PhilHealth office in Quezon City. —GRIG C. MONTEGRANDE
MANILA, Philippines — The Philippine Health Insurance Corp. (PhilHealth) has implemented a benefit package for optometric services for children up to 15 years old.
This benefit is outlined in Circular No. 2025-0002, signed by PhilHealth President and CEO Dr. Edwin Mercado on May 26.
“PhilHealth-accredited Konsulta Package Providers and other health facilities and schools that are conducting vision screening among children, shall refer the children (ages 0 to 15 years old) who failed the screening to PhilHealth-accredited optometric clinics for vision assessment and possible provision of prescription eyeglasses,” the state insurer said in a statement.
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“While an electronic referral module is being developed, the referring facility shall accomplish the referral form (see Annex C of PhilHealth Circular No. 2025-0002) and send it to the accredited optometric clinic, as this is required when the latter files the claim,” it added.
The agency also said that the PhilHealth-accredited optometric clinic shall file claims electronically through eClaims once the mandatory services are provided. After that, the facility shall encode the needed information in its eClaims module.
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The agency also reminded beneficiaries to attach the scanned copies of the following documents:
1. Referral form from the PhilHealth-accredited KPPs and other facilities and schools; and
2. Accomplished Claim Signature Form.
3. Optometry Patient Chart
“There is no need to submit hard copies of the claim form,” PhilHealth said.
It also instructed beneficiaries to use document codes, such as Referral Form and Optometry Patient Chart, when labeling attachments./mcm