PhilHealth Cataract Package

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PhilHealth Hemodialysis Benefits

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PhilHealth Case Rates

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PhilHealth Case Payment - The Hemodialysis Package

Another package offered under the Case Payment Scheme is the Hemodialysis Package for a total of Php4,000.00 with Php500.00 professional fee for every treatment inclusive in the package.

Coverage of Hemodialysis

• Covers all outpatient hemodialysis procedures with RVS code 90935;
• Includes payment per session for:
• Facility use and hemodialysis machine;
• Drugs and medicines (0.9% sodium chloride, heparin, bicarbonate or acetate hemodialysis solution, e-cart drugs and epoetin alfa or beta);
• Supplies and others (fistula kits, blood tubing set, dialyzet. syringe, and gauze).

Excluded in the package will be paid for through the fee-for-service scheme such as:

• Hemodialysis performed during hospital confinement;
• Other renal replacement therapy (e.g., CAPD, automated peritoneal dialysis);
• Emergency dialysis procedure for Acute Renal Failure (e.g., ARF secondary lo leptospirosis);
• Creadon of fistula for hemodialysis.

Source: PhilHealth Circular No. 011-B-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:

1. PhilHealth Circular No. 19 s-2003


2. How to fill-out the Claim Forms


3. TB-DOTS Benefit

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 Package	Case Rate (Php)
Maternity Care Package (MCP)	6,500.00
Normal Spontaneous Delivery (NSD) Package	6,500.00
TB-DOTS Package	4,000.00
SARS Package	50,000 - 100,000
Avian Influenza Package	50,000 - 100,000
New Born Care Package (NCP)	1,000.00
Bilateral Tubal Ligation (BTL) Package	4,000.00
Vasectomy Package	4,000.00
Malaria Package	600.00
Influenza A (H1N1) Package	75,000 - 100,000
NSD with BLT Package	10,500.00
Outpatient HIV / AIDS Treatment Package	30,000.00
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.