To help close the gap in financial protection for patients needing urgent or emergency care, PhilHealth has announced the strict implementation of its Outpatient Emergency Care Benefit (OECB). This benefit, outlined in PhilHealth Circular No. 2024-0033 and effective since February 14, 2025, ensures that accredited Level 1, 2, and 3 hospitals automatically provide coverage for qualified outpatient emergency cases without requiring a separate accreditation process.

This step supports the Universal Health Care Act (UHC) and strengthens PhilHealth’s commitment to expanding outpatient benefits. The benefit applies to outpatient emergency cases managed in the hospital’s emergency department, as long as the facility is duly licensed by the Department of Health.

Hospitals are reminded to apply the OECB package deduction directly. Failure to comply will be subject to assessment under the Health Care Provider Performance Assessment System (HCP PAS), which may include administrative action where needed.

PhilHealth encourages all accredited providers to uphold this policy to improve access to urgent medical services and ease the financial burden on patients and families.

For more details or concerns, members and providers may reach PhilHealth through their official website or contact centers listed in the advisory.

For PhilHealth members who were not able to avail of the OECB during their emergency visit, reimbursement is still possible. You may file for reimbursement at your Local Health Insurance Office (LHIO) within 180 calendar days from the date of the emergency. The following documents are required:

• Claim Form 1 (CF1) or generated PhilHealth Benefit Eligibility Form (PBEF)
• Claim Form 2 (CF2)
• Claim Form 4 (CF4)
• Statement of Account (SOA) or itemized billing
• Laboratory and/or imaging results
• Hospital waiver and official receipt

No Overall Ceiling: Fixed Fee Per Service

The OECB does not have a single overall ceiling amount. Instead, PhilHealth uses a fixed-fee system per service based on the Essential Emergency Care List (EECL). Each procedure, consultation, lab, or diagnostic test has a set amount that PhilHealth will pay, and members will only shoulder any excess beyond that rate. For the complete list and fixed fee schedule, see the pdf  below.

Examples of fixed fees include:

Emergency Services:

• Emergency Room Bed: ₱650
• Emergent ER Consultation: ₱707
• Urgent ER Consultation: ₱260

Diagnostic & Imaging Services:

• Arterial Blood Gas (ABG): ₱1,326
• Electrocardiogram (ECG): ₱423
• CT Scan (Chest, Plain): ₱6,444
• CT Scan (Abdomen-Lower, Contrast): ₱8,453
• Ultrasound (any organ or body region): ₱698
• X-ray (Chest): ₱426

Laboratory Tests:

• Random Blood Sugar: ₱247
• Complete Blood Count (CBC): ₱310
• Creatinine (Blood): ₱733
• D-dimer: ₱4,368
• Troponin I: ₱1,914

These rates apply to eligible outpatient emergency cases handled at PhilHealth-accredited hospitals.

PhilHealth Contact Details

• Phone: (02) 8441-7442
• SMS/Text: 0917-898-7442 or 0921-630-0009
• Email: actioncenter@philhealth.gov.ph
• Facebook: www.facebook.com/PhilHealthOfficial
• Website: www.philhealth.gov.ph

References:

• PhilHealth Circular No. 2024-0033
• PhilHealth Advisory No. 2025-0009
• Annex A: Essential Emergency Care List (EECL)

AnnexA_EECL