Here's a complete list of PhilHealth Benefits for Special Illnesses

Philippine Health Insurance Corporation or more popularly known to us as PhilHealth was created in 1995 to implement universal health coverage in the Philippines.

Do you know that you can get cash benefits from PhilHealth in case of a special illness? This post will provide you a complete list of how much you can get from this insurance if you are a member.

This post will also give you more information about eligibility, coverage and its guidelines for a 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

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.

Moreover, 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)

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:

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 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

Source: PHILHEALTH