Tag Archive: Philhealth Benefits


10 - 16

What is the No Balance Billing?

No Balance Billing or NBB is a privilege given to qualified PhilHealth members.  If you are covered by the NBB policy, you no longer need to pay for your hospitalization at any government hospital and selected private medical centers nationwide.  It is the government that pays for the member’s hospital expenses without prejudice to the quality of service and attention given to the patient.

Who are covered by the NBB Policy?

  • Indigent members
  • Sponsored members
  • Kasambahay members
  • Lifetime members
  • Senior Citizens

What services and benefits are covered by the NBB Policy?

All services and benefits afforded to other PhilHealth members are likewise extended to those under the NBB policy, such as:

  • All case rates
  • Case Type Z benefits
  • TB-DOTS package
  • Outpatient Malaria Package
  • Animal Bite Treatment Package
  • Voluntary Surgical Contraception Package
  • Outpatient HIV/AIDS Treatment (OHAT) Package

Which packages can be availed through NBB at both private and public hospitals?

NBB is currently offered at the following medical facilities:

Type of Facility Government

Hospital

Private

Hospital

Benefits Covered by NBB
Hospital Yes No All applicable benefits covered by NBB for hospitals.
Malaria – outpatient case Yes No Outpatient Malaria Package
Animal Bite Treatment Centers Yes No Animal Bite Treatment Package
Treatment Hubs Yes No Outpatient HIV/AIDS Treatment Package
Hospitals that offer Z Benefits Package Yes Yes Z Benefits Packages
Ambulatory Surgical Clinics Yes Yes All applicable benefits covered by the NBB, such as:

·         Cataract extraction

·         Bilateral Tubal Ligation

·         Vasectomy

Freestanding Dialysis Clinics Yes Yes Dialysis Package
Peritoneal Dialysis Center Yes Yes Peritoneal Dialysis
TB-DOTS Centers Yes Yes TB-DOTS Package
Lying-in Clinics (Maternity Cases) Yes Yes ·         Maternity Care Package

·         Antenatal Care

·         Normal Spontaneous Delivery

·         Newborn Care Package

·         Family Planning Procedures

Facilities for Primary Care Benefits Yes Yes ·         Primary Care Benefits

·         Family Planning

·         Procedures

Infirmaries / Dispensaries Yes Yes Public Infirmaries:

All applicable benefits covered by the NBB, including vasectomy.

 

Private Infirmaries:

·         Maternity Care Package

·         Antenatal Care

·         Normal Spontaneous Delivery

·         Newborn Care Package.

Will NBB be applied to a patient who is admitted on a private bed?

NBB is applicable only to service beds or PhilHealth beds?  If no service bed is available the time of admission, NBB can still be applied as long as the hospital guarantees that there are no service beds available.

Does the NBB Policy cover doctors’ professional fees?

Yes, that’s why doctors are not supposed to bill patients under the NBB policy; however, if the patient is admitted to a private room, doctor’s fees will still apply.

What if the hospital could not provide the needed medicines, laboratory, and diagnostic tests and the patient is compelled to transfer to a different facility?

It is the government hospital’s obligation to ensure that they have ample stocks of medicines, especially for NBB patients.

In case they are not able to provide the needed laboratory or diagnostic tests, they shall be held responsible and will have to make sure that the NBB patient is given the needed medicines and tests at their expense.

For more information on the No Balance Billing Policy, you may call the PhilHealth hotline at 02-441-7442.  They are able to take your calls, 24×7.

Source: www.philhealth.gov.ph

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10 - 11

Tuberculosis (TB) is a disease caused by bacterial infection, usually affecting the lungs.  The bacteria is highly contagious and can be passed on to others through coughing and sneezing, even through the accidental spread of saliva when laughing, singing, and spitting.  In 2012, it was reported to be the 6th leading cause of death with about 200,000 to 600,000 Filipinos having the bacteria in its active state in their system.

In spite of these seemingly bad news about the said disease, TB can be cured through effective anti-tuberculosis drugs, made available through national and local government health centers.  These are likewise made more affordable even when bought from private hospitals and pharmacies through the Generic Law.

The Philippine Health Insurance Corporation or Philhealth offers the Tuberculosis – Directly Observed Treatment Short Course (TB-DOTS) Benefit Package, worth P4,000, for members diagnosed with the disease.

Below is a summary of the package’s inclusions and how a Philhealth member can avail of the program.

Package Inclusions:

  • Consultation
  • Diagnostic Exams
  • Information and advice on the patient’s health and treatment progress
  • Medicines

The TB-DOTS package is available to all PhilHealth members and their qualified dependents who are likewise suffering from TB and requiring medical attention.  All they need to do is visit the nearest PhilHealth accredited TB-DOTS center in their area; you may ask for information on center locations in your barangay hall.

TB, although highly communicable, can now be easily cured with the right kind of medications.  Regular visits to your doctor will also help you determine how your system is responding to treatment.  To ensure that you get the proper treatment, visit the nearest Philhealth-accredited medical center in your area.

Source: www.philhealth.gov.ph

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10 - 09

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?

  1. Updated contributions as shown in the member’s MDR.
  2. Make sure you are seeking consultation or treatment at a PhilHealth-accredited hospital and by a PhilHealth-accredited doctor.
  3. 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?

  1. 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).
  1. 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:

  1. Copy of Medical Certificate where the following are clearly stated:
    • Final diagnosis
    • Confinement period
    • Services rendered
  2. Duly accomplished PhilHealth Claim Form 1
  3. Copy of Official Receipt or detailed Statement of Account
  4. 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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09 - 27

If you are fond of taking care of pets, or are in an area where dogs and cats freely roam the streets, you are at a higher risk of getting bitten by stray animals and exposed to the rabies virus.  Animal bites must be taken seriously because when left untreated, can cause irreversible infections and in worse cases, death.  According to the Department of Health, rabies is considered to be a neglected disease; it is 100% fatal yet also 100% preventable.  It is regarded as a significant public health problem.

One of the reasons why people neglect to see a doctor after they have been bitten by an animal is because they think the vaccines are expensive.  This is true especially if you intend to get the treatment from a private hospital.  In cases when the bite is almost superficial, nothing more than a scratch or a gash, people think it is nothing significant and therefore, can be passed off as just some wound that will heal on its own.

Exposure to rabies is a serious matter and all measures must be taken to arrest its spread in a person’s circulatory system.  It is for this reason that Philhealth has in its long list of care packages, the Animal Bite Treatment Package (ABTP) amounting to P3,000.  This provides additional financial assistance to members who have been exposed to rabies and needs to complete the series of vaccines to help fight the virus.

What are included in the ABTP?

The ABT package includes payments for Post Exposure Prophylaxis:

  • Rabies vaccine
  • Rabies immunoglobulins
  • Tetanus toxoid and anti-tetanus serum
  • Wound dressing
  • Supply of antibiotics

It covers the following animal type bites as well as the wound’s category, as recommended by the DOH:

  • Dog and cat bites, as well as cow, pig, horse, goat, bat, and monkey bites.
  • Category II exposure on the head and neck areas.  These are the bite types that resulted to superficial gashes and had minimal to no bleeding at all.
  • Category III
      • Bites that resulted to deep wounds or gashes that bled.
      • Exposure to a person infected by the rabies virus through bites, or contamination through mucus membranes such as the eyes, nose, mouse, or genitals.
      • Exposure to an animal’s carcass.
      • Ingestion of animal meat contaminated by the rabies virus.

Do not take animal bites for granted, whether among children or adults.  This could lead to serious physical and mental illnesses, and in most cases, death.  Infected individuals can also easily transfer the virus to other people.

For more information on the Philhealth’s Animal Bite Treatment Package (ABTP), you may call the Philhealth call center at 02-441-7442.

Reference: www.philhealth.gov.ph

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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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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/

Chips And Nibblers (1)

Closet Queen

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