The Social Security System (SSS) is in talks with the Philippine Health Insurance Corporation (PhilHealth) regarding a “portal-sharing” agreement that will allow it to access the PhilHealth database for payment information on members who undergo hemodialysis for work-related conditions following the Employees’ Compensation Commission (ECC) board resolution on the medical procedure issued this year.
SSS Officer-in-Charge of Medical Services Division Brenda P. Viola said the memorandum of agreement between the SSS and PhilHealth will help facilitate the pension fund’s processing of claims for hemodialysis patients which are covprerable by the Employees’ Compensation (EC) Program.
“SSS will pay or reimburse the cost of hemodialysis for qualified members after their PhilHealth coverage for the same procedure has been exhausted. Quick access to PhilHealth data will make it easier for us to determine how much members will get for these treatments under the EC Program,” she said.
The creation of the information-sharing agreement was spearheaded by PhilHealth President and Chief Executive Officer Alexander A. Padilla and ECC Executive Director Stella Zipagan-Banawis.
Hemodialysis involves the removal of waste, extra fluid and unnecessary chemicals from the blood of a person suffering from renal failure using an artificial kidney. Under EC guidelines, the payment for hemodialysis is P2,600 per session, which is equal to the rate currently provided by PhilHealth.
In line with EC policies, the SSS will shoulder the remaining cost for hemodialysis subject to the specified P2,600 limit per session after the 90-session PhilHealth coverage per year has been exhausted by the qualified SSS member.
The allotted P2,600 EC benefit is comprised of P350 for the professional fee and P2,250 for the health care institution fee, which covers the use of facilities and dialysis machines and the purchase of drugs, medicines and supplies such as fistula kits, blood tubing sets, dialyzers, syringes and gauzes.
Viola advised SSS members to first avail of PhilHealth’s payment or reimbursement for hemodialysis expenses, which is often automatically factored into the patient’s hospital bill. PhilHealth has a hemodialysis package rate of P2,600 per session that covers a maximum of 90 sessions per year.
“Once the 90-session allotment from PhilHealth is completely consumed, then the SSS member can file for hemodialysis payment or reimbursement under the EC Program. We emphasize that the member’s medical condition must be work-related for the claim to be covered by the program,” she said.
SSS members with work-connected chronic kidney diseases are coverable by the EC Program. They can already receive benefits for EC sickness or disability even while their payments or reimbursements for hemodialysis are still being shouldered by PhilHealth.
The EC Program provides additional benefits for illnesses, injuries, disabilities and deaths caused by the workers’ employment. EC benefit disbursements for SSS members amounted to P1.1 billion last year covering workers’ claims for sickness, disability, medical services, rehabilitation, death and funeral.
“Workers can claim benefits for the same contingency from the EC Program as well as from the Social Security (SS) Program, which is the regular package offered by SSS, provided that they meet the respective EC and SS requirements,” Viola explained.
The EC Program is jointly administered by the SSS for covered workers in the private sector, and by the Government Service Insurance System for employees in the public sector.
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