Outpatient benefits are applied on hospital visits that are less than 24 hours and without the need for confinement. Today’s article will focus on such benefits afforded by Philhealth to its contributing members and their dependents.
This is the second part of our feature blog series on Philhealth benefits.
Outpatient Benefits
1. Day Surgeries (Ambulatory or Outpatient Surgeries) – these include elective surgical procedures (non-emergency) ranging from minor to major operations, where patients are safely sent home within the same day for post-operative care.
- Payments for these procedures are made to the accredited facility through All Case Rates.
- The case rate amount shall be deducted by the HCI from the member’s total bill, which shall include professional fees of attending physicians, prior to discharge.
- The case rate amount is inclusive of hospital charges and professional fees of attending physician.
- Availment condition: Member must have at least three months’ premium contributions within the immediate six months prior to the month of availment.
- Documents needed: copy of Member Data Record (MDR) and duly accomplished Philhealth Claim Form 1.
- This is available in all accredited ambulatory surgical clinics (ASC).
2. Radiotherapy
- Case Rate: P2,000 for radiotherapy using cobalt and P3,000 for linear accelerator (case rate per session).
- 45 days benefit limit: one session is equivalent to one day deduction from the 45 allowable days per year.
- Availment condition: Member must have at least three months’ premium contributions within the immediate six months prior to the month of availment.
- This is available at Accredited HCIs including Primary Care Facilities that are accredited for the said service.
3. Hemodialysis
- Case Rate: P2,600 per session.
- 90 days benefit limit: One session is equivalent to one day deduction from the 90 allowable days per year.
- Availment condition: Member must have at least three months’ premium contributions within the immediate six months prior to the month of availment.
- This is available at all accredited HCIs.
4. Outpatient Blood Transfusion
- Case rate: P3,640 (one or more units).
- Includes drugs and medicines, X-ray, laboratory, operating room.
- 45 days benefit limit: One session for each procedure is equivalent to one day deduction from the 45 allowable days per year exempted from the SPC rule.
- Available at all accredited HCIs.
5. Primary Care Benefits
- Preventive Services
- Consultation
- Visual inspection with acetic acid
- Regular BP measurements
- Breastfeeding program education
- Periodic clinical breast examination
- Counseling for lifestyle modification
- Counseling for lifestyle modification
- Counseling for smoking cessation
- Body measurements
- Digital rectal examination
- Diagnostic Examinations
- Complete blood count
- Urinalysis
- Fecalysis
- Sputum microscopy
- Fasting blood sugar
- Lipid profile
- Chest x-ray
- Drugs and Medicines
- Asthma including nebulisation services
- Acute Gastroenteritis (AGE) with no or mild dehydration
- Upper Respiratory Tract Infection (URTI) / Pneumonia (minimal and low risk)
- Urinary Tract Infection (UTI)
Tomorrow we are going to feature Philhealth’s coverage for Z Benefit packages. These cases include cancer patients, kidney transplantation, Artery Bypass, and the like.
Stay tuned.
Source: https://www.philhealth.gov.ph/benefits/
MasterCitizen's Blog 
good day,ask ko lang po kung makaka kuha ng reinburstment po ba ang outpatient sa philhealth?
Hi Pamela,
May mga outpatient cases na sinasagot ng PhilHealth, it depends on the illness and the doctor’s diagnosis.
Pwede kang tumawag sa hotline ng Philhealth para mabigyan ka ng mas kumpleto at accurate na information tungkol sa outpatient cases. Just call 02-441-7442; bukas sila 24×7.
MC
Good day po. ang anak ko po ay nilalagnat for 2 weeks. sa first po ipinalaboratory ko po siya ayon po sa result may mild uti, impeksiyon sa dugo, kulang sa iron. after po na mapainom ng mga inireseta umayos na po ang mga result subalit lagi pa rin po siyang nilalagnat. dahil po sa inabot ng 2 linggo ang lagnat niya na nagaganap tuwing gabi pinayuhan po siya ng doktor na magpaconfine at magpablood culture. 27 years na po akong naghuhulog sa philhealth. May matatanggap po ba siyang bebepisyo sa hospitalization kung wala sa case rate ang karamdaman niya? Salamat po
Kung beneficiary mo siya pwede mo ipasok yan sa Philhealth mo makaka bawas yun sa bill nyo. Basta updated ang hulog ha.
panu po gagawin pg gagamitin q po ung philhealth ng asawa q sa panganganak q.kaso huling nabyaran ung philealth nya nung march.ntgil po ung hulog ng 4 mos.ngaung august nlng po ulit mahuhulugan..bka ds sept.n po mgamit ung philhealth nya po..
Subukan nyo na lang gamitin. Dapat kasi latest 6 months contribution ang makita sa MDR eh.
Nagdadialysis ang tatay ko gamit ang philhealth ng nanay ko. pero kailangan nya magpalagay ng fistula. pwede pa din ba nya gamitin phealth ng nanay ko para mabawasan ang gastos namin sa ospital? thanks.
Pwede pa din pong gamitin ang Philhealth ng asawa para sa pistula.
MC
Kailangan din pong ma check din yung remaining days ni dependent if exhausted na, for that pwede sya mag ask sa any Philhealth office ng benefit limit utilization… kasi po if exhausted yung 45 days hindi na po pede ma cover yung fictula
Good day po..tanong ko lng po kng magpa check up po ako s anak ko pwd ko ba magamit ang philhealt ko as outpatient po..
Maraming salamat po..
Hinid na gagamit ang Philhealth sa out patient.
Tanong ko lng po na hospital po kase ang mother ko wla po siyang philhealth pwede po ba nmin siya ikuha para po malaking tulong po kase ang philhealth sa kagaya nmin na wlang wla po talaga salamat po
Kung senior citizen na yung mother mo automatic member siya ng Philhealth eh.