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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/

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