What are the benefits that OFWs can enjoy as bona fide PhilHealth members? Are their dependents entitled to the same benefits as well?
Below are the latest case rates applicable to OFW members. The amount stated in this summary is PhilHealth’s participation in the member’s hospital and medical expenses. Any amount over the stated coverage will be shouldered by the member or by his Health Maintenance Organization (HMO).
1. Examples of Case Rates
| ILLNESS | AMOUNT OF BENEFIT |
| Pneumonia Moderate Risk (Pulmonya) | P15,000 |
| Pneumonia High Risk | P32,000 |
| Stroke – Infarction | P28,000 |
| Stroke – Hemorrhagic or Stroke with Bleeding | P38,000 |
| Hypertensive Emergency/Urgency | P9,000 |
| Dengue (Severe) | P16,000 |
| Acute Gastroenteritis (AGE) or Diarrhea with Dehydration | P6,000 |
| Asthma in Acute Exacerbation (Hika) | P9,000 |
| Newborn Care Package or Services for Newborn Babies | P1,750 |
| SURGERIES | AMOUNT OF BENEFIT |
| Hemodialysis | P4,000 |
| Maternity Care Package (Normal delivery in lying-in clinics) | P8,000 |
| Normal Spontaneous Delivery Package (Normal delivery in a hospital) | P6,500 |
| Cesarean Section | P19,000 |
| Radiotherapy Linear Accelerator (Linac) | P3,000 |
| Cataract Package | P16,000 |
| Dilatation and Curettage (Raspa) | P11,000 |
| Cholecystectomy | P31,000 |
| Appendectomy | P24,000 |
1.1 Z Benefits
These types of packages are for those stricken by diseases that need long and continuous medication. These normally entail costs beyond one’s usual hospitalization budget. Z Benefit packages have pre-conditions and selection criteria that need to be met in order to qualify for the benefits at selected government hospitals.
| ILLNESS / SURGERY | AMOUNT OF BENEFIT |
| Acute Lymphocytic Leukemia or ALL | P210,000 |
| Breast Cancer (Stage 0 to 3) | P100,000 |
| Prostate Cancer (Low to Intermediate Risk) | P100,000 |
| Kidney Transplant (Low Risk) | P600,000 |
| Coronary Artery Bypass Graft Surgery | P550,000 |
| Surgery of Tetralogy of Fallot in Children | P320,000 |
| Surgery for Ventricular Septal Defect in Children | P250,000 |
| Cervical Cancer Chemoradiation with Cobalt and Brachytherapy (Low Dose)
Linear Accelerator and Brachytherapy (High Dose) |
P120,000
P175,000 |
| External Lower Limb Prostheses | P15,000 |
1.2 Outpatient Benefits under All Case Rates
| SERVICES | AMOUNT OF BENEFIT |
| Tuberculosis – Directly Observed Treatment Short-course administered at accredited TB-DOTS centers | P4,000 |
| Malaria treatment administered at accredited rural health units. | P600 |
| Outpatient HIV/AIDS Treatment | P30,000 |
| Treatment package for animal bites administered at accredited government animal bite centers. | P3,000 |
| Vasectomy and Tubal Ligation | P4,000 |
Important Reminder: A member is allotted 45 days of hospitalization in one year and another 45 days to be divided among his qualified dependents.
What are the conditions before an OFW member or dependent may avail of PhilHealth benefits?
- Updated contributions as shown in the member’s MDR.
- Make sure you are seeking consultation or treatment at a PhilHealth-accredited hospital and by a PhilHealth-accredited doctor.
- You have not yet used up the 45-day hospitalization period (OFW or dependents).
How does an OFW member and his dependents avail of PhilHealth benefits?
- Before checking out of the hospital, submit the following documents at the Billing Section of the hospital:
- Duly accomplished PhilHealth Claim Form 1. You may request for a form at the hospital, PhilHealth offices and branches, or download from the PhilHealth website at philhealth.gov.ph
- Health Insurance ID Card and or Updated Member Data Record (photocopies).
- Proof of contributions (photocopies).
- Medicines purchased outside of the hospital while member is confined may be reimbursed at the hospital if the patient has not yet used up the allocated benefit amount. Make sure that PhilHealth benefits have been deducted from the total hospital bill and professional fees before signing the Claim Form 2.
What if the OFW member is confined in a hospital abroad? Can he still use his PhilHealth benefits?
A member confined abroad may file for benefits claim in the Philippines by submitting the following documents to any PhilHealth office, within 180 days after he has been discharged from the hospital abroad:
- Copy of Medical Certificate where the following are clearly stated:
- Final diagnosis
- Confinement period
- Services rendered
- Duly accomplished PhilHealth Claim Form 1
- Copy of Official Receipt or detailed Statement of Account
- Updated Member Data Record or proof of payment.
For further information on OFW’s PhilHealth membership, claims, and benefits, you may call the PhilHealth call center at 02-441-7442. They are available to take your calls, 24/7.
Source: www.philhealth.gov.ph
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