Most employees know that being a member of PhilHealth has its benefits. However, have you ever laid a thought on how much PhilHealth will put out for a specific illness? If not yet, then this article is definitely perfect for you. This post is featuring a comprehensive list of how much you can get out of being a member of PhilHealth. This will also include eligibility, coverage, and guidelines for a specific disease.
Requirements
1. The member must have at least three (3) months’ premium contributions within the immediate six (6) months before the month of availment.
2. 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 more information regarding the requirements, you can go to the PhilHealth website. Alternatively, you can contact them at:
- Trunkline (02) 441-7444
- Call Center (02) 441-7442
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
Pneumonia
- Moderate Risk Pneumonia: Php15, 000.00
- High Risk Pneumonia: Php32, 00.00
- Primary Care Moderate Risk Pneumonia: Php10, 500.00
Tonsillectomy (Primary or Secondary)
Php18, 000.00
Normal Spontaneous Delivery (NSD)
- Lying in: Php6, 500
- Hospitals: Php5, 000.00
- Pre-Natal: Php 1, 500.00
Tubal Ligation
Php4, 000.00
For IN PATIENTS benefits:
Benefits are paid ONLY to accredited Health Care Institutions (HCI)
- The case rate amount is to be deducted by the Institution (HCI) from the member’s total bill. Inclusive of professional fees of physicians BEFORE your discharge
- Member must have at least three (3) months’ premium contributions within the immediate six (6) months prior to the event
- The case rate amount is inclusive of hospital charges and professional fees of attending physician/s
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
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
PhilHealth Z Benefits
So if there are 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) |
Who are eligible for this Z-Type package?
Members covered are all eligible PhilHealth members whether:
- Employed
- Individually paying (Voluntary)
- Lifetime member program
- Sponsored program
- Overseas worker program
In addition to that, their dependents are also entitled of the package.
So aside from these illnesses listed, what else are covered?
Furthermore to the list of illnesses in the ‘Z” category, PhilHealth will cover:
- Operating Room
- Drugs and Laboratory exams
- Hospital room and Board fees
- Professional fees for the entire course of the treatment (Mandatory, *Other services required per ailment)
For the partner hospitals, you can refer to the image here to know where you can go. To make it simpler, you can just type PhilHealth Z Benefit in Google Maps and it will automatically give you a list of partner hospitals.
How can a member apply for the Z package?
For the illnesses in the Z package, a member can go to any contracted hospitals and have themselves check if they are eligible to be part of the or the Z Package.
Refer to this list:
- 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
Wow, who knew that PhilHealth really aims to support the whole country? With these in mind, I can say that it’s a pretty fair deal, after all.
Do you have diseases in which you would need financial assistance from government organization/s? Or do you know someone who dreadfully needs this? Spread the word now and save a life.
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