Wednesday, August 24, 2011

PhilHealth Outpatient Anti-Tuberculosis Directly Observed Treatment Short-Course (TB-DOTS) Benefit Package

The Anti-Tuberculosis Directly Observed Treatment Short-Course or more commonly known as TB-DOTS is a benefit package under the case payment scheme being implemented by PhilHealth since 2003. The said benefit amounts to Php 4,000.00 per case where payment of Php 2,500 will be given after completion of the intensive phase and the remaining Php 1,500 at the end of the maintenance phase.

Eligibility requirements for utilization of this package are:
  • All primary members and valid dependents who meet the required number of premium contributions for employed and individually paying members;

  • All primary members and valid dependents whose enrollment in the DOTS center is within the coverage or validity period of membership effectivity for sponsored, lifetime and Overseas Filipino Workers (OFWs);

  • Treatment of new cases of pulmonary and extrapulmonary tuberculosis for children and adults. New cases denotes that a patient has never had a treatment for TB or taken anti-tuberculosis drugs for less than one month.

PhilHealth shall not pay for:
  • Failure case;

  • Relapse case;

  • Return after default (RAD) case;

  • Additional services or extension of treatment.

Outpatient Services covered for the package:
  • Diagnostic work-up;

  • Consultation services;

  • Anti-TB drugs.

Documents required by PhilHealth:
  • Claim Form 1;

  • Claim Form 2;

  • NTP Treatment Card (to be submitted upon registration to TB Management Information System and an updated NTP card upon claiming of benefit).

Date of filing: 60 days from end of every treatment phase
Payable to: PhilHealth accredited TB-DOTS facility
Submit to: Any PhilHealth office corresponding to your area

Other references: