Low Risk Pneumonia — Not Covered by Philhealth

Low Risk Pneumonia is not covered by Philhealth.

This is based on experiences of  some patients who have commented on this blog and on Philhealth Circular No. 020, s-2011, signed on November 21, 2011 and Circular No. 011-A-2011,  signed August 5, 2011

This means that there’s a chance that your hospitalization due to pneumonia might not be covered by Philhealth if your x-ray shows that your pneumonia is not that serious.

Palagay ko sabi ng Philhealth dapat ay sa bahay na lang ginamot at hindi na kelangang i-confine.

What types of pneumonia are covered by Philhealth?

Moderate-Risk and High-Risk Pneumonia are covered.

What are the symptoms and signs of Moderate-Risk Pneumonia?

For Adults:

– Unstable vital signs (breaths, heartbeats and temperature)
– Extra pulmonary sepsis
– Suspected aspiration
– Presence of other illnesses, such as:
uncontrolled diabetes mellitus
unstable coronary artery disease
congestive heart failure Class II-IV
renal failure on dialysis
progressive neurologic disease
chronic obstructive pulmonary disease
liver disease
active malignancies

For children, up to 18 years old

– Moderate dehydration
– Inability to feed
– Increased respiratory rate
– Signs of respiratory failure
– Complications such as pneumothorax, effusion, etc.

Note:  Chest x-ray result is included in the claim documents.


Signs and Symptoms of High-Risk Pneumonia

– Signs and symptoms of moderate-risk pneumonia, plus the following:

– Shock

– Signs of hypoperfusion, such as:
altered mental state
acute hypercapnia

– Urine output is less than 30 ml per hour

Note:  Diagnostic test or chest x-ray result is included in the claim documents.


So what does these things mean about Philhealth and your hospital bill?

Be prepared to pay your whole hospital bill,  without any Philhealth deduction, kung yong pneumonia mo ay hindi pala serious na pneumonia, at puede palang gamutin lang sa bahay with strong antibiotics.

7 thoughts on “Low Risk Pneumonia — Not Covered by Philhealth”

  1. Last Oct 1-3 my husband was admitted and the diagnosis was Pneumonia moderate-risk. We used philhealth. This Oct 13 he was again admited and the diagnosis is pneumonia high risk. can we use philhealth this time?

    • Hi jacquelyn, you might not, as the diagnosis is the same, and the confinement dates are within the 90-day rule, only the severity is different. But ask the hospital.

  2. Covered po ba yung pneumonitis sa philhealth? Ung 14days old baby ko po kc na-confine sa gnyang sakit, magagamit po b ung philhealth ko? Tska mgkno po ang covered ng pneumonitis? Thanks po!

    • Hi Manilyn, ang coverage ng perinatal congenital rubella pneumonitis ay 12,700 (3,810 for PF and 8,890 for the hospital). You can use Philhealth if you paid 3 months within March to Aug

  3. Naconfine 5yrs old n anak ko ngaun dhil s pneumonitis sakop p rn b ng philhealth? Sayang nman kung hnd mpkinabangan informal sector p nman ako


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