Category: Philhealth News and Facts


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/

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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/

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03 - 16

Magandang balita!  Kung ikaw ay edad 60 years old pataas at isang Filipino citizen, ikaw ay automatic na miyembro na ng Philippine Health Insurance Corporation o Philhealth!  Maaari mo nang magamit at ma-enjoy ang iyong mga Philhealth benefits gamit lamang ang iyong Senior Citizen ID, PSA birth certificate, o ano mang ID na magpapatunay na ikaw ay edad 60 years old pataas.

Narito ang mga karagdagang impormasyon kung papano makakakuha ng Philhealth ID ang mga Senior Citizen.  Madaling lang!

May dalawang paraan ng pag enroll para makakuha ng Philhealth ID:

  1. Bulk Enrollment.
    • May listahan ng pangalan ng mga senior citizen sa isang siyudad o munisipalidad ang mga local health insurance offices ng Philhealth.  Siguraduhing nakapagpa lista kayo upang maisama kayo sa bulk enrollment.
    • Ang lahat ng qualified senior citizens (edad lang ang qualification) ay isasama sa bulk enrollment.
    • Ang inyong Philhealth IDs ay idedeliver sa Office of Senior Citizens Affairs (OSCA).
  2. Individual Enrollment
    • Requirements:
      • Duly accomplished Philhealth Member Registraton Form.
      • 1 x 1 photo taken within the last six months.
      • Senior Citizens’ ID na mula sa OSCA ng siyudad o munisipalidad kung saan nakatira ang senior citizen OR
      • Kahit na anong valid government-issued ID tulad ng Passport, Driver’s License, SSS o GSIS ID, PRC ID, Postal ID, Voter’s ID.

Kung wala pang Senior Citizen ID, mag apply na sa OSCA kung saan kayo nakatira.  Narito ang mga requirements kapag maga-apply ng Senior Citizen ID:

  1. Ihanda ang mga sumusunod na requirements:
    • PSA Birth Certificate
    • 2 pcs 1 x1 colored photo
    • Valid ID (kahit alin sa mga sumusunod: SSS, GSIS, PRC, Voter’s ID, Postal ID, Passport).
  2. Pumunta sa OSCA ng city o municipality kung saan nakatira ang Senior Citizen at i-submit ang mga requirements.
  3. Ang staff ng OSCA ang siyang maglalagay ng mga detalye sa inyong Senior Citizen ID base sa mga impormasyon sa inyong birth certificate at mga ID.
  4. Bago pirmahan ang ID card, basahing mabuti at i-confirm kung tama lahat ng impormasyong isinulat sa inyong ID, tapos ay pirmahan.

Ang ibang cities at municipalities ay nagbibigay ng one-hour orientation bago ibigay ang ID sa mga members.  Mag attend kayo nito sakaling i-require.

Kumuha na ng inyong Senior Citizen at Philhealth IDs sa pinakamalapit na OSCA sa inyong lugar!

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02-27

During the celebration of its 22nd anniversary, Philhealth announced that they are currently developing a benefit package that will focus on providing assistance to children with disabilities.  This is in support of the Department of Health’s (DOH) expanded national program for disabled persons.

The said benefit package is seen to be incorporated in the Z Benefit Package, a Philhealth package offered to members who have health conditions that require expensive treatments and prolonged stay in the hospital.

What types of benefits and assistance will be offered to CWD under the Z Benefit Package?

A. For Hearing Impairment:

  • Professional assessment
  • Diagnostic test
  • Hearing devices
  • Habilitative/rehabilitative speech therapy to enable CWDs to gain functionality in hearing and communication.

B. For Visual Impairment:

  • Vision assessment
  • Provision of electronic and non-electronic optical devices
  • Rehabilitation that will preserve and rehabilitate the children’s ability for sight and purposeful activities.

C. For Mobility Impairment:

  • Provide appropriate mobility devices
  • Habilitative/rehabilitative therapy that can potentially halt the progression of conditions limiting mobility and enable children to navigate access and become more independent.

D. For Developmental Disability:

  • Services for proper diagnosis in order to provide specific and individualized plans for therapy for services.
  • This will help optimize children’s capacities and increase their participation in education and in the community.

Philhealth will launch the CWD benefits in contracted facilities that specialize on services aimed at Z-benefit cases.

Sources:

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

http://news.mb.com.ph/2017/02/25/philhealth-to-introduce-benefit-packages-for-children-with-disabilities/

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