List of PhilHealth Cash Benefits For A Specific Illness

Being a member of PhilHealth has benefits, but do you know that there are specific cash benefits for different kinds of illness? Well, you should know it to get the most of your membership. This article is perfect to let you know about this matter, this also include eligibility, coverage, and guidelines for a specific disease.

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Requirements

  1. The member must have at least three (3) months’ premium contributions within the immediate six (6) months before the month of availment.
  2. 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

Sponsors

For more information regarding the requirements, you can go to the PhilHealth website. Alternatively, you can contact them at:

Trunkline (02) 441-7444

Call Center (02) 441-7442

Case Rate for Hemodialysis

Php2, 600.00 per session

Case Rate for Outpatient Blood Transfusion

Php3, 640.00 (one or more units)

Thyroidectomy (Total or Complete Cash Benefits)

Php31, 000.00

Sponsors

Ovarian Cystectomy (Unilateral or Bilateral)

Php23, 300.00

Pneumonia

Moderate Risk Pneumonia

Php15, 000.00

High Risk Pneumonia

Php32, 00.00

Primary Care Moderate Risk Pneumonia

Php10, 500.00

Tonsillectomy (Primary or Secondary)

Php18, 000.00

Normal Spontaneous Delivery (NSD)

Lying in:

Php6, 500

Sponsors

Hospitals:

Php5, 000.00

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Pre-Natal:

Php 1, 500.00

Tubal Ligation

Php4, 000.00

For IN PATIENTS benefits:

Benefits are paid ONLY to accredited Health Care Institutions (HCI)

Sponsors

The case rate amount is to be deducted by the Institution (HCI) from the member’s total bill. Inclusive of professional fees of physicians BEFORE your discharge

Member must have at least three (3) months’ premium contributions within the immediate six (6) months prior to the event

The case rate amount is inclusive of hospital charges and professional fees of attending physician/s

Intrauterine Device Insertion or IUD

Php2,000 

Vasectomy (Unilateral or Bilateral)

Php4,000

Sponsors

Viral Hepatitis

Php11,800

Rheumatic Fever

Php10,100

Intrauterine Device Insertion (IUD)

Php2, 000

Breech Extraction

Php12, 120

Appendectomy

Php24, 000

Cerebral Infarction

Php28, 000

Cerebral Palsy

Php9, 500

Cellulitis

Php9, 600

Cataract Surgery

Php16, 000

Cholecysectomy

Php31, 000

Cholecystitis

Php11, 300

Caesarian Section

Php19, 000

Congenital Anemia

Php15, 200

Newborn Care Package

Php1, 750

Emphysema

Php11, 400

Upper Respiratory Tract Infection (URTI)

Hospitals:

Php4, 000

Primary Care Facilities:

Php2, 800

Dengue

Dengue Fever:

Php10, 000

Severe Case of Dengue:

Php16, 000

Chronic Obstructive Pulmonary Disease  

(COPD Php12, 200

Congenital Syphilis

Php12, 800

Diabetes Mellitus

**With complications other than Coma and Ketosis: Php12, 600

Asthma

Asthma in acute exacerbation for hospitals:

Php9, 000

In primary care facilities:

Php6, 300

Congenital Hypothyroidism

Php9, 900

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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.

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What type of illnesses are covered?

  1. Z001 Acute lymphocytic leukemia, standard risk (for children)
  2. Z002 Early breast cancer, stage 0 to IIIA
  3. Z003 Prostate cancer, low to intermediate risk
  4. Z004 Kidney transplantation for end stage kidney disease, standard risk
  5. Z005 Coronary artery bypass graft surgery, standard risk
  6. Z006 Total correction of Tetralogy of Fallot (for children)
  7. Z007 Closure of ventricular septal defect (for children)
  8. Z008 Cervical Cancer, stage I to IV
  9. Z009 The Z MORPH (Mobility, Orthosis, Rehabilitation and Prosthesis Help)
  10. Who are eligible for this Z-Type package?

Members covered are all eligible PhilHealth members whether:

  • Employed
  • Individually paying (Voluntary)
  • Lifetime member program
  • Sponsored program
  • Overseas worker program

In addition to that, their dependents are also entitled of the package.

So aside from these illnesses listed, what else are covered?

Furthermore to the list of illnesses in the ‘Z” category, PhilHealth will cover:

  1. Operating Room
  2. Drugs and Laboratory exams
  3. Hospital room and Board fees
  4. Professional fees for the entire course of the treatment (Mandatory, *Other services required per ailment)

For the partner hospitals, you can refer to the image here to know where you can go. To make it simpler, you can just type PhilHealth Z Benefit in Google Maps and it will automatically give you a list of partner hospitals.

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How can a member apply for the Z package?

For the illnesses in the Z package, a member can go to any contracted hospitals and have themselves check if they are eligible to be part of the or the Z Package.

Refer to this list:

  1. PhilHealth Circular No. 30, s-2012 – for Z001 to Z004
  2. PhilHealth Circular No. 02, s-2013 – for Z005 to Z006
  3. 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:

  1. PhilHealth Circular No. 02, s-2013 – for Z005 to Z006
  2. PhilHealth Circular No. 19, s-2013 – for Z009
  3. PhilHealth Circular No. 48, s-2012 – for Z001 to Z001

It is great to know that that PhilHealth really aims to support the whole country.