Hospitalization, death of vaccinees covered under new PhilHealth circular

CEBU, Philippines —  Individuals inoculated with COVID-19 vaccines who develop serious adverse events after vaccination that lead to hospitalization, permanent disability or death can now be compensated by the Philippine Health Insurance Corporation.

According to PhilHealth Circular No. 2021-0007, the compensation covers claims filed from March 3, 2021 to March 2, 2026 or until completion of the vaccination program, whichever comes first.

The state health insurer said that the package is capped at P100,000 for hospitalizations to cover remaining charges after deduction of PhilHealth benefits, mandatory discounts, and other coverage provided by private health insurance companies and health management organizations (HMOs).

“Similarly, a lump sum of P100,000 per beneficiary (will be given) in case of permanent disability or death,” PhilHealth said.

The compensation package, however, is only available to those who received COVID-19 jabs through the Philippine COVID-19 vaccination program.

Vaccinees who can avail of this package must have had at least one vaccine received through the government vaccination program.

But PhilHealth clarified that it will cover patients who received inoculations through other initiatives, especially in the private sector, if the vaccines were sourced from the country’s Philippine COVID-19 vaccination program.

Hospitalization benefits can be availed of more than once if the cap of P100,000 has not been reached yet but coverage for permanent disability or death can only be claimed once.

Furthermore, PhilHealth said that it must also be established that the vaccine does not have a Certificate of Product Registration at the time of inoculation; the beneficiary has not received compensation from COVAX no-fault compensation program; and the result of the causality assessment must be “vaccine product-related reaction” or vaccine quality defect-related reaction”.

Among the requirements for compensation claims for hospitalization are proof of COVID-19 vaccination (vaccine card or slip), vaccine injury assessment survey, statement of account, medical certificate and official receipt indicating deductions of PhilHealth benefits, private insurers/HMOs, and out-of-pocket expenses.

Other supporting documents needed are the duly signed physical examination report describing the disabling manifestation or death certificate should also be included for permanent disability and death claims, respectively. — JMD (FREEMAN)