3 PhilHealth benefits na dapat mong malaman bukod sa in-patient at out-patient

Napapatanong ka ba kung para saan ang mga hinuhulog mong pera para sa Philhealth contributions? Narito ang iba pang PhilHealth benefits na iyong maaring makuha bilang isang miyembro ng ahensya maliban sa in-patient at out-patient benefits.

Ano ba ang in-patient at out-patient benefits?

Inpatient benefits

Covered ng inpatient benefits ang ano mang uri ng diagnostic o therapeutic procedure pati na rin ang hospital charges. Kabilang sa hospital charges ay ang patient room, mga gamot, professional fees at iba pa. Maaaring makapag-avail ng inpatient benefits sa ano mang Philhealth accredited healthcare institution (HCI). Kapag na-confine o na-admit ang pasyente, ibabawas ang case rate amount sa kaniyang total bill bago siya ma-discharge.

Outpatient benefits

Ang outpatient benefits naman ay ang assistance sa mga procedure at treatments na hindi nangangailangan ng confinement. Kabilang dito ang day surgeries, radiotherapy, outpatient blood transfusion, at hemodialysis. Maaaring magamit ang benefits na ito sa accredited ambulatory surgical clinics, HCIs at primary care facilities.

PhilHealth benefits

Para sa kaalaman ng mga miyembro ng PhilHealth, maliban sa in-patient o out-patient benefits na ibinibigay ng ahensya sa mga na-oospital o nagkakasakit, ay may iba pang mga serbisyo o benepisyong ini-ooffer ang PhilHealth. Ito ay ang sumusunod:

Philhealth Z benefit

Ang Z PhilHealth benefit ay ang package na ini-ooffer ng ahensya sa mga miyembro nitong nangangailangan ng matagalan at magastos na pagpapagamot. Sa ilalim ng Z benefit package ay nakapaloob ang mga sakit na nahahati sa apat na uri. Ito ay nagsisimula sa Type A bilang pinaka-simple at mura. At hanggang Type D bilang pinaka-malala at magastos. Ang mga sakit na ito ay ang mga kondisyon na kung tawagin ng PhilHealth ay “economically at medically catastrophic”.

Sa ilalim ng Z benefit pagkage ay nakapaloob na tutulungan ng ahensya ang miyembro nitong qualified na makakuha ng benepisyo sa mga sumusunod:

• Mandatory services na kakailanganin sa treatment ng kondisyon ng PhilHealth member
• Hospital services tulad ng accommodation, gamot, laboratories at professional fees.
• Iba pang serbisyon o alternative guideline na kakailanganin ng pasyente.

Lahat ng miyembro ng PhilHealth na aktibong nagbabayad ng kontribusyon sa ahensya ay eligible na makagamit ng benepisyo. Pati na ang kanilang mga qualified dependents.

Upang magamit ang Z benefits ay kailangan lang magpunta ng PhilHealth member o dependent sa PhilHealth accredited hospital na nag-ooffer ng benepisyo. Dito ay i-evaluate siya ng doktor upang matukoy kung eligible siyang makatanggap ng benepisyo. Sa oras na siya ay ma-qualify agad na siyang maaring makakuha ng Z benefits. Tulad ng regular check-up upang masubaybayan ang kaniyang kondisyon.

Samantala, ang mga indigent PhilHealth member naman na tinukoy ng DSWD ay awtomatikong qualified na makakuha ng benepisyong ito.

Ang mga sakit at kondisyon na napapailalim sa Z benefits ay ang sumusunod kalakip ang nakalaaang presyo ng benepisyong makukuha mula rito.

Z benefit packages

• Acute Lymphocytic / Lymphoblastic Leukemia (standard risk) P500,000
• Breast Cancer (Stage 0 to IIIA) P100,000
• Prostate Cancer (Low to intermediate risk) P100,000
• End-stage renal disease eligible for requiring kidney transplantation (Low risk) P600,000
• Coronary Artery Bypass Graft Surgery (Standard risk) P550,000
• Surgery for 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) or Primary surgery for Stage IA1, IA2 – IIA1 P120,000
• Chemoradiation with Linear Accelerator and Brachytherapy (High dose) P175,000

Z-MORPH

• Mobility, Orthosis, Rehabilitation, Prosthesis Help- First right and/or left below the knee P15,000; Both limbs P30,000

Selected Orthopedic Implants

• Implants for Hip Arthroplasty,
• Implants Hip Prosthesis, cemented*P103,400
• Total Hip Prosthesis, cementless** P169,400
• Partial Hip Prosthesis, bipolar P73,180

(*cemented: 66 years old and above/** cementless: 65 years and 364 days old and below)

• Implants for Hip Fixation
• Multiple screw fixation (MSF)*** 6.5mm cannulated cancellous screws with washer P61,500

(***59 years and 364 days old and below (both displaced and undisplaced fracture); 60 years old and above (undisplaced fracture)

• Implants for Pertrochanteric Fracture
• Compression Hip Screw Set (CHS) P69,000
• Proximal Femoral Locked Plate (PFLP) P71,000
• Implants for Femoral Shaft Fracture
• Intramedullary Nail with Interlocking Screws P48,740
• Locked Compression Plate (LCP) – Broad / Metaphyseal / Distal Femoral LC P50,740
• “PD First” – for End-Stage Renal Disease Requiring Peritoneal Dialysis P270,000 per year

Colon and Rectum Cancer

• Low-risk Colon Cancer Stage I-II – P150,000
• High-risk Colon Cancer Stage II (high risk) – III – P300,00

Rectum Cancer

• Stage I (clinical and pathologic) – P150,000
• 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

Premature and Small Newborn

Prevention of Preterm Delivery

• With severe pre-eclampsia/eclampsia – 3,000.00
• Preterm pre-labor rupture of membrane (pPROM) – 1,500.00
• Without pre-eclampsia/eclampsia or rupture of membranes but with labor or vaginal bleeding or multifetal pregnancy – 600.00
• With coordinated referral and transfer from a lower level of facility – 4,000.00

Preterm and Small Newborns (24 to < 32 weeks)

• Essential interventions for 24 to < 32 weeks – 35,000.00
• Intervention with minor ventilator support and Kangaroo Care for 24 weeks to < 32 weeks – 85,000.00
• Essential interventions with major ventilatory support and Kangaroo Care for 24 weeks to < 32 weeks – 135,000.00

Preterm and Small Newborns (32 to < 37 weeks)

• Essential interventions for 32weeks to < 37 weeks – 24,000.00
• Essential interventions with mechanical ventilation and Kangaroo Care for 32 weeks to < 37 weeks – 71,000.00

Children with Developmental Disabilities

• Assessment and discharge assessment ranges from P3,626.00 – P5,276.00
• Rehabilitation Therapy Sessions P5,000.00 per set*

Children with Mobility Impairment

• Requiring assistive devices ranges from P13,110.00 – P163,540.00
• Requiring seating device, basic and intermediate wheelchair ranges from P12,730.00 – P29,450.00
• Yearly services and replacement of devices ranges from P1,590.00 – P13,690.00

Children with Visual Disabilities

• Initial assessment and intervention (i.e. rehabilitation and training) for Category 1 Visual impairment – 25,920.00
• Assessment and intervention (i.e. electronic assistive device, rehabilitation and training) for Categories 2, 3, and 4 Visual impairment – 31,920.00
• Initial assessment and intervention (i.e. electronic assistive device, rehabilitation and training) for Category 5 Visual impairment – 9,070.00
• 1 Optical Aid: Low Power Distance, Categories 1, 2, 3 and 4 visual impairment eyeglasses + low power optical device – 7,350.00
• 2 Optical Aid: High power Distance, Categories 1, 2, 3 and 4 visual impairment progressive eyeglasses + high optical device – 13,820.00
• 3 Optical Aid: Colored Filter, Categories 1, 2, 3 and 4 visual impairment – 2,940.00
• White cane, Category 5 visual impairment – 1,000.00

Description for yearly diagnostics, after the first year of enrolment

• Yearly Diagnostics for Categories 1, 2, 3 and 4 – 3,220.00
• Yearly follow up consultation for Category 5 – 780.00

Description for other benefits

• Electronic Aid Replacement done every 5 years – 6,000.00
• Ocular Prosthesis, per eye – 20,250.00

Children with Hearing Impairment

• For 0-3 years old with moderate hearing loss P53,460; with severe profound hearing loss P67,100.
• For 3-6 years old with moderate hearing loss P45,400; with severe to profound hearing loss P54,100.
• For 6-18 years old with moderate hearing loss P43,880
• Speech therapy assessment and session for moderate hearing loss P22,100; with severe to profound hearing loss P63,420.

Philhealth SDG Benefits

Maliban sa Z PhilHealth benefits ay mayroon ring SDG benefits na ini-ooffer ang PhilHealth. Ito ay magagamit para sa mga kondisyon na nasa ilalim ng Sustainable Development Goals o SDG. Tulad ng malaria, HIV-AIDS, tuberculosis, at animal bites. Ang benepisyong makukuha sa bawat kondisyon ay ang sumusunod:

• Malaria Package (Outpatient), P600.00
• HIV-AIDS Package (Outpatient), P30,000.00 per year (P7,500/quarter)
• Outpatient Anti-Tuberculosis Treatment through Directly-Observed Treatment Short-course (DOTS) Package, P4,000; P2,500 – Intensive phase; P1,500 –Maintenance Phase
• Voluntary Surgical Contraception Procedures, P4,000.00
• Animal Bite Treatment Package, P3,000.00

Maternity benefits

May mga packages din ang PhilHealth para sa mga buntis at bagong silang na sanggol. Ito ay ang sumusunod:

• Normal spontaneous delivery package
• Hospital birth P6,500
• Non-hospital birth P1,500
• Maternity benefits for high-risk delivery
• Caesarian delivery P19,000
• Complicated vaginal delivery P9,700
• Breech extraction P12,120
• Vaginal delivery after C-section o VBAC P12,120
• Newborn care package such as screening test and hearing test, P1,750.00

PhilHealth requirements na kailangan para maka-avail ng mga nabanggit na benepisyo

Ang mga PhilHealth requirements na kakailanganin upang maka-avail ang isang miyembro ng mga nabanggit na benepisyo ay ang sumusunod:

• Member Data Record (MDR) at PhilHealth Claim Form na may pirma ng employer para sa mga miyembrong nagtratrabaho.
• Proof ng pagbabayad ng PhilHealth contribution tulad ng ORs o certificate of payment
• PhilHealth ID at isa pang valid ID
• Medical/ hospitalization documents at iba pang kakailanganing personal na dokumento

PhilHealth benefits contribution table

Samantala narito naman ang latest na PhilHealth benefits contribution table ngayong taon.

Updates by Jobelle Macayan

Basahin:

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