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Monday, April 03, 2017

What are the OFW's Benefits from PhilHealth and How to Claim It?

As an Overseas Filipino Worker (OFW) it is important that you are prepared with health insurance that you can lean on in times of emergency, not just for yourself, but also for your dependents here in the Philippines.  Here in the Philippines, the most common health care insurance program is the Philhealth from the government. As OFW, you are encouraged to be an active member to fully enjoy its benefit.



(PhilHealth para sa OFW: Alamin ang inyong Benepisyo)

As an Overseas Filipino Worker (OFW) it is important that you are prepared with health insurance that you can lean on in times of emergency, not just for yourself, but also for your dependents here in the Philippines.

Here in the Philippines, the most common health care insurance program is the Philhealth from the government. As OFW, you are encouraged to be an active member to fully enjoy its benefit.


Who are the OFWs to be covered by the Philhealth?

1. Sea-based Filipino workers or seafarers – any person who is employed or engaged in any capacity on board a seagoing ship navigating foreign seas other than a government ship used for military or non-commercial purposes. Example - fishermen, cruise ship personnel and those serving foreign maritime mobile offshore and drilling units.

2. Land-based OFWs - an OFW who is other than a sea-based OFW.

3. Filipinos with Dual Citizenship – Filipinos who are also citizens of other countries.


(Watch:Benepisyong PhilHealth para sa mga OFW)

As an OFW, what are the advantages of being a Philhealth member?


1. As an OFW, you may avail of PhilHealth benefits for hospital confinements and out-patient surgeries in the Philippines. Confinements of OFWs and their dependents in any accredited healthcare institution in the Philippines are being paid for by PhilHealth through the All Case Rate payment scheme. Confinements of OFs overseas may be reimbursed



2. OFW confined abroad are entitled to PhilHealth benefits through claim reimbursements.Members are given 180 days upon discharge to submit their claim documents to any of the PhilHealth offices in the Philippines. 



3. Qualified dependents of members are entitled to the same set of benefits as the principal members. This means reduced stress for OFs from worrying about family members’ health care needs while abroad. Should any of the OF’s qualified dependents gets hospitalized in the Philippines, the same set of benefits shall be available for the dependents to avail themselves of. PhilHealth supports inpatient care through the All Case Rate payment scheme for most illnesses and surgical procedures.



4. OFWs may be entitled to Lifetime membership. Overseas Filipinos who have reached the age of retirement and have paid at least 120 months’ contribution are automatic Lifetime members of PhilHealth



5. Availment for both the OF and qualified dependents is easy and readily accessible. Should hospitalization become necessary for both the OF and dependents, they need not worry about numerous documents to submit because most accredited healthcare institutions are now connected to the Health Care Institution Portal where eligibility to avail of benefits can readily be checked?



6. PhilHealth covers over 4,600 medical and surgical procedures including cancer cases and other dreaded diseases. Most illnesses and other causes of hospitalization are being paid for by PhilHealth. 


(Watch:Former OFW can't avail Philhealth benefits)




The following are OFWs and their benefits under Philhealth

1. Inpatient Benefits 

  • These benefits are paid to the accredited Health Care Institution (HCI) through All Case Rates.
  • The case rate amount shall be deducted by the HCI from the member’s total bill, which shall include professional fees of attending physicians, prior to discharge
  • The case rate amount is inclusive of hospital charges and professional fees of attending physician
Availment Condition:
  • Member must have at least three (3) months’ premium contributions within the immediate six (6) months prior to the month of availment
Documents needed

  • A copy of Member Data Record or PhilHealth Benefit Eligibility Form (PBEF) 
  • duly accomplished PhilHealth Claim Form 1

2. Outpatient Benefits

A. Day Surgeries (Ambulatory Or Outpatient Surgeries) Are Services That Include Elective (Non-Emergency) Surgical Procedures Ranging From Minor To Major Operations, Where Patients Are Safely Sent Home Within The Same Day For Post-Operative Care

B. Radiotherapy

C. Hemodialysis

D. Outpatient Blood Transfusion 

E. Primary Care Benefits



Availment Condition
  • Member must have at least three (3) months’ premium contributions within the immediate six (6) months prior to the month of availment
Documents Needed

  • Copy of Member Data Record and duly accomplished PhilHealth Claim Form 1

3. Z Benefits

  • Acute Lymphocytic / Lymphoblastic Leukemia (standard risk) P210,000
  • Breast Cancer (stage 0 to IIIA) P100,000
  • Prostate Cancer (low to intermediate risk) P100,000
  • End-state 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 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

1. 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

2. 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)

3. Implants for Pertrochanteric Fracture

  • Compression Hip Screw Set (CHS) - P69,000
  • Proximal Femoral Locked Plate (PFLP) - P71,000

4. 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 Colon Cancer

  • Stage I-II (low risk) – P150,000
  • Stage II (high risk) – III – P300,00
Rectum Cancer
  • Stage I (clinical and pathologic) – P150,000
  • Pre-operative clinical stage I but with post-operative pathologic 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

(Philhealth - Z Benefits)


4. MDG-Related Benefits

Benefits Package and Amount of Benefit

  • Outpatient Malaria Package - P600.00
  • Outpatient HIV-AIDS Package - 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
(Watch:How to claim Philhealth benefits of an OFW)


Filing a claim for overseas confinements

If an Overseas Filipino member is confined abroad, the following documents must be sent either via overseas courier or electronic mail to the PhilHealth Regional Office or Local Health Insurance Office nearest the OF’s Philippine address within 180 calendar days from the date of discharge:

1. Medical abstract or medical record written in English or copy of Medical Certificate indicating the final diagnosis, confinement period and medical services rendered;



2. Copy of the operative record written in English, if an operation was performed



3. Statement of account

4. Official Receipt issued by the hospital and doctor

5. Properly filled out PhilHealth Claim Form 1

If an Overseas Filipino member or his qualified dependent is confined in the Philippines, a properly filled out PhilHealth Claim Form 1 must be submitted to the Billing Section of the accredited hospital before being discharged.

SEE MORE:








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