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Showing posts with label public health insurance. Show all posts
Showing posts with label public health insurance. Show all posts

Sunday, July 10, 2016

OWWA And PhilHealth Launches New MEDPLUS Program For OFWs


Another hooray for OFWs for their personal health insurance or public health insurance for their families!
The Vice President for Corporate Affairs Group of

PhilHealth, Dr. Israel Francis Pargas announced the recently launched program for Overseas Filipino Workers - the OWWA ad PHILHEALTH OFW MEDPLUS.






 Bandila also reported it here in this video news below.


WHAT IS OFW MedPlus? 

OFW MedPlus is a program worked together by OWWA (Overseas

Workers Welfare Administration) and PhilHealth which provides health assistance and medical health benefit for  OFW (Overseas Filipino Worker)  in case they are confined in hospitals abroad.
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WHO CAN AVAIL THIS BENEFIT?
Aside from the OFW, this assistance can also be availed by the OFW's qualified dependent/s in the Philippines. 
Dr. Pargas further explained, “…it’s a benefit for our active members and PhilHealth members na kung sila ay mao-ospital or maco-confine due to a dreaded disease,[mayroong] on top of [that] na ibibigay ang OWWA as a benefit doon sa ating mga members…This is a 50,000-peso benefit para sa mao-ospital na mga active OWWA and PhilHealth members. So on top of that na binibigay ng PhilHealth, sila ay bibigyan pa rin ng 50,000 [pesos]… although this is for one time financial incentive...”


Requirements For The OFW MedPlus

According to Dr. Pargas, for OFWs to be able to avail the said

benefit, they should qualify to the following:

1. The Overseas Filipino Worker should be an active OWWA and PhilHealth member.

2. The identified illness must be under the category of “dreaded” disease.

3.  The annual benefit limit from PhilHealth hasn’t consumed.

4.   The health care facility where confined is accredited.

Process for Filing Claim Forms


If confined abroad, the Overseas Filipino member should provide

their claim forms (which is also known as PhilHealth Claim Form 1) together with the medical record (or operation record if operation is performed) and Statement of Account. Within 180 days from the date of discharge, it should be sent either via overseas courier or e-mail to the PhilHealth Office or any Local Health Insurance Office nearest to the member.


On  the other hand, if the OFW or his qualified dependent is confined in the Philippines, claim form (PhilHealth Claim Form 1) must be neatly filled out and submitted to the Billing Section of the accredited hospital before the date of  discharged.

SEE ALSO:

REPUBLIC ACT NO. 10645: FREE AND MANDATORY PHILHEALTH COVERAGE FOR ALL SENIOR CITIZENS


Dr. Pargas plainly discussed that the two departments

provided an amount of nearly 150 Million Pesos for this year only. This is favourable to all our OFWs and their families in case of emergency for medical health insurance benefits. Hopefully, this program could help and assist thousands of OFWs across the globe who may have health issues. 

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FOR INQUIRIES :

OWWA HOTLINES
02-551-1560
02-551-6641

Also, you may inquire at their respective offices for further clarifications or you may watch the video segment of "Ikonsulta Mo" in which OFW MedPlus is discussed. Here's the video:

Go to time
1:22:37 - Ikonsulta Mo: Philhealth OFW MEDplus


©2016 THOUGHTSKOTO

Friday, July 08, 2016

REPUBLIC ACT NO. 10645: FREE AND MANDATORY PUBLIC HEALTH INSURANCE COVERAGE FOR ALL SENIOR CITIZENS



REPUBLIC ACT NO. 10645: FREE AND MANDATORY PUBLIC HEALTH INSURANCE COVERAGE FOR ALL SENIOR CITIZENS
As a person gets older, there is a greater chance that they suffer from illnesses because of their weakened immunity. And in our country (Philippines), poverty is one of the main reasons why elderly are neglecting their health issues.
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According to  to Republic Act No. 10645 “All senior citizens shall be covered by the national health insurance program of PhilHealth. Funds necessary to ensure the enrollment of all senior citizens not currently covered by any existing category shall be sourced from the National Health Insurance Fund of PhilHealth from proceeds of Republic Act No. 10351, in accordance with the pertinent laws and regulations."


This is a good news especially for poor senior citizens. They will have the opportunity to get treated without worrying where to get money to pay for the hospital. There's no need to pay for premium contributions in PhilHealth. Funds for this program will be sourced from National Health Insurance Fund of PhilHealth from proceeds of RA No.10351, commonly known as the Sin Tax Law (tax on alcohol and tobacco products).

SEE ALSO:

Who are qualified to enroll for this program?

  • Filipino citizens who are residents of the Philippines, aged sixty (60) years or above and are not currently covered by any membership category of PhilHealth; 
  • Qualified dependents of senior citizen members who are also senior citizen themselves; and
  • Qualified dependents of members belonging to other membership categories, with or without coverage who are senior citizens themselves.
Senior Citizens who are gainfully employed or who remain to have regular sources of income shall continue to pay their premium contributions to PhilHealth under the applicable membership categories.

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How to be a member?


There are two options to enroll as a Senior Citizen member of PhilHealth.
1. Through Office for the Senior Citizens Affairs (OSCA)
  • Submit duly accomplished PMRF to the OSCA in the city or municipality where the elderly resides
  • Await Member Data Record and Identification card issued by PhilHealth through OSCA
2. Through PhilHealth Local Health Insurance Office (LHIO)
  • Attached 1 x 1 photo taken within the last six months;
  • Present Senior Citizens’ Identification Card issued by the OSCA in the city or municipality where the elderly resides or a valid government issued ID.
  • Submit duly accomplished PMRF

  • Await Member Data Record and PhilHealth Identification Card

source: http://www.philhealth.gov.ph/members/senior/

Download the PMRF form here

To avail their benefit, all they need to do is to present in hospitals their senior citizen card,  Philhealth MDR (member data record), or any proof of their identity and age.



REPUBLIC ACT NO. 10645: FREE AND MANDATORY PUBLIC HEALTH INSURANCE COVERAGE FOR ALL SENIOR CITIZENS
©2016 THOUGHTSKOTO

Tuesday, March 08, 2016

AFFORDABLE INSURANCE SYSTEM IN THE PHILIPPINES FROM P200 to P1,000 MONTHLY

Insurance system is composed of three system, the government service insurance system or the GSIS which covers health insurance, optional life insurance, retirement, separation and employees compensation. Another is the public insurance system, the Philippine Health Insurance System or Philhealth. The other public insurance system is the Social Security System. There are other private insurance systems and we opted to gather the affordable ones with at least less than P1,000 monthly contribution.
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Product & Insurer
Maximum Benefit Limit
Pre - Existing Condition
Outpatient Benefit
Accidental Death
Monthly Premiums
In PESOS
PHILHEALTH
NO
YES
P200
SSS
SEE IMAGE
BELOW
Blue Cross Select Standard Plan (Ward) 
500,000.00
YES
25,000.00
P504.25
Eastwest Health Option 2A 
80,000.00
YES
YES
-
P670.08
Medicard Plan 8,000 
50,000.00
YES
YES
20,000.00
P745.75
Eastwest Health Option 1A 
80,000.00
YES
YES
-
P763.25
Eastwest Health Option 2B 
100,000.00
YES
YES
-
P779.25
Blue Cross Select Standard Plan (Semi-private) 
750,000.00
YES
50,000.00
P828.08
Medicard Plan 10,000 
60,000.00
YES
YES
20,000.00
P836.75
Eastwest Health Option 1B 
100,000.00
YES
YES
-
P891.67
Eastwest Health Option 2C 
150,000.00
YES
YES
-
P989.50












































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SSS BENEFIT PACKAGE
source: SSS

©2016 THOUGHTSKOTO

Wednesday, February 24, 2016

HOW MUCH WILL YOU SAVE IN YOUR MEDICAL BILLS WITH PHILHEALTH BENEFIT PACKAGES?

Philippine Health Insurance Benefit Packages, HOW MUCH YOU WILL SAVE? - The Insurance Benefits called Case Payment Rates.

YOUR P2,400 PAYMENT YEARLY, OR YOUR FAMILY MEMBER'S P2,400 PUBLIC INSURANCE COVERAGE SYSTEM, WHAT ARE THE BENEFITS? Check out below.





Watch the video below for more about this info: 

Below contains the lists of insurance benefit packages under the case payment scheme, that are available to all active Philippine Health Insurance members. For OFW's with their dependents, although I suggest if you have extra cash, you can buy them their own insurance, if they are not working or they have no Philhealth membership.



Name of Benefit Package

Maternity Care Package (MCP)
6,500.00

Normal Spontaneous Delivery (NSD) Package
6,500.00

TB-DOTS Package
4,000.00

SARS Package
50,000 - 100,000

Avian Influenza Package
50,000 - 100,000

New Born Care Package (NCP)
1,000.00

Bilateral Tubal Ligation (BTL) Package
4,000.00

Vasectomy Package
4,000.00

Malaria Package
600.00

Influenza A (H1N1) Package
75,000 - 100,000

NSD with BLT Package
10,500.00

Outpatient HIV / AIDS Treatment Package
30,000.00

Dengue I (dengue fever and DHF Grades I and II)*
8,000.00

Dengue II (dengue hermorrhagic fever grades III and IV)*
16,000.00

Pneumonia I (moderate risk)*
15,000.00

Pneumonia II (high risk)*
32,000.00

Essential Hypertension*
9,000.00

Cerebral Infarction (CVA I)*
28,000.00

Cerebro - vascular Accident with Hemorrhage (CVA II)*
38,000.00

Acute Gastroenteritis (AGE)*
6,000.00

Typhoid Fever*
14,000.00

Asthma*
9,000.00

Cesarian Section (CS)*
19,000.00

Dilatation and Curettage (D&C)*
11,000.00

Hysterectomy*
30,000.00

Mastectomy*
22,000.00

Appendectomy*
24,000.00

Cholecystectomy*
31,000.00

Herniorrhaphy*
21,000.00

Thyroidectomy*
31,000.00

Radiotherapy*
3,000.00

Hemodialysis*
4,000.00

Cataract Package*
16,000.00

* Means that Philhealth will pay the health care facility directly inclusive of doctors fee or professional fee, therefore, this is directly deducted to the bill of the eligible PhilHealth member. 

There are other private health insurance available and that will be posted later.






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: copy of Member Data Record or PhilHealth Benefit Eligibility Form (PBEF) and duly accomplished PhilHealth Claim Form 1
Where available: all accredited HCIs*
*Different case rate amounts for selected medical conditions are being implemented when done in Primary Care facilities (PhilHealth Circular 14, s-2013)
Only admissible cases shall be reimbursed



Outpatient Benefits

1. 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
  • Payments for these procedures are made to the accredited facility 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: copy of Member Data Record and duly accomplished PhilHealth Claim Form 1
  • Where available: Accredited Ambulatory Surgical Clinics (ASCs)
2. Radiotherapy
  • The case rate for radiotherapy using cobalt is P2,000 per session and P3,000 per session for linear accelerator
  • Includes radiation treatment delivery using cobalt and linear accelator
  • Claims for multiple sessions may be filed using one (1) claim form for both inpatient and outpatient radiation therapy
  • May be availed of even as second case rate (full case rate amount)
  • 45 days benefit limit: One session is equivalent to one day deduction from the 45 allowable days per year
  • If procedure is done during confinement, only the total number of confinement days shall be deducted
  • Exempted from Single Period of Confinement (SPC) rule (admissions and re-admissions due to same illness or procedure within 90-calendar day period)
  • Availment condition: Member must have at least three (3) months’ premium contributions within the immediate six (6) months prior to the month of availment
  • Where available: Accredited HCIs including Primary Care Facilities that are accredited for the said service
3. Hemodialysis
  • The Case Rate for hemodialysis is P2,600 per session
  • Covers both inpatient and outpatient procedures including emergency dialysis procedures for acute renal failure
  • Claims for multiple sessions may be filed using one (1) claim form for both inpatient and outpatient hemodialysis
  • May be availed of even as second case rate (full case rate amount)
  • 90 days benefit limit: One session is equivalent to one day deduction from the 90 allowable days per year
  • If procedure is done during confinement, only the total number of confinement days shall be deducted
  • The procedure is exempted from Single Period of Confinement rule (admissions and re-admissions due to same illness or procedure within 90-calendar day period)
  • Availment condition: Member must have at least three (3) months’ premium contributions within the immediate six (6) months prior to the month of availment
  • Where available: All Accredited HCIs – this benefit is no longer restricted to hospitals and free standing dialysis centers provided that the service is within their capability as provided for in the DOH license
4. Outpatient Blood Transfusion
  • The case rate for outpatient blood transfusion is P3,640 (one or more units)
  • Includes Drugs & Medicine, X-ray, Lab & Others, Operating Room
  • Covers outpatient blood transfusion only
  • One day of transfusion of any blood or blood product, regardless of the number of bags, is equivalent to one session
  • May be availed of as second case rate (full case rate amount)
  • 45 days benefit limit: One session for each procedure is equivalent to one day deduction from the 45 allowable days per year Exempted from the SPC rule
  • Where to avail: All Accredited HCIs
5. PCB 1
i. Preventive Services
  1. 1. Consultation
  2. 2. Visual inspection with acetic acid
  3. 3. Regular BP measurements
  4. 4. Breastfeeding program education
  5. 5. Periodic clinical breast examinations
  6. 6. Counseling for lifestyle modification
  7. 7. Counseling for smoking cessation
  8. 8. Body measurements
  9. 9. Digital rectal examination
ii. Diagnostic Examinations (as recommended by the doctor)
  1. 1. Complete blood count
  2. 2. Urinalysis
  3. 3. Fecalysis
  4. 4. Sputum microscopy
  5. 5. Fasting blood sugar
  6. 6. Lipid Profile
  7. 7. Chest x-ray
iii. Drugs and Medicines
  1. 1. Asthma including nebulisation services
  2. 2. Acute Gastroenteritis (AGE) with no or mild dehydration
  3. 3. Upper Respiratory Tract Infection (URTI)/Pneumonia (minimal and low risk)
  4. 4. Urinary Tract Infection (UTI)
  • Payments for these services are made to the primary care provider through Per Family Payment Rate (PFPR)
  • Availment condition: Indigent and Sponsored Members, as well as migrant workers and their legal dependents should avail of these benefits within the effectivity of their coverage as indicated in their PhilHealth ID cards or Member Data Records. iGroup (Gold) members may avail themselves of these benefits within the validity of their group policy contracts, while DepEd personnel may avail themselves of the benefits as long as they are still active members of PhilHealth
  • Documents needed: Copy of Member Data Record or PhilHealth ID
  • Where available: accredited rural health units, health centers or outpatient departments of selected government hospitals where members are enlisted
©2016 THOUGHTSKOTO

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