As we all know, being a member of PhilHealth has its benefits. But have you every laid a thought on how much PhilHealth will put out for a specific illness? If not, then this article is 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:

Read: How to get PhilHealth Member Data Record (MDR)

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:

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:

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.

Read Also:

Source: PhilHealth

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