9/21/2016

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Benets

Inpatient | Outpatient | Z Benets | MDG Related

InpatientBenefits
ThesebenefitsarepaidtotheaccreditedHealthCare
All Case Rates
Institution(HCI)throughAllCaseRates
ThecaserateamountshallbedeductedbytheHCIfromthe
memberstotalbill,whichshallincludeprofessionalfeesof
attendingphysicians,priortodischarge
Thecaserateamountisinclusiveofhospitalchargesand
professionalfeesofattendingphysician
Availmentcondition:Membermusthaveatleastthree(3)
monthspremiumcontributionswithintheimmediatesix(6)
monthspriortothemonthofavailment
Documentsneeded:copyofMemberDataRecordorPhilHealth
BenefitEligibilityForm(PBEF)anddulyaccomplished
PhilHealthClaimForm1
Whereavailable:allaccreditedHCIs*
*Differentcaserateamountsforselectedmedicalconditions
arebeingimplementedwhendoneinPrimaryCarefacilities(PhilHealthCircular14,s2013)
Onlyadmissiblecasesshallbereimbursed
Backtotop

OutpatientBenefits
1.DaySurgeries(AmbulatoryOrOutpatientSurgeries)AreServicesThatIncludeElective(NonEmergency)
SurgicalProceduresRangingFromMinorToMajorOperations,WherePatientsAreSafelySentHomeWithinThe
SameDayForPostOperativeCare
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Benefits| PhilHealth

PaymentsfortheseproceduresaremadetotheaccreditedfacilitythroughAllCaseRates
ThecaserateamountshallbedeductedbytheHCIfromthememberstotalbill,whichshallincludeprofessionalfeesof
attendingphysicians,priortodischarge
Thecaserateamountisinclusiveofhospitalchargesandprofessionalfeesofattendingphysician
Availmentcondition:Membermusthaveatleastthree(3)monthspremiumcontributionswithintheimmediatesix(6)
monthspriortothemonthofavailment
Documentsneeded:copyofMemberDataRecordanddulyaccomplishedPhilHealthClaimForm1
Whereavailable:AccreditedAmbulatorySurgicalClinics(ASCs)

2.Radiotherapy
ThecaserateforradiotherapyusingcobaltisP2,000persessionandP3,000persessionforlinearaccelerator
Includesradiationtreatmentdeliveryusingcobaltandlinearaccelator
Claimsformultiplesessionsmaybefiledusingone(1)claimformforbothinpatientandoutpatientradiationtherapy
Maybeavailedofevenassecondcaserate(fullcaserateamount)
45daysbenefitlimit:Onesessionisequivalenttoonedaydeductionfromthe45allowabledaysperyear
Ifprocedureisdoneduringconfinement,onlythetotalnumberofconfinementdaysshallbededucted
ExemptedfromSinglePeriodofConfinement(SPC)rule(admissionsandreadmissionsduetosameillnessorprocedure
within90calendardayperiod)
Availmentcondition:Membermusthaveatleastthree(3)monthspremiumcontributionswithintheimmediatesix(6)
monthspriortothemonthofavailment
Whereavailable:AccreditedHCIsincludingPrimaryCareFacilitiesthatareaccreditedforthesaidservice

3.Hemodialysis
TheCaseRateforhemodialysisisP2,600persession
Coversbothinpatientandoutpatientproceduresincludingemergencydialysisproceduresforacuterenalfailure
Claimsformultiplesessionsmaybefiledusingone(1)claimformforbothinpatientandoutpatienthemodialysis
Maybeavailedofevenassecondcaserate(fullcaserateamount)
90daysbenefitlimit:Onesessionisequivalenttoonedaydeductionfromthe90allowabledaysperyear
Ifprocedureisdoneduringconfinement,onlythetotalnumberofconfinementdaysshallbededucted
TheprocedureisexemptedfromSinglePeriodofConfinementrule(admissionsandreadmissionsduetosameillnessor
procedurewithin90calendardayperiod)
Availmentcondition:Membermusthaveatleastthree(3)monthspremiumcontributionswithintheimmediatesix(6)
monthspriortothemonthofavailment
Whereavailable:AllAccreditedHCIsthisbenefitisnolongerrestrictedtohospitalsandfreestandingdialysiscenters
providedthattheserviceiswithintheircapabilityasprovidedforintheDOHlicense

4.OutpatientBloodTransfusion
ThecaserateforoutpatientbloodtransfusionisP3,640(oneormoreunits)
IncludesDrugs&Medicine,Xray,Lab&Others,OperatingRoom
Coversoutpatientbloodtransfusiononly
Onedayoftransfusionofanybloodorbloodproduct,regardlessofthenumberofbags,isequivalenttoonesession
Maybeavailedofassecondcaserate(fullcaserateamount)
45daysbenefitlimit:Onesessionforeachprocedureisequivalenttoonedaydeductionfromthe45allowabledaysper
yearExemptedfromtheSPCrule
Wheretoavail:AllAccreditedHCIs

5.PCB1
i.PreventiveServices
1.Consultation
2.Visualinspectionwithaceticacid
3.RegularBPmeasurements
4.Breastfeedingprogrameducation
5.Periodicclinicalbreastexaminations
6.Counselingforlifestylemodification
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Benefits| PhilHealth

7.Counselingforsmokingcessation
BenefitPackageand
Selectionscriteria
8.Bodymeasurements
AmountofBenefit

Whereavailable

9.Digitalrectalexamination

ii.DiagnosticExaminations(asrecommendedbythedoctor)
1.Completebloodcount
2.Urinalysis
3.Fecalysis
4.Sputummicroscopy
5.Fastingbloodsugar
6.LipidProfile
7.Chestxray

iii.DrugsandMedicines
1.Asthmaincludingnebulisationservices
2.AcuteGastroenteritis(AGE)withnoormilddehydration
3.UpperRespiratoryTractInfection(URTI)/Pneumonia(minimalandlowrisk)
4.UrinaryTractInfection(UTI)
PaymentsfortheseservicesaremadetotheprimarycareproviderthroughPerFamilyPaymentRate(PFPR)
Availmentcondition:IndigentandSponsoredMembers,aswellasmigrantworkersandtheirlegaldependentsshould
availofthesebenefitswithintheeffectivityoftheircoverageasindicatedintheirPhilHealthIDcardsorMemberData
Records.iGroup(Gold)membersmayavailthemselvesofthesebenefitswithinthevalidityoftheirgrouppolicycontracts,
whileDepEdpersonnelmayavailthemselvesofthebenefitsaslongastheyarestillactivemembersofPhilHealth
Documentsneeded:CopyofMemberDataRecordorPhilHealthID
Whereavailable:accreditedruralhealthunits,healthcentersoroutpatientdepartmentsofselectedgovernmenthospitals
wheremembersareenlisted
Backtotop

ZBenefits
Z Benets Testimonials

Z Benets Infomercial

BenefitPackageand
AmountofBenefit

https://www.philhealth.gov.ph/benefits/

Selectionscriteria

Whereavailable

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BenefitPackageand
AmountofBenefit
AcuteLymphocytic/Lymphoblastic
Leukemia(standardrisk)
P210,000

Benefits| PhilHealth
Selectionscriteria

Whereavailable

a.SignedMemberEmpowerment(ME)Form

NCR
PhilippineChildren'sMedicalCenter

b.Age1tolessthan10yearsold
UPPhilippineGeneralHospital
c.Whitebloodcellcount50,000/L
d.NoCNSleukemiaatdiagnosis

RegionI
IlocosTrainingandRegionalMedicalCenter

e.Thereshouldbenotesticularinvolvementof
malepatientatdiagnosisand

CAR
BaguioGeneralHospitalandMedicalCenter

f.WHOClassification:BorTlymphoblastic
leukemiaimmunophenotype(matureBcellALLor
Burkittleukemiaareexcluded).

RegionIIIA
JoseB.LingadMemorialRegionalHospital
RegionIIIB
Dr.PaulinoJ.GarciaMemorialResearch&
MedicalCenter
RegionIVB
MaryMediatrixMedicalCenter
RegionV
BicolRegionalTrainingandTeachingHospital
BicolMedicalCenter
RegionVI
CorazonLocsinMontelibanoMemorialRegional
Hospital
WesternVisayasMedicalCenter
RegionVII
VicenteSottoMemorialMedicalCenter
RegionX
NorthernMindanaoMedicalCenter
RegionXI
SouthernPhilippinesMedicalCenter

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BenefitPackageand
AmountofBenefit
BreastCancer
(stage0toIIIA)
P100,000

Z Benets - Breast C...

Benefits| PhilHealth
Selectionscriteria

Whereavailable

a.SignedMEForm

NCR
EastAvenueMedicalCenter

b.ClinicalandTNMstaging:
Stage0TisN0M0
StageIAT1N0M0
StageIBT0,T1N1M0
StageIIBT2N1M0orT3N0M0
StageIIIAT0,T1,T2N2M0orT3N1N2M0

QuirinoMemorialMedicalCenter
NationalKidneyandTransplantInstitute
UPPhilippineGeneralHospital
RizalMedicalCenter
RegionI
IlocosTrainingandRegionalMedicalCenter
RegionII
CagayanValleyMedicalCenter
CAR
BaguioGeneralHospitalandMedicalCenter
RegionIIIB
Dr.PaulinoJ.GarciaMemorialResearchand
MedicalCenter
RegionIVB
BatangasMedicalCenter
RegionV
BicolMedicalCenter
BicolRegionalTeachingandTrainingHospital
RegionVI
CorazonLocsinMontelibanoMemorialHospital
WesternVisayasMedicalCenter
RegionVII
VicenteSottoMemorialMedicalCenter
RegionX
NorthernMindanaoMedicalCenter
RegionXI
DavaoRegionalHospital
SouthernPhilippinesMedicalCenter

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BenefitPackageand
AmountofBenefit
ProstateCancer
(lowtointermediaterisk)
P100,000

Benefits| PhilHealth
Selectionscriteria

Whereavailable

a.SignedMEForm

NCR
QuirinoMemorialHospital

b.Malepatientsageupto70yearsold
NationalKidneyandTransplantInstitute
c.Clinicalstage(T1aT2c),PSAlevel10to20
ng/ml,
TumorGrade(Gleasonsscoreof27)
Lowrisk:T1T2aandGleasonscore26,and
PSA10ng/ml
Intermediaterisk:T2btoT2c,Gleasonscoreof
7,
andPSA1020ng/ml
d.Localizedprostatecancerand

UPPhilippineGeneralHospital
RegionI
IlocosTrainingandRegionalMedicalCenter
CAR
BaguioGeneralHospitalandMedicalCenter
RegionV
BicolMedicalCenter

e.Nouncontrolledcomorbidconditions
BicolRegionalTeachingandTrainingHospital
RegionVI
WesternVisayasMedicalCenter
CorazonLocsinMontelibanoMemorialRegional
Hospital

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BenefitPackageand
AmountofBenefit
Endstaterenaldiseaseeligibleforrequiring
kidneytransplantation(lowrisk)
P600,000

Benefits| PhilHealth
Selectionscriteria

Whereavailable

a.SignedMEForm

NCR
NationalKidneyandTransplantInstitute

b.Age10and70years
UPPhilippineGeneralHospital
c.Singleorgantransplant
St.Luke'sMedicalCenterGlobalCity
d.Patientonchronicdialysisbecauseofendstage
renaldiseaseorpatientforpreemptivekidney
transplantationwiththefollowing:
i.Thepotentialrecipientshouldhavean
irreversiblerenaldiseasethathasbeenprogressive
overtheprevious612months
ii.Therecipientsmeasured(nuclearscan)
glomerularfiltrationrate,24hoururinecreatinine
clearanceorcalculatedglomerularfiltrationrate
shouldbelessthan20ml/min/1.73m2indiabetics
orlessthan15ml/min/1.73m2inpatientswith
nondiabeticrenaldisease
e.Lowimmunologicriskdefinedas:
i.PastPanelReactiveAntibody(PRA)lessthanor
equalto20%
ii.Primarykidneytransplant(noprevioussolid
organtransplant)
iii.Nodonorspecificantibody(DSA)inthe
potentialrecipient
iv.Atleast1HLADRmatch

RegionI
LormaMedicalCenter
RegionIIIA
AngelesUniversityFoundationMedicalCenter
RegionVI
St.Paul'sHospitalofIloilo,Inc.
RegionVII
VicenteSottoMemorialMedicalCenter
RegionX
NorthernMindanaoMedicalCenter
RegionXI
DavaoRegionalHospital

f.Potentialrecipienthasnoprevioushistoryof
cancer(exceptbasalcellskincancer),shouldbe
HIVnegative,HepatitisBsurfaceantigen
negative,andHepatitisCantibodynegative
g.TransplantcandidatewhoisCMVnegative
cannotreceiveanorganfromaCMVpositive
donor.
h.Absenceofcurrentsevereillness(Congestive
heartfailureClass34,livercirrhosis(findingsof
smallliverwithcoarsegranular/heterogenousecho
patternwithsignsofportalhypertension),chronic
lungdiseaserequiringoxygen,etc)
i.Absenceofthefollowing:hemiparalysisbecause
ofstroke,legamputationbecauseofperipheral
vasculardiseaseordiabetes,mentalretardation
suchthatinformedconsentcannotbemade,and
substanceabuseforatleast6monthspriorto
startoftransplantworkup.
j.Eligiblepatientforkidneytransplantmusthavea
certificationfromthesocialserviceofthehospital
thattheycanmaintainantirejectionmedicinesfor
thenextthree(3)years.

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BenefitPackageand
AmountofBenefit
CoronaryArteryBypassGraftSurgery
(standardrisk)
P550,000

Benefits| PhilHealth
Selectionscriteria

Whereavailable

a.SignedMEForm

NCR
PhilippineHeartCenter

b.Age1970years
UPPhilippineGeneralHospital
c.StableCoronaryArteryDiseaserequiring
ELECTIVEISOLATEDCoronaryArteryBypassGraft
Surgery(CABG)withindicationbasedoncoronary
anatomy,symptomseverity,LVfunction,and/or
viabilitytestsnoninvasivetestingcompletedand
discussedwithpatient
d.CurrentMedicalStatus
i.Notinseveredecompensatedheartfailure
(NYFCIV)
ii.Notwithsevereangina(CCSClassIII)
iii.Noothercardiac/vascularprocedures
/interventionsplannedtobedonewithCABG
duringtheadmission

RegionIIIA
AngelesUniversityFoundationMedicalCenter
RegionVII
VicenteSottoMemorialMedicalCenter
RegionX
NorthernMindanaoMedicalCenter
RegionXI
SouthernPhilippinesMedicalCenter

e.PastHistory:
i.NopreviouscardiacsurgerysuchasCABG,valve
surgery,etc.
ii.Noprevioustranscutancouscardiacintervention
suchascoronaryangioplastyorstenting
f.ONLINEEUROSCOREIIand/orSTSscoring
predictiveoflowmortalityrisk(5%)
SurgeryforTetralogyofFallotinChildren
P320,000

a.SignedMEForm

NCR
PhilippineHeartCenter

b.Age:1to10years+364days
UPPhilippineGeneralHospital
c.2Dechocardiogram:
i.Pulmonaryarterysize
McGoonsindex(Aorta/Paratio)1.5
ZscorePulmonaryValveAnnulus:Acceptableif
zscore/BSA:3orbetter
ZscoreperipheralPAs:Acceptableif2or
better
ii.Absenceofmajoraortopulmonarycollateral
arteries(MAPCAs)

RegionX
NorthernMindanaoMedicalCenter
RegionXI
SouthernPhilippinesMedicalCenter

d.Ifcardiaccatheterization/hemodynamicstudy
available:PAsize:adequatebyZscorestandards/
BSA
e.Nopreviouscardiacsurgery(BlalockTaussig
Shunt)
f.FunctionalClassIII
g.Nocomorbidfactors,suchasanyoftheff:
i.Preoperativeseizures
ii.Brainabscess
iii.Strokeevents
iv.Bleedingdisorders
v.Infectiveendocarditis
vi.Othercongenitalanomalies

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BenefitPackageand
AmountofBenefit
SurgeryforVentricularSeptalDefectin
Children
P250,000

Benefits| PhilHealth
Selectionscriteria

Whereavailable

a.SignedMEForm

NCR
PhilippineHeartCenter

b.Age:1to5years+364days
UPPhilippineGeneralHospital
c.2Dechocardiography
i.IsolatedVSDperimembranous,subaorticor
subpulmonic
ii.Nocombinedshuntssuchasatrialseptaldefect
orpatentductusarteriosusoratrioventricular
septaldefect
iii.NootherassociatedCHDs:suchascoarctation
oftheaorta,ormoderatetosevereaortic
insufficiency,ormoderatetoseverepulmonic
stenosis
iv.Pulmonaryarterypressure:50mmHgorat
least2/3systolicbloodpressure
v.QPQS:>1.5:1

RegionX
NorthernMindanaoMedicalCenter
RegionXI
SouthernPhilippinesMedicalCenter

d.Nopreviouscardiacsurgery(PABanding)
e.FunctionalClassIII
f.Nocomorbidfactors,suchasanyoftheff:
i.Preoperativeseizures
ii.Brainabscess
iii.Strokeevents
iv.Bleedingdisorders
v.Infectiveendocarditis
g.Nochromosomalabnormalitiesandother
associatedcongenitaldefects
CervicalCancer:

ChemoradiationwithCobaltand
Brachytherapy(lowdose)orPrimary
surgeryforStageIA1,IA2IIA1
P120,000

a.SignedMEForm
b.Nopreviouschemotherapy
c.Nopreviousradiotherapy

ChemoradiationwithLinearAcceleratorand
Brachytherapy(highdose)
P175,000

d.Nouncontrolledcomorbidconditions

ZMORPH(Mobility,
Orthosis,Rehabilitation,ProsthesisHelp)
firstrightand/orleftbelowtheknee
P15,000

a.SignedMEForm

bothlimbs
P30,000

RegionVII
VicenteSottoMemorialMedicalCenter
RegionIX
ZamboangaCityMedicalCenter

e.Treatmentplanfromgynecologiconcologist

b.Noassociateddisabilitiesorcomorbidities,such
ascontractures,deformities,mentalorbehavioral
incapacity,quadriparesis,cardiopulmonarydisease
c.Communityambulationwithorwithoutcane,
crutchesorwalker

NCR
UniversityoftheEastRamonMagsaysay
MemorialMedicalCenter
UPPhilippineGeneralHospital
RegionIX
ZamboangaCityMedicalCenter

d.Atleastthree(3)monthspostamputation,if
acquiredand
e.Atleast15yearsand364daysofage,if
congenital.
SelectedOrthopedicImplants
1.ImplantsforHipArthroplasty
ImplantsHipProsthesis,cemented*
P103,400
TotalHipProsthesis,cementless**
P169,400
PartialHipProsthesis,bipolar

https://www.philhealth.gov.ph/benefits/

a.SignedMEForm
b.ClinicalFeatures
i.hipfracture
1.withavascularnecrosisofthefemoral
headOR
2.neglectedfractureofthehipOR
3.hipfracturewithpreexistingcox

NCR
PhilippineOrthopedicCenter
CAR
BaguioGeneralHospitalandMedicalCenter
RegionVI
CorazonLocsinMontelibanoMemorialRegional
Hospital

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Benefits| PhilHealth

P73,180
BenefitPackageand
AmountofBenefit
*cemented:66yearsoldandabove
**cementless:65yearsand364days
oldandbelow

arthritisOR
Selectionscriteria
4.displacedhipfracture

Z Bene t Rates for S...

ii.withavascularnecrosisofthefemoral
head(FICATStageIIIandIV)OR
iii.hipdysplasia(CROWEIIV)OR
iv.severeosteoarthritisOR
v.severeinflammatoryjointdisease
(rheumatoid,gout,psoriatic,ankylosing
spondylitis)

Whereavailable
RegionVII
VicenteSottoMemorialMedicalCenter
RegionIX
ZamboangaCityMedicalCenter
RegionX
NorthernMindanaoMedicalCenter

c.Preinjurystatus:ambulatorypatients
d.Withnomorethantwocomorbidillnesses
basedon:Physicalstatusclassificationbasedon
ASA(lowtomoderaterisk)

ASAInormalhealthypatient
ASAIIPatientwithmildsystematicdisease
nofunctionallimitation

a.SignedMEForm

b.Anyhipfracturenotcoveredunderthetotal
hippackageforfemoralneckfracture
i.withnoavascularnecrosisofthefemoral
headOR
ii.acutefractureofthehipOR
iii.hipfracturewithnopreexistingcox
arthritisOR
iv.displacedhipfracture

2.ImplantsforHipFixation
Multiplescrewfixation(MSF)***
6.5mmcannulatedcancellousscrews
withwasher
P61,500

c.Preinjurystatus:ambulatorypatients

***59yearsand364daysoldandbelow
(bothdisplacedandundisplaced
fracture)60yearsoldandabove
(undisplacedfracture)

ASAInormalhealthypatient
ASAIIPatientwithmildsystematicdisease
nofunctionallimitation

d.Withnomorethantwocomorbidillnesses
basedon:Physicalstatusclassificationbasedon
ASA(lowtomoderaterisk)

a.SignedMEForm

3.ImplantsforPertrochantericFracture
CompressionHipScrewSet(CHS)
P69,000

https://www.philhealth.gov.ph/benefits/

b.CHS:stablefractureoftheintertrochanteric
area(AOClassificationTypeA1fracture)
c.PFLP:unstable/comminutedpertrochanteric
fracture(AOClassificationTypeA2andA3
fracture)
d.Preinjurystatus:ambulatorypatients
e.Withnomorethantwocomorbidillnesses
basedon:Physicalstatusclassificationbasedon
ASA(lowtomoderaterisk)
ASAInormalhealthypatient

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ProximalFemoralLockedPlate(PFLP)
BenefitPackageand
P71,000
AmountofBenefit

Benefits| PhilHealth
ASAIIPatientwithmildsystemicdiseaseno
Selectionscriteria
functionallimitation

Whereavailable

a.SignedMEForm
b.Femoralshaftfracture
i.withoutmalignant/metastaticpathologic
fracture:AND
ii.withanycompletefractureofthefemur
Preinjurystatus:ambulatorypatients

4.ImplantsforFemoralShaftFracture
IntramedullaryNailwithInterlocking
Screws
P48,740

c.PhysicalstatusclassificationbasedonASA
(lowtomoderaterisk)
ASAInormalhealthypatient
ASAIIPatientwithmildsystemicdisease:no
functionallimitation

LockedCompressionPlate(LCP)
Broad/Metaphyseal/DistalFemoralLC
P50,740

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BenefitPackageand
AmountofBenefit
PDFirstforEndStageRenalDisease
RequiringPeritonealDialysis
P270,000peryear

Benefits| PhilHealth
Selectionscriteria

Whereavailable

a.SignedMEForm(tobesubmittedannually
togetherwiththepreauthorization)

NCR
NationalKidneyTransplantInstitute

b.PatientsmusthaveapermanentTenckhoff
peritonealdialysiscatheterproperlyplacedinthe
abdominalcavity

RegionVI
CorazonLocsinMontelibanoMemorialRegional
Hospital

c.PatientsmusthavecompletedPDinitiationin
anaccreditedhealthcareinstitutionsothatthe
patientisnolongeruremic,withstablevitalsigns
andadequatelytrained(patienthimself/herselfor
acaregiver)toperformPDathomeusingmanual
exchanges
ClinicalCriteria
i.Mustbeatleast10yearsofage
ii.Diagnosedtohaveendstagerenaldisease
requiringrenalreplacementtherapy
iii.Noprevioushistoryofcancerotherthana
successfullyandcompletelytreatedcutaneous
squamouscellorbasalcellcarcinomaorcarcinoma
insituofthecervix,withinthepast5years
iv.HIVnegative
v.Nomentalincapacitysuchthatinformed
consentcannotbemadeorthatwouldinterfere
withthepatientsabilitytocomplywiththePD
prescription
vi.Forpediatricpatients,aged10to18yearsand
364days,informedconsentfromtheparentsor
whenappropriate,fromtheguardian,mustbe
secured
vii.Absenceofcurrentsevereillness,including
congestiveheartfailureClassIV,livercirrhosis
(findingsofsmallliverwithcoarse
granular/heterogeneousechopatternwithsigns
ofportalhypertension)andchroniclungdisease
requiringoxygen
viii.Absenceofhemiparalysisandlegamputation
becauseofperipheralvasculardisease
ix.Nohistoryofsubstanceabuseforatleast3
monthspriortostartofchronicdialysistreatment
x.Absenceofanydiseaseoftheabdominalwall,
suchasinjuryorsurgery,burns,hernia,extensive
dermatitisinvolvingtheabdomen
xi.Absenceofanyinflammatoryboweldiseases
(ex.Crohnsdisease,ulcerativecolitisor
diverticulitis)
xii.Absenceofanyintraabdominaltumorsor
intestinalobstruction
xiii.Absenceofactiveserositis
xiv.AbsenceofknownorsuspectedallergytoPD
solutions

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BenefitPackageand
AmountofBenefit

Benefits| PhilHealth
Servicesincluded
Selectionscriteria

ColonandRectumCancer
ColonCancer
StageIII(lowrisk)P150,000
StageII(highrisk)IIIP300,00

1.SignedMemberEmpowerment(ME)Form

RectumCancer
StageI(clinicalandpathologic)P150,000
PreoperativeclinicalstageI
butwithpostoperativepathologic
stageIIIII
usinglinearacceleratorasmodeof
radiotherapy)P400,000
usingcobaltasmodeofradiotherapy
P320,000

b.Preoperativephysicalriskclassification
ASAInormalhealthpatientOR
ASAIIpatientwithmildsystemicdisease

ForColonCancer

Where
Whereavailable
Conditions
available
NCR
UPPhilippineGeneralHospital

a.ClinicalandTNMStagingfromstageItoIII
(ClinicallyT1T4,N02,M0)

c.ECOGPerformanceStatus
d.Mandatoryandotherservices(procedures,
diagnostics,medicines&others)
e.SeeTable1ofCircularNo.0282015

ClinicalStageIIIII
usinglinearacceleratorasmodeof
radiotherapy)P400,000
usingcobaltasmodeofradiotherapy
P320,000

ForRectumCancer

a.BiopsyprovenrectumcancerstagesItoIII
(clinicallyT14,N02,M0)
b.Nopreviouspelvicradiation
c.Preoperativephysicalriskprotection
ASAInormalhealthpatientOR
ASAIIpatientwithmildsystemicdisease
d.ECOGPerformanceStatus
e.Mandatoryandotherservices(procedures,
diagnostics,medicines&others)
SeeTables6,7,8ofCircularNo.0282015
AsofMarch31,2016

Backtotop

MDGRelated
BenefitPackageand
AmountofBenefit

Servicesincluded

Where
available

Conditions
Patientsdiagnosedwith
malariaconfirmedeither
through:
a.Microscopydetectionof
malariaparasitesinGiemsa
stainedbloodsmearor
b.RapidDiagnosticTest(RDT)
inareaswithnoaccessto
microscopycentersorduring
outbreaks.

OutpatientMalariaPackage
P600.00

Diagnosticmalariasmearsandotherlaboratory
proceduresdrugsandmedicines&consultation
services,includingpatienteducation&counseling.

Initialproviders
arethe
accredited
facilitiesforthe
Outpatient
benefitforthe
indigent
members,i.e
RuralHealth
Units(RHUs)

OutpatientHIVAIDSPackage
P30,000.00peryear
(P7,500/quarter)

Drugsandmedicines,laboratoryexaminations,
includingClusterDifference4(CD4)level
determinationtestandtestformonitoringofanti
retroviraldrugs(ARV)toxicityandprofessional
feesofproviders

DOH
CasesconfirmedbySTD/AIDS
designated
CentralCooperativeLaboratory
treatmenthubs (SACCL)orResearchInstitute
forTropicalMedicine(RITM).

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BenefitPackageand
AmountofBenefit
OutpatientAntiTuberculosisTreatment
throughDirectlyObservedTreatment
Shortcourse(DOTS)Package
P4,000

Benefits| PhilHealth
Servicesincluded

Where
available

Diagnosticexams,consultationservices,drugs,
healtheducationandcounselingduringtreatment

AccreditedTB
DOTSCenters

TBcasesthataresusceptible
to1stlineantiTBdrugs
Coversadultandchildren
underthefollowing
registrationgroups:
New
Retreatment
Relapse
TreatmentAfterFailure
TreatmentAfterLostto
Followup
(ReturnAfterDefault)
PreviousTreatment
OutcomeUnknown
Transferin

Healthcarefacilityfeecomponenttocoverall
applicablehealthfacilitychargesinclusiveofanyof
thefollowing:

Accredited
hospitals,
ambulatory
surgicalclinics
(ASCs)and
Primarycare
facilities(For
Nonscalpel
vasectomy
only)

Vasectomyincludingnon
scalpelvasectomyLigationor
transectionoffallopiantube
(s),abdominalorvaginal
approach

P2,500Intensivephase
P1,500MaintenancePhase

VoluntarySurgicalContraception
Procedures
P4,000.00

RoomandBoard
Drugsandmedicinesusedduringsurgeryor
confinement
Xray,laboratoryandotherancillaryprocedures
Suppliesusedduringsurgeryorconfinement
Useofspecialroomse.g.,operatingroom,
recoveryroom

Conditions

Physicianfeecomponenttocoveranyofthe
following:
Familyplanningcounselingandclientassessment
Intraoperativeservicesincludingprovisionof
anesthesia
Postoperativeconsultationwithin90daysfrom
dayofsurgeryincludingdressingchanges,local
incisioncare,removalofsutures,managementof
complicationsthatdonotrequirehospitalization

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9/21/2016
BenefitPackageand
AmountofBenefit
AnimalBiteTreatmentPackage
P3,000.00

Benefits| PhilHealth
Servicesincluded
i.Rabiesvaccine
PurifiedVeroCellRabiesVaccine(PVRV)or
PurifiedChick:EmbryoVaccine(PCECV)
ii.RabiesImmuneGlobulin(RIG)
HumanRabiesImmuneGlobulin(HRIG)or
PurifiedEquineRabiesImmuneGlobulin(pERIG)
iii.Localwoundcare
iv.Tetanustoxoidandantitetanusserum(ATS)
v.Antibiotics
vi.Suppliessuchas,butnotlimitedto,syringes,
cotton,alcoholandotherantiseptics

Where
available
PhilHealth
accredited
AnimalBite
Treatment
Centers

Conditions
Thispackageshallcoverthe
following:
a.ThecostofprovidingPost
exposureProphylaxis(PEP)
services.Thefollowingare
identifiedasreimbursablePEP
serviceitems:
i.Rabiesvaccine
PurifiedVeroCellRabies
Vaccine(PVRV)or
PurifiedChick:Embryo
Vaccine(PCECV
ii.RabiesImmuneGlobulin
(RIG)
HumanRabiesImmune
Globulin(HR1G)or
PurifiedEquineRubies
ImmuneGlobulin(pERIG)
iii.Localwoundcare
iv.Tetanustoxoidandanti
tetanusserum(ATS)
v.Antibiotics
vi.Suppliessuchas,butnot
limitedto,syringes,cotton,
alcoholandotherantiseptics
b.Dogbitesprimarily.
However,personsbittenby
otherdomesticanimals(cats)
andlivestock(cows,pigs,
horses,goats)aswellaswild
animals(bats,monkeys)may
becovered.
c.CategoryIIIRabies
exposure
i.Transdermalbite(puncture
wounds,lacerations,avulsions)
orscratches/abrasionswith
spontaneousbleeding
ii.Exposuretoarabiespatient
throughbites,contamination
ofmucousmembranes(eyes,
oral/nasalmucosa,genital/anal
Mucousmembraneoropen
skinlesionswithbodyfluids
throughsplatteringand
mouthtomouthResuscitation
iii.Handlingofinfectedcarcass
oringestionofrawinfected
meativ.CategoryIIRabies
exposureinvolvingthehead
andneckc.Patientswith
repeatexposure

Documentsneeded:copyofMemberDataRecordandPhilHealthClaimForm1

Backtotop

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9/21/2016

Benefits| PhilHealth

2014PhilippineHealthInsuranceCorporation|CitystateCentre,709ShawBoulevard1603PasigCity|CallCenter(+632)4417442

https://www.philhealth.gov.ph/benefits/

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