Being a member of PhilHealth has benefits, but do you know that there are specific cash benefits for different kinds of illness? Well, you should know it to get the most of your membership. This article is perfect to let you know about this matter, this also include eligibility, coverage, and guidelines for a specific disease.
Requirements
- The member must have at least three (3) months’ premium contributions within the immediate six (6) months before the month of availment.
- 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
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)
- 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
It is great to know that that PhilHealth really aims to support the whole country.
