Wednesday, 7 November 2018

PhilHealth Cash Benefit for a Specific Illness

In this article, i’ll show you how you can use your PhilHealth and the benefits of it as a member. Members covered are all eligible PhilHealth members whether your employed, individually paying (voluntary), lifetime member program, sponsored program, and overseas worker program.
Below are the list of requirements needed and the corresponding amount for the specific cases you avail.
REQUIREMENTS:
a. The member must have at least three (3) months’ premium contributions within the immediate six (6) months before the month of availment.
b. An aspiring member also needs to submit:
  • 1 copy of Member Data Record or PhilHealth Benefit Eligibility Form (PBEF)
  • A duly accomplished PhilHealth Claim Form 1
For IN PATIENTS 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 (6) months prior to the month of availment.
Here are the list of the cases and the amount to be deducted:
Tubal Ligation
  • Php4, 000.00
Intrauterine Device Insertion or IUD  
  • Php2,000
Vasectomy (Unilateral or Bilateral)
  • Php4,000
Viral Hepatitis
  • Php11,800
Rheumatic Fever
  • Php10,100
Intrauterine Device Insertion (IUD)
  • Php2, 000
Breech Extraction
  • Php12, 120

Appendectomy

  • Php24, 000

Cerebral Infarction

  • Php28, 000
Cerebral Palsy
  • Php9, 500
Cellulitis
  • Php9, 600
Cataract Surgery
  • Php16, 000

Cholecysectomy

  • Php31, 000
Cholecystitis
  • Php11, 300
Caesarian Section
  • Php19, 000
Normal Spontaneous Delivery (NSD)
  • Lying in: = Php6, 500
  • Hospitals: = Php5, 000.00
  • Pre-Natal:= Php 1, 500.00
  • Tubal Ligation = Php4, 000.00
Congenital Anemia
  • Php15, 200
Newborn Care Package
  • Php1, 750

Emphysema

  • Php11, 400
Upper Respiratory Tract Infection (URTI)
  • Hospitals: Php4, 000
  • Primary Care Facilities: Php2, 800
Dengue
  • Dengue Fever: Php10, 000
  • Severe Case of Dengue: Php16, 000

Chronic Obstructive Pulmonary Disease (COPD)

  • Php12, 200
Congenital Syphilis
  • Php12, 800
Diabetes Mellitus
  • **With complications other than Coma and Ketosis: Php12, 600
Asthma
  • Asthma in acute exacerbation for hospitals: Php9, 000
  • In primary care facilities: Php6, 300
Congenital Hypothyroidism
  • Php9, 900

Case Rate for Hemodialysis

  • Php2, 600.00 per session

Case Rate for Outpatient Blood Transfusion
  • Php3, 640.00 (one or more units)
Thyroidectomy (Total or Complete Cash Benefits)
  • Php31, 000.00
Ovarian Cystectomy (Unilateral or Bilateral)
  • Php23, 300.00

Tonsillectomy (Primary or Secondary)
  • Php18, 000.00
PhilHealth Z Benefits
Aside from the benefits to the diseases mentioned above, PhilHealth extends its help furthermore. The Z Benefit Package is a program of PhilHealth to its members to address health conditions that trigger expensive treatments. In addition to that, it also aids illnesses and diseases that promote prolonged hospitalization.
The conditions under type Z are the farthest end of the spectrum. Moreover, these are the cases “perceived as economically and medically catastrophic” due to the seriousness of each.
What type of illnesses are covered?
Z001: Acute lymphocytic leukemia, standard risk (for children)
Z002: Early breast cancer, stage 0 to IIIA
Z003: Prostate cancer, low to intermediate risk
Z004: Kidney transplantation for end stage kidney disease, standard risk
Z005: Coronary artery bypass graft surgery, standard risk
Z006: Total correction of Tetralogy of Fallot (for children)
Z007: Closure of ventricular septal defect (for children)
Z008: Cervical Cancer, stage I to IV
Z009: The Z MORPH (Mobility, Orthosis, Rehabilitation and Prosthesis Help)
To apply the Z package, go can use it for any affiliated hospitals or any government hospital. To know if they are eligible, check for it:
PhilHealth Circular No. 30, s-2012 – for Z001 to Z004
PhilHealth Circular No. 02, s-2013 – for Z005 to Z006
PhilHealth Circular No. 19, s-2013 – for Z009
If you are indeed qualified, PhilHealth will receive documents and endorsements from the hospital/s. If you want to know documentation requirements and checklists, you can find them here:
PhilHealth Circular No. 02, s-2013 – for Z005 to Z006
PhilHealth Circular No. 19, s-2013 – for Z009
PhilHealth Circular No. 48, s-2012 – for Z001 to Z001

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