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PhilHealth Benefits You Didn’t Know You Have

PhilHealth is a government agency that was created to provide affordable, accessible and easily available health insurance coverage to the citizens of the Philippines. This includes employees, senior citizens, OFWs, dependents and even the less fortunate people who couldn’t afford to pay their medical bills.

PhilHealth

via philhealth.gov.ph

So if you are one of the Filipinos who is a member of the national health insurance program, it is important to know your rights, the benefits you can avail and what your beneficiaries can acquire from their program. So without further ado, here are the benefits package and amount that you can claim if you are a member of PhilHealth.

 

Basic Benefits:

Not only you but also your dependents are entitled to claim all PhilHealth benefits for each sickness or operation in accredited medical centers

  • Each year you can claim a total of 45 days of hospitalization allowance
  • Each year your dependent can claim a total of 45 days of hospitalization allowance (if more than one dependent, the number of days will be equally divided for each of them)

And to know how much discount you can avail when claiming your basic benefit, below are the packages and the amount of discount you can get for each case:

Outpatient and Z Benefits:

1. Malaria Patients

Patients diagnosed with this condition can avail 600 pesos worth of services including laboratory procedures, medicine and drugs, and consultation services. This service can only be availed in rural health units accredited by PhilHealth.

2. HIV-Aids Patients

Patients diagnosed with this condition can avail as much as 30,000 pesos a year or 7,500 pesos per quarter worth of services. This includes laboratory examination, medicines and drugs, and professional fees in DOH designated treatment facilities.

3. Anti-Tuberculosis Treatment for Patients

Depending on the TB case, an outpatient may be allowed to up to 4,000 pesos worth of services from accredited TB-DOTS centers. The services include consultation, diagnostic exams, drugs, counseling, and health education.

4. Voluntary Vasectomy Patients

If you are considering to undergo Vasectomy, PhilHealth offers a 4,000 pesos package that you can avail of accredited hospitals and primary care facilities. The package should cover all charges including room and board, medicines and drugs, laboratory, X-ray, and any other ancillary procedures, use of operating room, and supplies during surgery.

5. Animal Bite Patients

Members who need to undergo animal bite treatment can avail PhilHealth’s 3,000 pesos package. This includes the vaccine, Rabies Immune Globulin, Tetanus toxoid and anti tetanus serum, antibiotics, and supplies used in the treatment.

6.Acute Lymphocytic / Lymphoblastic Leukemia Patients

Patients of this condition that are 1 to 10 years old, with less than 50,000/µL white blood cell count, no CNS Leukemia at diagnosis, no testicular involvement (for male patients) at diagnosis and classified as B or T lymphoblastic Leukemia immunophenotype can avail this package.

If the patient qualifies, he will be able to avail up to 210,000 worth of services in accredited medical centers and hospital.

7.Breast Cancer Patients

Depending on the patient’s case and stage, she may be able to avail as much as 100,000 worth of services in accredited medical centers and hospitals. In NCR, East Avenue Medical Center, Quirino Memorial Medical Center, UP-Philippine General Hospital, National Kidney Transplant Institute and Rizal Medical Center can provide the services.

8.Prostate Cancer Patients

Male patients up to 70 years old can avail this package that is worth 100,000. Just as long as they qualify with the other requirements imposed by PhilHealth. Medical centers or hospitals where they can avail this package can also be found not just in NCR but also in Region 1, CAR, Region 3, Region 5, Region 7, and Region 10.

Other conditions that also comes with a package includes:

  • 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 with package worth 120,000
  • Z MORPH (Mobility,
    Orthosis, Rehabilitation, Prosthesis Help)
    Up to P30,000
  • Selected Orthopedic Implants Up to 169,400
  • “PD First” – for End-Stage Renal Disease Requiring Peritoneal Dialysis
    P270,000 per year
  • Colon and Rectum Cancer with package worth up to 400,000
  • Prevention of Preterm Delivery with package worth up to 4,000
  • Preterm and Small Newborns with package worth up to 135,000

*NOTE
Just keep in mind that there are requirements that must be met before a patient can avail the said packages. It is best to directly inquire to PhilHealth to confirm it or visit this link.

Inpatient Benefits:

PhilHealth has announced case rates which are amounts based on the diagnosis that will be deducted from the member’s total bill. Each diagnosis has an equivalent case rate. For example:

  • Dengue patients can get a total discount of 16,000 pesos from total bill
  • Certain cases of Pneumonia can get you a total discount of 15,000 pesos
  • Certain cases of Diabetes can get a total discount of 10,100 pesos

To view more case rates, download PhilHealth’s official mobile app

Also Read : All the Benefits You Get as a Pag-IBIG Fund Member

Requirements to Avail PhilHealth Benefits

However, PhilHealth has conditions that need to be met before you qualify for all the said benefits. According to iMoney.PH, you need to:

  • Have at least paid an equivalent of 3 months premium within the immediate six months of confinement. For pregnancy cases, you must have already paid 9 months of contribution in the last 12 months
  • Be confined in an accredited medical center for at least 24 hours for a disease or illness that require medical attention or hospitalization
  • The attending doctor must be accredited by PhilHealth
  • Be within the 45-day allowance given for each member
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8 Comments »

  1. Hi po ! I’m an ofw & I’ve been active for philhealth for 30 yrs. Up to the present. My hubby was diagnosed diabetes 3months ago & also he has problems of spondylolis from the limbo sacral vertebra disc L5 & S1. So this time , he couldn’t stand & walk. He’s undergoing therapy. Can we get some benefits from the philhealth? For the medicines cost 500pesos/day & he has done all laboratories including MRI. He was not confined only OLD patient. Could we claim or refund the expenses? He’s already ST.

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  3. I am aphilhealth member for more than 10 years. .it was stop…now i need an operation…how can philhealth help me….almost 7 years no more contribution

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