Wednesday, August 17, 2011

PhilHealth Benefit Packages - Case Payment Rates

This post contains a list of benefit packages, under the case payment scheme, that are available to active PhilHealth members.

Name of Benefit PackageCase Rate (Php)
Maternity Care Package (MCP)6,500.00
Normal Spontaneous Delivery (NSD) Package6,500.00
TB-DOTS Package4,000.00
SARS Package50,000 - 100,000
Avian Influenza Package50,000 - 100,000
New Born Care Package (NCP)1,000.00
Bilateral Tubal Ligation (BTL) Package4,000.00
Vasectomy Package4,000.00
Malaria Package600.00
Influenza A (H1N1) Package75,000 - 100,000
NSD with BLT Package10,500.00
Outpatient HIV / AIDS Treatment Package30,000.00
Dengue I (dengue fever and DHF Grades I and II)*8,000.00
Dengue II (dengue hermorrhagic fever grades III and IV)*16,000.00
Pneumonia I (moderate risk)*15,000.00
Pneumonia II (high risk)*32,000.00
Essential Hypertension*9,000.00
Cerebral Infarction (CVA I)*28,000.00
Cerebro - vascular Accident with Hemorrhage (CVA II)*38,000.00
Acute Gastroenteritis (AGE)*6,000.00
Typhoid Fever*14,000.00
Asthma*9,000.00
Cesarian Section (CS)*19,000.00
Dilatation and Curettage (D&C)*11,000.00
Hysterectomy*30,000.00
Mastectomy*22,000.00
Appendectomy*24,000.00
Cholecystectomy*31,000.00
Herniorrhaphy*21,000.00
Thyroidectomy*31,000.00
Radiotherapy*3,000.00
Hemodialysis*4,000.00
Cataract Package*16,000.00

* PhilHealth will be directly paying the health care facility inclusive of the professional fee, hence, this is directly deducted to the bill of the eligible PhilHealth member. Will also take effect for claims with admission date September 1, 2011.

This list will be updated once additional benefit packages become available. We shall also be discussing each of these packages in detail in succeeding posts so stay tuned.

31 comments:

  1. Hi, based on the list, does it mean that MCP, NSD and NCP are 3 different packages that can be availed by pregnant members?

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  2. The MCP is a package for delivery in accredited non-hospital facilities while the NSD is for delivery in an accredited hospital. Hence, only one of these benefit may be availed.

    In addition to the MCP or NSD, a separate benefit package Newborn Care Package (NCP) may be availed by PhilHealth members where the accredited hospital or non-hospital are certified newborn screening facility. This claim is filed separately.

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  3. How much will it cost me, if I under go a cesarian section with out a philhealth?

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  4. it would differ based on your doctor and your hospital as no fixed rate is being implemented for all hospitals and doctors. It might range from 40k to 60k for some and others a bit higher.

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  5. How much does Philhealth cover, if any, for heart related surgery (angiogram, angioplasty)?

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  6. As the benefit is not included in the case payment, it would be difficult to determine the amount of benefit you will be entitled as it would depend on various factors such as the hospital level, the relative value unit of the surgical procedure, the case type of illness and others.

    ReplyDelete
  7. May possibility ba na less than the allocated amount ang makuha?

    ReplyDelete
    Replies
    1. yes, depende un sa inilagay na amount ng ospital sa claim form.

      Delete
  8. comment ko lng... since me bagong benefit package naman kayo n inimplement... wala na kaming magagawa doon kahit umangal kami... pro sana i categorize nyo rin ung mga nagbabayad ng standard rate at ung nagbabayad mas malaki... pare-parehong benefits nakukuha namin pro nd naman pare pareho ang bayad namin...nd namin na eenjoy ngayon ang bagong sistema nyo...

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  9. You must mention the precautions measures too.



    Reimbursement forms

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  10. hi my status in my MDR is still single,im married now and my wife is pregnant can my wife still avail my philhealth?is it need for me to update my philhealth? or all i need is to present our marriage contract to the hospital?

    ReplyDelete
    Replies
    1. If information is not available in the mdr, supporting documents might do. Attach your marriage contract and her birth certificate. However it is recommended to ensure an updated membership profile prior availment so as to avoid discrepancy issues.

      Delete
  11. parehas lang ba ang binabayad ng philhealth sa accredited na hospital sa naging billing ng pasyente kung saan na confined base sa binawas sa binayaran nya. di ba sumusubra sa billing ng passyente ang binabayad ng philhealth sa kanila o ospital?

    ReplyDelete
    Replies
    1. Posible na mas malaki ang maibayad ng philhealth sa ospital kumpara sa ibinawas ng ospital at makikita ito sa benefit payment notice na binibigay ng philhealth sa miyembro. I compare ang resibo galing ospital at bayad ng philhealth para sa doctor o ospital. Kung mas malaki ang binayad ng philhealth, maaaring kuhanin ang difference sa ospital kung hindi pa naibabalik ang pera sa philhealth. Kung naibalik na ay sa philhealth na ito kukunin.

      Delete
  12. I saw on philhealth website:
    NSD Package in Level I Hospitals 8,000
    NSD Package in Levels 2 to 4 Hospitals 6,500
    I am just wondering what hospitals are considered lebel 1 and levels 2 to 4? Thanks

    ReplyDelete
    Replies
    1. It is included in the list of accredited hospitals which can be found in the philhealth website.

      Delete
  13. Can i avail of 2 benefit in one confinement - delivery by cesarian & BLT?

    ReplyDelete
  14. I just received my philhealth check amounting to P1050.00 only for the newbown package. for the breakdown, they only refunded the lab charges,etc..none and for the pedia's pf. As I checked the official receipt from the hospital,I can find any deduction from the doctor's pf either.. I thought the newborn package now is P1750.Did I receive the right amount for the refund?Thanks

    ReplyDelete
    Replies
    1. You may refer to the PhilHealth Circular No. 015 s-2011 in this URL: http://www.philhealth.gov.ph/circulars/2011/circ15_2011.pdf

      It details the services that will be payable and corresponding rates. If there are services not provided then it will be deducted from the package.

      Delete
  15. gd mrning.i just want o ask about the refund...nanganak po ako november 2011 cs po ng private hospital.ang bill ko po 40k plus yon ang pera galing sa bulsa ko pro nabawasa na yan sa philhealth yong 40k plus..sa ngayon nakatanggap ako ng notice galing philhealth hospital and laboratory amount 19k..ang tanong ko,makukuha ko po ba eto sa main ng philhealth office ang 19k?please reply

    ReplyDelete
    Replies
    1. kung automatikong binawas na ng ospital ang benefits ninyo, wala ka nang macla-claim sa PhilHealth dahil payable yan sa ospital. Ngayon kung mas malaki ang mapupunta sa ospital keysa sa naging deduction mo sa ospital bill, pwede mo ireimburse sa ospital ung difference.

      Delete
  16. boyeasy

    my mother is undergoing operations for a broken hip however in the course of preparations at the hospital before the operations, she was also treated with pneumonia. May we ask if she is entitled to more than one benefit package during this confinement? Saang package po na belong ang surgical operation nga broken hip? thank you po.

    ReplyDelete
    Replies
    1. Philhealth will use the case rate for the primary illness or the main causs of confinement.

      Delete
  17. hello, tanong ko lang kung bakit pareho lang ang benefits ng nagbabayad ng maximum at minimum share? maximum share ang binabayaran ko every payday,,so para saan po ba ang contribution bracket kung pareho nga lang ang benefits?Thank you.

    ReplyDelete
    Replies
    1. Yes, PhilHealth is trying to promote the same level of healthcare for all filipinos. You may refer to this post we found for additional explanation:
      http://www.pcp.org.ph/images/stories/pjim_49/issue1_jan-mar2011/00_editorial.pdf

      Delete
  18. Hello. just wanna ask po if philhealth covers coronary angioplasty or heart bypass surgery?.were an average family and cant afford as what this procedures cost?. my father is also a senior citizen. wanna know how much discount can he avail pls help. thankyousomuch! Godbless!

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  19. my father is in the hospital right now and confined in a government hospital I would to inquire for the allotted meds for the following working diagnosis Pulmonary TB, Electrolyte imbalance, hypertensive urgency, CAPMR. he is also a senior citizen

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  20. is it true that if one is a dependent of a philhealth member and undergoing hemodialysis treatment, he is only entitled to one half of the alloted total dialysis treatment in a year which is 45 days? the other half, will be reserved for the actual member even though he is not undergoing dialysis treatment.

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  21. Is bronchopneumonia not included in Pneumonia package? My relative was not deducted according to this package as her baby was diagnosed with Bronchopneumonia. please reply asap..thanks

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  22. Hi good day! Iam currently employed & I have my own PIN but is it possible that my husband can file me as one of his Philhealth dependents? He also has an acyive PIN. Thanks

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  23. Good day po, totoo po bang ma reenbursed yung pinambili ng gamot sa labas ng hospital during naka confined, If yes papano po? Thanks

    ReplyDelete