Category: Philhealth News and Facts


09 - 25

The arrival of a newborn is always an exciting moment for parents.  There is nothing more precious than welcoming a new member of the family into your home.

Philhealth makes having babies easier and more manageable through its care packages and benefits.  Knowing you are covered by these privileges as a Philhealth member allows you to free your mind from additional expenses in childbirth and post-natal medical care, so you can focus on the new bundle of joy in your arms!

Below are the most updated list of care packages available to Philhealth members who are pregnant or have just given birth to their babies:

Antenatal Care Package

Care package for women during pregnancy: P1,500

  • Pre-natal consultation on essential health services.
  • Hospital, birthing homes, lying-in clinics, maternity clinics, infirmary/dispensaries and check-up providers.

Expectant mother must undergo pre-natal check-ups of not less than four times where:

  • 3 check-ups are done within the first six months of pregnancy.
  • 1 check-up done during the last three months of pregnancy.

Maternity Care Package (MCP)

Care package for the entire duration of pregnancy until giving birth including:

  • Pre-natal consultation and essential health services
  • Normal delivery
  • Post-partum care including follow-up visits from the 3rd to the 7th day after giving birth.
    • Hospital – P6,500
    • Birthing Homes, Lying-in Clinics, Infirmary/Dispensaries, Maternity Clinics – P8,000

Normal Spontaneous Delivery (NSD) Package

Benefits for mothers on during and after childbirth including:

  • P5,000
    • Normal delivery
    • Post-partum care including follow-up visits from the 3rd to the 7th day after giving birth.
  • P6,500
    • Birthing homes
    • Lying-in clinics
    • Infirmary/Dispensaries and maternity Clinics

Newborn Care Package (NCP)

Care packages for newborn babies, including:

  • Essential newborn care
  • Newborn screening test (P1,750)
  • Newborn hearing screening test

Quick reminders to expectant moms:

  • Make sure that your Philhealth records are updated and that your membership status is active.
  • Prepare your documents such as Claim Form 1 and Philhealth ID long before your expected due date.
  • Before checking out of the hospital, double-check your bill to make sure that all Philhealth benefit claims have been deducted from the total amount of hospital bill.
  • Have yourself checked at Philhealth-accredited medical centers right on the first month of your pregnancy; return for regular check-ups as advised by your attending physician.
  • Bring your newborn child to Philhealth-accredited medical centers and hospitals for Essential Newborn Care, Newborn Screening Tests, and Newborn Hearing Screening Test.

If you have more questions regarding the maternity care packages of Philhealth, you may call their hotline at 02-441-7442.  They are available to take your call, 24/7.

Reference: www.philhealth.gov.ph

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09 - 12

Here is the continuation of yesterday’s feature article on Philhealth contributions and membership renewals.  In today’s blog, we will cover the answers to common questions from Philhealth members such as refunds for unused contributions, how to “reactivate” membership after failing to pay several months, and how to continue paying for your Philhealth membership after you have resigned from your employment.

Read on!

How do I maintain my eligibility?

The key to maintaining eligibility is paying your premiums on-time.  If there are gaps in premium contribution, eligibility will also be affected.  Here are several tips for each member category to ensure that you’ll always be able to use your benefits:

  1. Sponsored Members
  • If the member’s card is about to expire, the member must proactively inquire, whether the Sponsor will renew his/her membership.
  • If not, the member may opt to register as an Individually Paying Member.
  1. Individually Paying Member
  • Ensure that each calendar quarter has been paid.
  • If possible, pay your premiums yearly for your own convenience.
  1. Overseas Workers Program Member
  • Premiums must be remitted prior to your membership’s expiration.
  • If your contract abroad is already terminated, make sure that you shift member category from OWP to IPM (or other applicable categories) to be able to pay premiums again.
  1. Employed Members
  • For seasonal employment or if you’re going to take a leave without pay, just head to the nearest Philhealth Service Office to pay your contributions for the months that you will not be compensated. You may continue paying your premiums as an Individually Paying Member (IPM).
  • To pay your premiums as an IPM, visit any Philhealth office and present a copy of the RF-1 from your employer indicating that you are on leave without pay or a Certification from your employer indicating the same.
  • Once you get separated from employment, make sure you shift category to IPM.

If I missed paying the past quarters, can I still pay for this now to become eligible again?

This is an example of a retroactive payment.  Unfortunately, Philhealth does not accept retroactive payments to avoid abuse of benefits.  This policy has to be in place to avoid those instances when members only choose to pay when they get sick or need to avail of benefits (and conversely stop paying when they don’t need it), which will be unfair for those who pay their premium contributions regularly.

What is the tolerable delay for paying premiums for a member to still be able to use his/her benefits?

None.  Philhealth strictly follows its policies on premium payment and benefit availment.

 Can contributions be refunded by the member who was not able to use it?

No. Philhealth is a social insurance program, wherein members’ premiums are pooled into a single fund used to pay for the benefits of sick members.  Even if a member is not able to use benefits or does not get sick within a particular enrolment year, funds are kept in the pool.

If I stopped paying my premium for considerable amount of time, can I still use my benefits?  Do I need to pay the missed contributions to be able to avail of the benefits again?

No.  Only active members are eligible to avail of Philhealth benefits.  Member should have paid at least three months premium contributions within the immediate six month period prior to medical confinement.  However, payment of at least nine months within the last 12 months shall be asked of Individually Paying Members availing of the following procedures/packages:

  • Pregnancy-related cases
  • Dialysis (except those undergoing emergency dialysis service during confinement)
  • Chemotherapy
  • Cataract Extraction
  • Radiotherapy
  • Selected surgical procedures

Individually Paying Members and Employed Members will now be required to have at least nine (9) months contributions within twelve (12) months prior to the month of availment for all confinements including availment of outpatient benefits.

What if the member passes away?  Can the dependents still use their benefits?

In case the member dies, his/her membership privileges are also terminated.  However, dependents of Sponsored Members may still avail of the Philhealth benefits for the unexpired portion of the member’s contribution.

I used to be employed, but am now self-employed.  Can I still continue paying for my premiums?  How do I go about this?

In case you get separated from employment, you may continue your Philhealth membership by becoming an Individually Paying Member and paying the applicable premium.  Simply accomplish the Philhealth Member Registration Form (PMRF) and tick the box “For Updating” and the appropriate box of the membership category to which you are shifting.  Make sure you continuously and religiously pay your premiums so as to avoid suspension of benefits.

If you have further questions regarding your Philhealth membership, claims, and other benefits, you may call their hotline at 02-441-7442.  They are available to take your call 24/7!

If this blog helped you, share it with others so it would help them too.

Source: www.philhealth.gov.ph

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09 - 07

There are two types of Philhealth members, those whose contributions are regularly remitted by their employers, part of which is deducted from their salaries, and those who pay for their contributions voluntarily.  Of the two types, the latter often fall into the trap of foregoing monthly remittances to Philhealth and as a result, their claims for benefits and assistance are adversely affected.

We ran a research on how Pinoys can keep their contributions regular and consistent, and why we all need to make an effort to ensure that our Philhealth memberships are updated.

Read on!

Why must a member pay his contributions regularly?

Regularly contributing to Philhealth assures the member of hassle-free availment of hospitalization benefits when medical needs arise.  This will also ensure the member’s qualification/eligibility to register under the Lifetime Member Program upon reaching the age of 60 years old, provided he has paid at least 120 monthly premium contributions.

How much is the premium contribution rate?

The premium contribution that each member has to pay is detailed in the following table:

09 - 07 TABLE (2)

Are overtime pay, commissions, and allowances included in the computation of premium contributions of employees?

No they are not included.  The amount of monthly premium contribution of members shall be based on the employee’s salary or wage, which is the basic monthly compensation received for services rendered.

Where can the members remit their contributions?

  1. Philhealth has over 100 service offices all over the country wherein members can pay for their premiums.
  2. Philhealth has also accredited the following collecting agents:
  • More than 1,000 CIS Bayad Centers
  • Collecting Banks
  • MLhuillier Philippines Pawnshops
  • LBC Express outlets
  • Offices of the Philippine Postal Corporation
  • Selected Local Government Units
  1. For Overseas Workers Program Members, i-Remit branches, other partner agents, and foreign offices of Philippine Veterans Bank (UK, Abu Dhabi, and Qatar) also accept premium payments.

When is the deadline for paying my premium contributions?

The following table summarizes when premiums have to be in for each member category:

Membership Category Deadline for Paying Premium
Overseas Worker Before leaving the country or before the last contribution expires.
Employed Tenth day of the following month.
Sponsored Based on the agreement between the Sponsor and Philhealth
Individually Paying 1. Semi-annually/Annually – last day of the third month of the first quarter.

2. Quarterly – last day of the third month of a quarter.

3. Monthly – last day of the month.

What is the effectivity date of Philhealth coverage?

Philhealth benefit coverage starts upon payment of premium (no waiting period) and is valid for one year from the date of payment.

 What are the requirements for eligibility?  When is a member eligible to claim?

In order to become eligible to claim benefits, a member must pay premium contributions regularly.  If the member missed paying for a certain period, he/she and his/her dependents may not be able to use the benefits.  The table below summarizes the eligibility requirements:

Sponsored Members Date of hospitalization/availment must be within the effectivity period indicated in the member’s ID and MDR.
Individually Paying Members 1. There are certain confinement cases wherein three months’ worth of premium within the last six months (3/6) prior to confinement is acceptable.

2. For pregnancy-related cases, dialysis, chemotherapy, radiotherapy, and other selected surgical procedures, the member must have paid nine months worth of premium within the last 12 months (9/12) prior to confinement in order to become eligible.

Lifetime Members and Senior Citizens The member just has to show their Lifetime ID Card or Senior Citizen ID; no need to pay premiums anymore.
Employed Members Three months worth of premium within the last six months (3/6) prior to hospitalization.
Overseas Workers Date of hospitalization/availment must be within the coverage period specified in the member’s MDR.

Just remember the 3/6, 9/12, and effectivity period requirements and you’re good to go!

We will continue with more information on eligibility, contributions, and benefits availment tomorrow.  Meantime, if you have questions about Philhealth membership, send us a message and we will answer your questions to the best of our abilities (and as far as our research will take us!).  You are most welcome to share your knowledge on related topics as well.

Source: www.philhealth.gov.ph

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08 - 23

Dual citizenship among natural-born Filipinos is made possible by RA 9225 or the Citizenship Retention and Re-acquisition Act of 2003.   Pinoys who have lost their Filipino citizenship by virtue of naturalization in a foreign country may now reacquire or retain their Philippine citizenship and enjoy the same benefits afforded to Filipinos in our country.

One such benefit is the social health insurance coverage provided by Philhealth.

Yes!  Pinoys with dual citizenship can now avail of Philhealth benefits.  This good news was shared through the Philhealth website last August 10, 2017.

Here’s how a Filipino with Dual Citizenship (FDC) can register his Philhealth membership:

  1. Submit a properly filled out Philhealth Member Registration Form (PMRF);
  2. Submit a copy of your Certificate of Re-acquisition/Retention of Philippine Citizenship (CRPC) or Identification Certificate (IC) issued by the Philippine Embassy or Philippine Consulate abroad, or by the Bureau of Immigration.

For FDCs declaring legal dependents, the same requirements above, including:

  1. Copy of the CRPC or IC to the PMRF for children below 21 years old who are not gainfully employed and unmarried.
  2. If declaring children above 21 years old but are suffering from disability, either physical or mental, or any disability acquired that renders them totally dependent on the member for support, the FDCs should attach a copy of the CRPC or IC and a Medical Certificate stating and describing the extent of disability.

For FDCs declaring their spouses as dependents:

A legitimate spouse who is similarly a Filipino with dual citizenship but is not a Philhealth member may be declared as dependent.  Here are the requirements:

  1. Copy of the marriage contract;
  2. CRPC or IC must be attached to the PMRF.
  3. Foreign spouses are not considered qualified legal dependents of FDCs.

For FDCs declaring their Filipino parents as dependents:

  1. Parents who are below 60 years and are suffering from disability, either physical or mental, or any disability acquired that renders them totally dependent on the member for support.
  2. Copy of the FDC’s birth certificate;
  3. Copy of the parents’ birth certificate;
  4. Medical Certificate stating the extent of the parents’ disability must be attached to the PMRF as support documents.

How much should an FDC remit as his monthly contribution?

The premium contribution of FDCs is pegged at Php 3,600.00 a year.  This shall be remitted to any Philhealth office or to any accredited local or overseas collecting agent.  Advance payment of premiums shall be allowed for a maximum period of two consecutive years only.

Where can FDC members and their dependents avail of Philhealth benefits?

The FDCs and their qualified dependents can avail themselves of Philhealth benefits in any accredited health care institution in the Philippines, or in health care facilities abroad, provided that they have paid their premium contributions or at least three (3) months within the six-month period prior to the first day of availment.

What benefits can FDC Philhealth members avail of and where?

FDCs and their qualified dependents can avail themselves of Philhealth benefits in any accredited health care institution  in the Philippines, or in health care facilities abroad, provided that they have paid their premium contributions of at least three (3) months within the six-month period prior to the first day of availment.

Aside from the in-patient benefits, they are also entitled to the following:

  1. Special benefit packages
  2. Z benefits subject to implementing guidelines on availment.
  3. Eligible to reimburse benefits for confinements abroad equivalent to the full Case Rate amount, payable in Philippine peso.

If you have further questions about FDCs’ Philhealth membership, you may call the Philhealth Action Center hotline at 02 441 7442 or through the Overseas Filipinos Program at ofp@philhealth.gov.ph.

Source: www.philhealth.gov.ph

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07 - 27

Matagal na akong hindi nakapag hulog sa aking SSS / Philhealth account; ngayon, may sakit ako at maco-confine.  Pwede ko bang habulin ang mga nalibanan kong buwan para makapag claim pa din ako ng benefits?

This is a common question we receive from followers.  Apparently, a lot of Filipinos think that paying their monthly contributions for government-mandated insurances is optional.

It isn’t.  We all need to activate our SSS and Philhealth memberships and diligently remit our monthly contributions to ensure that we are protected and covered by benefits.

We summarized SSS and Philhealth’s requirements and needed premium payments before a member can claim his benefits from these government agencies.  We aim to encourage everyone to update and maintain their monthly contributions to ensure hassle-free benefits claim anytime emergency strikes.

Read on.

Philhealth

  • Member must have paid at least three months’ premium contributions within the immediate six-month period prior to the first day of confinement to avail of benefits.
  • Philhealth does not accept retroactive payments for unpaid months.
  • Contributions made on admission date, during the confinement period, or after the member or dependent is discharged from the health care institution will not be counted as qualifying contributions.

What are the requirements for eligibility and when is a member eligible to claim?

Sponsored Members Date of hospitalization/availment must be within the effectivity period indicated in the member’s ID and MDR.
Individually Paying Members 1. There are certain confinement cases wherein three months worth of premium within the last sixmonths (3/6) prior to confinement is acceptable.

2. For pregnancy-related cases, dialysis, chemotherapy, radiotherapy and other selected surgical procedures, the member must have paid nine months worth of premium within the last twelve months.

Lifetime Member The member just has to show their Lifetime ID Card; no need to pay premiums anymore.  This now includes Senior Citizens; in which case, all they need to show is their SC IDs.
Employed Members Three months worth of premium within the last six months (3/6) prior to hospitalization.
Overseas Workers Date of hospitalization/availment must be within the coverage period specified in the member’s MDR.

 

SSS

A. Maternity Benefits

The maternity benefit is offered only to female SSS members.  A member is qualified to avail of this benefit if:

  1. She has paid at least three monthly contributions within the 12-month period immediately preceding the semester of her childbirth or miscarriage.
  2. She has given the required notification of her pregnancy to SSS through her employer if employed; or submitted the maternity notification directly to the SSS if separated from employment, a voluntary or self-employed member.
  3. SSS does not accept retroactive payments for unpaid months.

The maternity benefit shall be paid only for the first four (4) deliveries or miscarriages.

B. Sickness Benefits

The sickness benefit is a daily cash allowance paid for the number of days a member is unable to work due to sickness or injury.

A member is qualified to avail of this benefit if:

  1. He is unable to work due to sickness or injury and confined either in a hospital or at home for at least four days;
  2. He has paid at least three months of contributions within the 12-month period immediately before the semester of sickness or injury;
  3. He has used up all current company sick leaves with pay; and
  4. He has notified the ER, or directly the SSS, if separated from employment, VM or SE regarding his sickness or injury.

C. Retirement

The retirement benefit is a cash benefit paid either in monthly pension or as lump sum to a member who can no longer work due to old age.

A member is qualified to avail of this benefit if:

  1. Member must have paid at least 120 monthly contributions prior to the semester of retirement and is any of the following, whichever is applicable:
    • At least 60 years old and separated from employment or has ceased to be an SE/OFW/Household Helper (optional retirement);
    • At least 65 years old whether still employed/SE, working as OFW/Household Helper or not (technical retirement);
    • At least 55 years old and separated from employment or has ceased to be an SE, if an “underground mineworker” (optional retirement);
    • At least 60 years old whether still employed/SE or not, if an “underground mineworker” (technical retirement); or
    • A total disability pensioner who has recovered from disability and is at least 60 years old (or at least 55 years old, if an underground mineworker).
  2. A former retiree-pensioner whose monthly pension was suspended due to re-employment / self-employment and is now separated from employment or has ceased to be an SE.
  3. A member who is 60 years old and above, but not yet 65, with 120 contributions or more may continue paying as VM up to 65 years old to avail of the higher amount of benefit.

If you have questions regarding benefit claims from Philhealth and SSS, send us a message and we will do our best to find the answers for you.

 

Sources:

www.sss.gov.ph

www.philhealth.gov.ph

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07 - 10

The fourth and final installment of our series on Philhealth benefits will focus on orthopedic surgeries, renal diseases, and other types of cancer.  When availing of these benefits, it is best to see a Philhealth representative at the hospital where you are confined or call their Action Center number at 02-447-7442.

Read on.

Benefit Package and Amount Selections Criteria
Z MORPH (Mobility, Orthosis, Rehabilitation, Prosthesis Help)

–          First right and / or left below the knee P15,000.00

–          Both limbs P30,000.00

a. Signed ME Form;

b. No associated disabilities or co-morbidities, such as contractures, deformities, mental, and behavioral incapacity, quadriparesis, cardiopulmonary disease;

c. Community ambulation with or without cane, crutches, or walker;

d. At least three months post-amputation, if acquired; and

e. At least 15 years and 364 days of age, if congenital.

Selected Orthopedic Implants

1. Implants for Hip Arthroplasty

a.  Implants hip prosthesis, cemented P103,400.

b. Total hip prosthesis, cementless P169,400.

c. Partial hip prosthesis, bipolar P73,180.

a. Signed ME Form;

b. Should pass Philhealth’s prescribed Clinical Features.

c. Pre-injury status: ambulatory patients.

d. With no more than two co-morbid illnesses based on physical status classification based on ASA.

2. Implants for Hip Fixation

a. Multiple screw fixation (MSF) – P61,500

a. Signed ME Form

b. Any hip fracture not covered under the total hip package for femoral neck fracture.

c. Pre-injury status: ambulatory patients.

d. With no more than two co-morbid illnesses based on: Physical status classification based on ASA (low to moderate risk).

3. Implants for Pertrochanteric Fracture

a. Compression Hip Screw Set (CHS) – P69,000

b. Proximal Femoral Locked Plate (PFLP) – P71,000

a. Signed ME form;

b. CHS: stable fracture of the intertrochanteric area.

c. PFLP: unstable/comminuted pertrochanteric fracture .

d. Pre-injury status: ambulatory patients.

e. With no more than two co-morbid illnesses based on: Physical status classification based on ASA (low to moderate risk).

4. Implants for Femoral Shaft Fracture

a. Intramedullary Nail with Interlocking Screws – P48,740.

b. Locked Compression Plate (LCP) – Broad/Metaphyseal/Distal Femoral LC – P50,740.

a. Signed ME Form

b. Should pass Philhealth’s requirements for Femora Shaft Fracture and physical status classification based on ASA.

“PD First” – for End-stage Renal Disease Requiring Peritoneal Dialysis – P270,000 per year. a. Signed ME Form (to be submitted annually together with the pre-authorization)

b. Patients must have a permanent Tenckhoff peritoneal dialysis catheter properly placed in the abdominal cavity;

c. Patients must have completed PD initiation in an accredited healthcare institution so that the patient is no longer uremic, with stable vital signs and adequately trained (patient himself/herself or a caregiver) to perform PD at home using manual exchanges;

d. Must pass Philhealth’s clinical criteria (including age of patient, history of cancer, etc.)

Colon and Rectum Cancer

a. Colon Cancer

– Stage I – II (low risk) – P150,000

– Stage II (high risk) – III – P300,000

b. Rectum Cancer

– Stage I (clinical and pathologic) – P150,000

– Pre-operative clinical stage I but with post-operative pathologic stage II – III

– Using linear accelerator as mode of radiotherapy P400,000.

– Using cobalt as mode of radiotherapy P320,000

– Clinical Stage II – III

-Using linear accelerator as mode of radiotherapy P400,000.

-Using cobalt as mode of radiotherapy P320,000.

It pays to be well-informed especially with government benefits such as financial assistance when a family member is sick and needs to be hospitalized.  Always make sure that you are transacting with a Philhealth-accredited health institution and medical practitioners.

If you have questions about Philhealth benefits, send us a message and we will do our best to find the answers for you.

Source: https://www.philhealth.gov.ph/benefits/

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07 - 07

Z Benefit Packages were created by the government to help address patients’ needs of some cancer cases and other illnesses that require longer hospital confinement and special treatment procedures.  These are available through Philhealth and may be availed by contributing members and their qualified dependents.

In the third installment of our blog series on Philhealth benefits, we are going to feature the partial list of illnesses categorized as “Z” cases and the corresponding amount of Philhealth benefits for each:

Benefit Package and Amount of Benefit Selections Criteria
Acute Lymphocytic / Lymphoblastic Leukemia (standard risk)

Php 210,000.00

a. Signed Member Empowerment (ME) Form;

b. Age 1 to less than 10 years old;

c. White blood cell count <50,000/µL;

d. No CNS leukemia diagnosis

Breast Cancer (Stage 0 to IIIA)

Php 100,000.00

a. Signed ME form

b. Follow Philhealth’s prescribed clinical and TNM staging.

Prostate Cancer (low to maintenance risk)

Php 100,000.00

a. Signed ME Form;

b. Male patients age up to 70 years old;

c. Follow Philhealth’s prescribed clinical stage.

d. Localized prostate cancer; and

e. No uncontrolled co-morbid conditions.

End-state renal disease eligible for requiring kidney transplantation (low risk)

Php 600,000.00

a. Signed ME Form;

b. Age >10 and <70 years old;

Single organ transplant

c. Follow prescribed conditions for kidney transplant for recipient.

d. Certification from social service of the hospital that they can maintain anti-rejection medicines for the next three years.

Coronary Artery Bypass Graft Surgery (standard risk)

Php 550,000.00

a. Signed ME Form

b. Age 19 to 70 years

c. Should pass current medical status and past history as prescribed by Philhealth.

Surgery for Tetralogy of Fallot in Children

Php 320,000.00

a. Signed ME Form

b. Age: 1 to 10 years + 364 days

c. Should pass 2D Echo and Functional Class specifications prescribed by Philhealth.

Surgery for Ventricular Septal Defect in Children

Php 250,000.00

a. Signed ME Form

b. Age: 1 to 5 years + 364 days

c. Must pass 2D Echo results as prescribed by Philhealth.

d. No previous cardiac surgery.

e. Must pass pulmonary artery pressure as prescribed by Philhealth.

Cervical Cancer:

a. Chemoradiation with Cobalt and Brachytherapy (low dose).

Php 120,000.00

 

b. Chemoradiation with Linear Accelerator and Brachytherapy (high dose)

Php 175,000.00

a. Signed ME Form

b. No previous chemotherapy

c. No previous radiotherapy

d. No uncontrolled co-morbid conditions

e. Treatment plan from gynecologic oncologist

On Monday, we will feature Z benefits dealing with fractures, orthopedic implants, and rehabilitation, so stay tuned.

If you have questions about Philhealth benefits, send us a message and we will do our best to search for the best answers for you.

Have a great weekend!

Source: https://www.philhealth.gov.ph/benefits/

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07 - 06 (1)

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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07 - 05

The rainy season has officially begun in our country!  And along with the unpredictable changes in weather (warm and sunny in the morning, cold and wet in the afternoon) come different types of bacteria and viruses that cause infections and ailments among kids and adults.  Visiting your doctor’s clinic, or worse, the Emergency Room, could be inevitable during these wet season.

Good thing we have Philhealth to help us cover the unexpected expenses of getting medical treatment!

This week, we will dedicate a blog series on the different benefits that we can avail as Philhealth members, starting off with INPATIENT BENEFITS.  Share this with your friends and family!

Read on!

Inpatient Benefits

  • These benefits are paid to the accredited Health Care Institution (HCI) 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 (3) months’ premium contributions within the immediate six months prior to the month of availment.
  • Documents needed are:
    • Copy of Member Data Record or
    • Philhealth Benefit Eligibility Form (PBEF)
    • Duly accomplished Philhealth Claim Form 1
  • These benefits can be obtained at all accredited HCIs.  Different case rate amounts for selected medical conditions are being implemented when done in Primary Care facilities.
  • Only admissible cases shall be reimbursed.

Tomorrow we will feature the Outpatient Benefits offered by Philhealth to contributing members.  Meantime, you may send us your questions about Philhealth coverage and we will try our best to look for the answers for you.

See you tomorrow!

Source: https://www.philhealth.gov.ph/benefits/

Chips And Nibblers (1)

Closet Queen

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03 - 20

Madz works as a call center agent in a multi-national company in Makati.  She delivers her job well, has an impeccable attendance record, and is an effective team player.

Madz is also a Person with Disability (PWD); she lost her ability to walk after being stricken with polio at 3 years old.  She grew up maneuvering a wheelchair whenever she needs to go from one room to another.  Yet she did not let this disability become a detriment to her dreams of becoming a successful corporate executive like her father.  She will stop at nothing to get to her dreams.

Her medical expenses could sometimes cause huge dents in the family’s budget.  So even while studying, Madz would take odd jobs at school like helping out in the library or sitting in as an assistant to the Registrar during enrollment season.  She would grab any opportunity to earn extra money to help her get through college.  She wanted to liberate her parents from her medical expenses as soon as she can.  Now that she is employed, she pays for all her medicines and doctor’s appointments out of the money she earns as a call center agent.  It helps that some of her medical needs are covered by their company’s HMO and her Philhealth.

While Madz’s salary is well above the minimum wage, her growing medical expenses have started taking its toll on her monthly budget.  If only she could get more discounts on her medicine purchases and hospital expenses, she would be able to at least enjoy part of her hard-earned salary.  She tried her luck by asking the Philhealth if PWDs like herself are considered automatic members of Philhealth like Senior Citizens.

The answer was “No”.  Unlike Seniors who become “lifetime members” upon reaching the age of 60, PWDs still need to make monthly contributions to the Philhealth in order to enjoy the benefits afforded by the agency to Filipinos.

There is Hope.

Lawmakers are seeking to have RA 7277 or the Magna Carta for Persons with Disability amended in order to grant mandatory Philhealth coverage to all Persons with Disability.  The bill covers the following purposes:

  • This bill provides all PWDs with automatic health insurance coverage under the PHIC.
  • To support their enrollment to Philhealth, the national government shall pay for their premium payments to be sourced from the sin tax collections in accordance with Republic Act No. 10351 otherwise known as “An Act Restructuring the Excise Tax on Alcohol and Tobacco Products.”

This move came about after the UN Convention enjoined all member-states to ensure that PWDs enjoy their rights, freedom and dignity.  The same body defined PWDs as those who have long-term physical, mental, intellectual, or sensory impairments which may hinder their full and effective participation in the society on an equal basis with others.

The bill is yet to be approved; once enacted into law, all PWDs shall be able to enjoy the benefits of Philhealth and be freed from the financial burden of availing the health care services they need.  The government shall fund their health insurances out of the sin tax collections in accordance with RA 10351 or the Act Restructuring the Excise Tax on Alcohol and Tobacco Products.

Philhealth’s Role in Uplifting the Privileges of PWDs

Meantime that the government is working at improving the health insurances of PWDs, Philhealth continues to look out for opportunities to advance their support in making the lives of Pinoy PWDs more comfortable through specialized health packages.

One such package is the Z-Morph Prosthesis Package worth Php 15,000.00, launched in 2013.  This is granted to members or dependents in need of lower limb prosthesis, a device replacing a missing part of a person’s lower extremities.  All a member has to do to avail of this benefit is show his Philhealth card; this is initially available in three hospitals in Metro Manila: UE-RMMC, Philippine General Hospital, and Philippine Orthopedic Center.

While the government continues to explore more opportunities to expand the benefit packages for PWDs, affected individuals will have to continue making monthly contributions out of their salaries, or be listed as a beneficiary of a bona fide relative or family who is a Philhealth member, in order to avail of health benefits and privileges from the government.

For more information on the special packages offered by Philhealth to PWDs, visit their website at www.philhealth.gov.ph

Sources:

https://www.philhealth.gov.ph/members/

http://www.rappler.com/

Chips And Nibblers (1)

Closet Queen

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