PhilHealth and the benefits of it as a member. Members covered are all eligible PhilHealth members whether your employed, individually paying (voluntary), lifetime member program, sponsored program, and overseas worker program.
Below are the list of requirements needed and the corresponding amount for the specific cases you avail.
REQUIREMENTS:
a. The member must have at least three (3) months’ premium contributions within the immediate six (6) months before the month of availment.
b. 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
For IN PATIENTS 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.
PhilHealth Z Benefits
Aside from the 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)
To apply the Z package, go can use it for any affiliated hospitals or any government hospital. To know if they are eligible, check for it:
- 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 indeed 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
