PhilHealt

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Benefits

Abecilla, Alfred Moses D.

Berona, Patrick C.
Bragais, Jude Faith D.
Fojas, Riguel F.
Mediran, Shaquille Klein R

Dr. Charles Onda, CPA

1 Inpatie
nt
Benefit
s

2 3 4

Benefits paid to the accredited Health Care Institution (HCI)

through All Case Rates
The case rate amount shall be deducted by the HCI from the
members total bill, which shall include professional fees of
attending physicians, prior to discharge
The case rate is inclusive of hospital charges and professional
fees of attending physician
Documents needed:
Availment condition: Member must have at least three (3)
copy of Member Data Record or PhilHealth Benefit Eligibility
months premium contributions within the immediate six (6)
Form (PBEF)
months prior to the month of availment
Where
duly accomplished
Claim Form 1
available: PhilHealth
all
accredited
HCIs
Note: Only admissible
cases shall be reimbursed
PhilHealth

1 Inpatie
nt
Benefit
s

2 3 4

WHA
ALL
T IS

CASE

RATE

PhilHealth

1 2 Outpatient 3 4
urgeries (Ambulatory Or Outpatient Surgeries
Benefits
Include elective (Non-Emergency) surgical procedures ranging from
minor to major operations, where patients are safely sent home
within
the same day
for as
post-operative
care
Requirements:
Same
Inpatient Benefits

Where available: Accredited Ambulatory Surgical Clinics

(ASCs)
2. Radiotherapy
Case rate:
cobalt
P2,000 per session
linear accelerator
P3,000 per session
3. Hemodialysis
P2,600 per session
utpatient Blood Transfusion P3,640 (one or more units)

PhilHealth

1 2 Outpatient
5. PCB 1
Benefits
Diagnostic
Examinations

1. Complete
blood count
2. Urinalysis
3. Fecalysis
4. Sputum
microscopy
5. Fasting blood
sugar
6. Lipid Profile
7. Chest x-ray

Preventive Services

1. Consultation
2. Visual inspection with
acetic acid
3. Regular BP
measurements
4. Breastfeeding program
education
5. Periodic clinical breast
examinations
6. Counseling for lifestyle
modification
7. Counseling for smoking

3 4

Drugs and Medicines

1. Asthma including
nebulisation services
2. Acute Gastroenteritis
(AGE) with no or mild
dehydration
3. Upper Respiratory
Tract Infection
(URTI)/Pneumonia
(minimal and low risk)
4. Urinary Tract
Infection (UTI)

PhilHealth

Outpatient
1
2
5. PCB 1
Benefits

3 4

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
Documents needed: Copy of Member Data Record or PhilHealth ID
are
still active
members
of PhilHealth
Where
available:
accredited
rural health units, health centers or
outpatient departments of selected government hospitals where
members are enlisted

PhilHealth

1 2 3Z
Benefit
s
Benefit Package

4
Amount of
Benefit

Surgery for Ventricular Septal Defect in

Children

P210,000

Breast Cancer (stage 0 to IIIA)

P100,000

Prostate Cancer (low to intermediate risk)

P100,000

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

Conclusion

Chronicles
PhilHealth

1 2 3Z
Benefit
s
Benefit Package

4
Amount of
Benefit

Cervical Cancer:

Chemoradiation with Cobalt and Brachytherapy

(low dose) or Primary surgery for Stage IA1, IA2
IIA1

P120,000

Chemoradiation with Linear Accelerator and

Brachytherapy (high dose)

P175,000

Z MORPH (Mobility, Orthosis, Rehabilitation,

Prosthesis Help)
first right and/or left below the knee

P15,000

both limbs

P30,000

Conclusion

Chronicles
PhilHealth

1 2 3Z
Benefit
s

Selected Orthopedic Implants

Benefit Package

Amount of
Benefit

Implants for Hip Arthroplasty

Implants Hip Prosthesis, cemented (66 years old

and above)

P103,400

Total Hip Prosthesis, cementless (65 years and

364 days old and below)

P169,400

Partial Hip Prosthesis, bipolar

Conclusion

P73,180

Chronicles
PhilHealth

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Benefit
s

Selected Orthopedic Implants

Benefit Package

Amount of
Benefit

Implants for Hip Fixation

Multiple screw fixation (MSF)*** 6.5mm

cannulated cancellous screws with washer

P61,500

***59 years and 364 days old and below (both

displaced and undisplaced fracture); 60 years old
and above (undisplaced fracture)

Conclusion

Chronicles
PhilHealth

1 2 3Z
Benefit
s

Selected Orthopedic Implants

Benefit Package

Amount of
Benefit

Implants for Pertrochanteric Fracture

Compression Hip Screw Set (CHS)

P69,000

Proximal Femoral Locked Plate (PFLP)

P71,000

Implants for Femoral Shaft Fracture

Intramedullary Nail with Interlocking Screws

P48,740

Locked Compression Plate (LCP) Broad /

Metaphyseal / Distal Femoral LC

P50,740

Conclusion

Chronicles
PhilHealth

1 2 3Z
Benefit
s
Benefit Package

PD First - for End-Stage Renal Disease

Requiring Peritoneal Dialysis

4
Amount of
Benefit
P270,000 per year

Colon Cancer
Stage I-II (low risk)
Stage II (high risk) III

Conclusion

P150,000
P300,00

Chronicles
PhilHealth

1 2 3Z
Benefit
s
Benefit Package

4
Amount of
Benefit

Rectum Cancer

Stage I (clinical and pathologic)

P150,000

Pre-operative clinical stage I

but with post-operative pathologic
stage II-III
using linear accelerator as mode of
radiotherapy
using cobalt as mode of radiotherapy
Conclusion

P400,000
P320,000
Chronicles
PhilHealth

1 2 3Z
Benefit
s
Benefit Package

4
Amount of
Benefit

Rectum Cancer

Clinical Stage II-III

using linear accelerator as mode of

radiotherapy
using cobalt as mode of radiotherapy
Outpatient Malaria Package
Outpatient HIV-AIDS Package

Conclusion

P400,000
P320,000
P600.00
P30,000.00 per
year
(P7,500/quarter)
Chronicles
PhilHealth

1 2 3 4 MDG
Related
Benefit Package

Outpatient Anti-Tuberculosis Treatment through

Directly-Observed Treatment Short-course
(DOTS) Package

Amount of
Benefit
P4,000

Intensive Phase

P2,500

Maintenance Phase

P1,500

Voluntary Surgical Contraception Procedures

P4,000.00

Animal Bite Treatment Package

P3,000.00

Recommendation

Chronicles
PhilHealth