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Wednesday, February 24, 2016

How Much Will You Save In Your Medical Bills With Philhealth Insurance Benefits?



Philippine Health Insurance Benefit Packages, HOW MUCH YOU WILL SAVE? - The Insurance Benefits called Case Payment Rates, see the table and watch the videos below to know more about your insurance and benefits.

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
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This article is filed under: Workers Compensation Insurance, International Health Insurance, International Medical Insurance, Online Life Insurance, Get Insurance
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