to PhilHealth which will be subjected to the usual processing of claims.

While in availing the expanded NSD package and Maternity Care Package, members under the Individually Paying Program (IPMs), including the IPMs under the Group Enrolment Scheme, are required nine months of contribution within the immediate 12 months prior to the month of benefit claims.

However, those who are employed members and IPMs enrolled by Organized Groups through the KASAPI must have paid at least three months of contribution within the immediate six months prior.

Members under the Sponsored Program and the Overseas Workers Program are entitled to the package if the date of claims falls within the validity period of their membership as stated in their ID card/enhanced Member Data Record.