What Are Hospital Levels, as Used by Philhealth?

Philhealth mentions Levels 1 to 4 in its Case Rates payment scheme?  What are these Levels?
For quick understanding, we can just say that a:
– Level 1  —  very small hospital
– Level 2  —  a small hospital
– Level 3  —  a big hospital
– Level 4  —  a very large hospital
The Department of Health (DOH) though has a more detailed description of these types of hospitals.  It’s even covered by administrative law, the DOH Administrative Order 205-0029.
Level 1 Hospital
– Emergency hospital
– initial treatment for cases that require immediate treatment and that provides primary care for prevalent diseases in the area
– general medicine, pediatrics, minor surgeries, and non-surgical gynecology
– primary clinical laboratory, pharmacy and first level radiology
– nursing care for patients needing minimal supervised care
Level 2 Hospital
– Non-departmentalized hospital
– general medicine, pediatrics, surgery, anesthesia, obstetrics and gynecology, first level radiology, secondary clinical laboratory, pharmacy
– nursing care for patients needing intermediate supervised care
Level 3 Hospital
– Departmentalized hospital
– all clinical services provided by Level 2 hospitals
– specialty clinical care
tertiary clinical laboratory, pharmacy, second level radiology
– nursing care for patients needing total and intensive care
Level 4 Hospital
– Teaching and training Hospital
– all clinical services provided by Level 3 hospitals
– specialized forms of treatments, intensive care and surgical procedures.
– tertiary clinical laboratory, third level radiology, pharmacy
-nursing care for patients needing continuous and specialized critical care
Hospitals can also be classified as:
1. General
2. Special
Other health facilities are:
– Birthing homes — maternity clinics that provide pre-natal and post-natal care, normal spontaneous delivery and newborn baby care
– Psychiatric care facilities — care of mentally ill patients

38 Comments

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  1. Jinelyn Villaver

    helo!

    may i know what is a cadaver holding room in hospital?

    1. Hi Jinelyn, it is the hospital mortuary or morgue. It’s where they store bodies of the dead awaiting identification, autopsy or transfer to funeral homes.

  2. I am confined in a hospital in China due to gastroenteritis. It will probably be for 2-3 days. Is this covered by Philhealth? If the level is 3 for confinements abroad, how much would be the estimated claim for this? My other problem is the original receipt or statement of billing written in English. I am not sure if they can provide an original in English language. Can the original documents be in Chinese, then supported with English translation? Thanks!

    1. Hi Jhen, yes, the original documents can be in Chinese with English translation (page 40 of Philhealth FAQs). In the Case Rate list, the coverage for acute gastroenteritis is 6k pesos. Here are the docs required for confinements abroad: http://www.healthphilippines.net/2012/03/how-to-claim-philhealth-benefit-for-overseas-hospitalization/

  3. Thanks for your reply. The hospital has provided me original documents written in English.

  4. sir, ask ko lang po how much po kaya ang maire-reimburse samin ng philhealth for the IJ (internal Jugular)surgery of my dad today?Un po ung para sa dialysis na nilagay sa leeg ng pasyente. We paid a total of 14,500.00 (6.5k sa hospital and 8K sa doctor). I went to philhealth today din po,but the staff said i need to get a waiver from doctor and hospital stating that no philhealth deduction was made.Thanks po

  5. anong level po ba ng hospital nakapaloob ang mga geriatric hospitals?

    1. Hi sha, what’s the name of the hospital? Parang wala akong naririnig na hospital na identifying itself as exclusively geriatric. Nakahalo ang geriatric care section sa big hospitals (level 3 to 4). Siguro merong mga small private clinics specializing in caring for older people, pero wala akong alam as of now.

  6. good day po! ang endoscopy po ba ay anong case type medyo naguguluhan po kasi kami sa mga cases na sinansabi sa philhealth. ginawa po ito sa Bulacan polymedic Hospital di ko rin po alam kung anong level ng hospital at 5 days po naconfine doon
    . thanks po

    1. Hi jojo, ang endoscopy ay diagnostic procedure. Ano ba ang nakitang sakit? At ano ang treatment? Kasama itong procedure na ito sa Philhealth coverage kung merong nakitang sakit at merong treatment. Ask the doctor kung ano ang sakit.

  7. Hi, pwede ba makahingi ng link ng naka categorize na hospitals dito sa pilipinas accdg to level? Like level 1, 2, 3, and 4. Mejo naguguluhan kasi akong i classify pagdating sa level 3 and 4 e. Thank you po. 🙂

  8. Hi! My father undergo hemorrhoidectomy at Makati Medical Center yesterday, he was admitted last Oct. 23 and we were advise that he will be discharge tomorrow. Do you have any idea how much will be covered by philhealth in cases like hemorrhoidectomy? Thanks.

    1. Hi Nes, sorry, I can’t say because hemorrhoidectomy is not under Case Rate; will be covered under the fee-for-service scheme https://sites.google.com/site/informationphilippines/philhealth/inpatient-coverage-fee-for-service-1

  9. hello po my daughter admitted December 23.2013 and diagnose moderate pneumonia.total bill po namin is 12,317.40 the deduction for the philhealth is 10,817.40 dba po 15k dapat ang deduction nila.and balance ko na dapat bayaran ay 1,500..pede ba ma refund nila sa akin ang 1.5k?please reply [po

    1. Hi grace, yong 15k is further divided into 10,500 for hospital and 4500 for doctor. Tanungin mo na lang yong hospital kung marerefund mo pa yong 1500 sa PF ng doctor. Usually, kasi idinadagdag pa sa PF ng doctor yong coverage na yon.

  10. is Level 1 Hospital the same as a Primary Hospital?

    1. Hi yolanda, yes, karamihan ng level 1 hospital ay primary hospital.

  11. Hi, Just want to ask the following po. Why yung procedure at pf n ginawa ng radiologist-doctor for ultrasound guided biopsy using needle to get sample for possible cancer ay hindi included s billing ng patient. Ganun din po yun ibang pf ng histopathologist ay hindi included s billing. I have to pay them separately but they issued O.Rs.naman. another question po is pwede ko po b iclaim s philhealth lahat ng hindi isinama s bill at medicines n binili outside; yun pong pf ng nagcheck ng immunostain ng biopsy result also i paid separately. One last question po, un pong nagtake over while my pulmo doc is not around, i have to pay him also separately. Will all of these be refunded to me by philhealth? Im still confined here at the pgh while waiting for the result of immunostain or immunohistochemistry.
    Thank you and please enlighten me.

    1. Hi Bing, what I can advise is you file your Philhealth papers with PGH before discharge because Philhealth now rejects direct filing. Ask them if you can submit your PF and medicine ORs — usually sasabihin nila Case Rate system na so hindi na needed ang ORs. Basically kasi, dahil Case Rate system na, meaning fixed rates na ang coverage for any condition, isusulat ng doctor ang diagnosis and code, plus procedure and code (if policy allows certain procedure and condition to both be covered) with other details on the claim forms, and then Philhealth will refund the amount, based on the Case Rate chart — fixed na yong amount ng coverage for each specific condition and medical procedure.

  12. hi po! gusto ko lang po malaman kung what level ang mga lying clinics?

    1. Hi janet, nasasama siya sa level 1. Hindi siya puede for CS, other surgeries and complex medical conditions. Pero 6500 ang coverage ng normal delivery sa level 1. 5k lang pag level 2 and up

  13. magkano ang makuha sa philhealth pag sa private na level 4 facilities?
    and sa private na level 1??

    1. Hi chandee, I need to update this article on levels. Philhealth has been implementing the Case Rate system, and now there are only 2 rate levels: one for primary hospitals and the other, for levels 2 to 4. There’s a fixed rate for every kind of illness or surgery, like CS coverage is 19k, normal delivery is 5k, etc. There are lists for rates: https://sites.google.com/site/informationphilippines/philhealth/case-rate-guidelines-2013

  14. Hello po,

    ask ko lang po kasi my husband is for future dialysis at nalagyan na po sya ng AVFISTULA, how much po ba talaga ang covered ng philhealth sa hemodialysis if sa james gordon hospital po ako mag papadialysis and how much po is sa isang private hospital ako magpapadialysi? thanks po hoping po for your reply on this matter.

    1. Hi Lhae, the coverage per dialysis session is 4k, whether you have it in a private or public facility. You’re covered for 45 sessions per year. First, ask the facility their Philhealth packages — you pay an additional amount depending on the supplies to be used.

  15. Good day. Can I use my Philhealth for my mother’s cataract operation? I’m not sure if she qualifies as my dependent.

    1. Hi marites, is your mother 60 years old or older? If yes, she can be your dependent. Update your MDR. Present your ID, your birth certificate and your mother’s senior citizen ID or birth certificate (or any proof of her age).

  16. What are the Philhealth case types A & B? My child was admitted for 2nd degree burn in Jesus the Savior, under what case type is he?

    1. Hi Emilio, here’s the Philhealth Case Rate list for BURNS Click + on your top right to make the letters appear bigger

  17. Hello. Can we file a claim if patient was discharged Dec.18? How long is the process? We paid the hospital bill in full even if the papers were complete. The patient was for transfer but was not pushed through. So it was a discharge. Thank you in advance. More power. Godbless!

    1. Hi Cha, you can file an appeal with Philhealth, explaining the circumstances why the hospital did not deduct the benefit. Get claim papers and waiver from the hospital. File within 60 days from Dec 18. Direct filing with Philhealth is no longer allowed, but present your valid reasons.

  18. hi, can I use my husband’s philhealth who’s ofw even if he’s not here in pilipinas when I undergo goiter operation? tnx

    1. Hi joana, yes. Your name should be in his MDR as dependent. Ask him to email you authorization letter to process Philhealth documents and his IDs and Philhealth premium payment receipt.

  19. Hello, do you know how much will philhealth pay for my ob-gyn pf for hystetectomy to be done in st. Luke QC? There will be a gyne oncology on team. Will the pf be higher if my main sugeon is a gyne oncology? My concern is my HMO is Caritas. Caritas base its doctor’s PF on philhealth fp.

    1. Hi Laine, Philhealth’s coverage for hysterectomy is only 30k (12k for PF and 18k for hospital). Yes, you will pay a high PF cost because you said there will be a team. And yes, gyne oncologists are specialists so their PFs are higher than regular ob-gynecologists. It’s unfair that Caritas uses Philhealth’s PF as basis. Philhealth’s PF payments are usually in the low end. Many HMOs pay the balance after Philhealth’s deduction, up to the annual maximum limit of the plan (including limits on room type).

  20. Hello po. I’m a mother of a 6months old baby. And I found out that he had a murmur. The cardiologust said na magpa 2D echo kami to know kung ano talaga sakit niya. Pwede ba gamitin ang philhealth sa laboratory test? Member po ako ng philhealth and dependents ko po si baby. Thank you

    1. Hi Chin, sorry hindi kasama ang outpatient lab test sa coverage. Pero tanungin mo pa rin doon sa hospital na pupuntahan mo.

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