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"Sulit na Benepisyo sa Bawat Miyembro, Dekalidad na Serbisyo para sa Lahat"

Innovation Quality Service Utmost Integrity Equity Social Solidarity & Total Care

BENEFIT PACKAGES
Inpatient coverage
Subsidies for hospital room and board fees, drugs and medicines, xray and other laboratory exams, operating room and professional fees for confinements of not less than 24 hours.

Outpatient coverage
Day surgeries, dialysis and cancer treatment procedures such as chemotheraphy and radiotheraphy.

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Special Benefit Packages

Case Rates TB Treatment through DOTS SARS and Avian Influenza Novel Influenza A(H1N1)

Benefits
Inpatient coverage
Subsidies for hospital room and board fees, drugs and medicines, xray and other laboratory exams, operating room and professional fees for confinements of not less than 24 hours.

Hospital classifications:
Tertiary Secondary Primary (Levels 3 & 4 Hospital) (Level 2 Hospital) (Level 1 Hospital)
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Benefits
Inpatient coverage
Subsidies for hospital room and board fees, drugs and medicines, xray and other laboratory exams, operating room and professional fees for confinements of not less than 24 hours.

Types of Illness:
A B C D - ordinary case - intensive case - catastrophic case - super catastrophic case
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Benefits
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Benefits
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Benefits

Outpatient coverage:
Day surgeries, dialysis and cancer treatment procedures such as chemotheraphy and radiotheraphy in accredited hospitals and free-standing clinics outpatient HIV/AIDS treatment package (applicable for HIV/AIDS Treatment Hubs)

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Special benefit packages:

Coverage for up to the fourth normal delivery! Newborn Care Package TB treatment through DOTS SARS and Avian Influenza Package Influenza A (H1N1) Package Cataract Package Bitubal Ligation (BTL) or Vasectomy www.philhealth.gov.ph Outpatient Blood Transfusion Package

Benefits
Special benefit packages:
TB treatment through DOTS
Treatment of new cases of pulmonary and extra-pulmonary tuberculosis in children and adults are covered through the Directly Observed Treatment Shortcourse or DOTS, the shortest and most effective internationally accepted treatment protocol for TB. www.philhealth.gov.ph Amount of coverage Php 4,000 (P2,500 intensive phase & P1,500 maintenance phase)

Benefits
Special benefit packages:
SARS and Avian Influenza Package
Amount of coverage for members and their qualified dependents.
Php 50,000 per case.

For health care workers or HCW (forefront and high risk)

Php 100,000 per case.
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Benefits
Special benefit packages:
Influenza A (H1N1) Package
Amount of coverage maximum of Php 75,000 for nonhealth worker-members. Maximum of Php 150,000 for health worker-members.
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Benefits
Special benefit packages:
Bitubal Ligation (BTL) or Vasectomy
P3,000 facility (room & board, OR Fee, meds, lab, supplies) P1,000 Professional Fee www.philhealth.gov.ph Total amount: P4,000

Benefits
Special benefit packages:

Outpatient Blood Transfusion Package Case type B package

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Case Rates
Since September 1, 2011, the following medical cases and surgical procedures are being paid through case rate:
Cases 1 2 3 4 5 6 7 8 9 Dengue I (Dengue Fever and DHF Grades I & II) Dengue II (DHF Grades III & IV) Pneumonia I (Moderate Risk) Pneumonia II (High Risk) Essential Hypertension Cerebral Infarction (CVA I) Cerebral Hemorrhage (CVA II) Acute Gastroenteritis (AGE) Asthma Newborn Care Package in Hospitals and Lying-in Clinics Rates 8,000 16,000 15,000 32,000 9,000
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28,000 38,000 6,000 9,000 14,000 1,750

10 Typhoid Fever 11

Case Rates
Since September 1, 2011, the following medical cases and surgical procedures are being paid through case rate:

Cases
1 2 3 Radiotherapy Hemodialysis Maternity Care Package (MCP) NSD Package in Level 1 Hospitals NSD Package in Levels 2 to 4 Hospitals 4 5 6 7 8 9 10 11 12 Cesarean Section Appendectomy Cholecystectomy Dilatation & Curettage Thyroidectomy Herniorrhapy Mastectomy Hysterectomy Cataract Surgery

Rates
3,000 4,000 8,000 8,000 6,500 19,000 24,000 www.philhealth.gov.ph 31,000 11,000 31,000 21,000 22,000 30,000 16,000

Membership

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These are self-practicing professionals who voluntarily contribute to the program

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These are the employees in the government and private sectors, as well as household employees and sea-based OFWs whose premiums are jointly shouldered by the employee and the employer

These are land-based overseas contract workers whose premiums are paid prior to departure

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These are retirees and pensioners who are entitled to lifetime coverage once they reach the age of retirement and have made at least 120 monthly contributions13

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These are the marginalized and less privileged families whose coverage is jointly shouldered by the National Government and the Local Government Units or by private individuals and companies, members of Congress and other philanthropists

The following also enjoy PhilHealth coverage without additional premiums Legal spouse (non-member or whose membership is inactive)

Child or children - legitimate, legitimated, acknowledged and illegitimate (as appearing in birth certificate) adopted or stepchild or stepchildren below 21 years of age, unmarried and unemployed. Child or children - 21 years old or above but suffering from congenital disability, either physical or mental, or any disability acquired that renders them totally dependent on the member for support. Parents (non-members or membership is inactive) who are 60 years old and above, including stepparents (biological parents already deceased) and adoptive parents (with adoption papers). Qualified dependents shall be entitled to a separate coverage of up to 45 days per calendar year. However, the 45 days allowance shall be shared among them. Important: Qualified dependents must be declared by the principal member. Their names must be listed under the principal member's Member Data Record (MDR) to ensure hasslefree benefits availment

Submit duly accomplished PhilHealth Member Registration Form (PMRF) for the following:

Original or Certified True Copy (CTC) of birth certificate or any two of the following: Marriage Contract/Certificate, (if married) Passport NBI Clearance PRC ID SSS/GSIS ID Postal ID Driver's License Alien Certificate of Registration or (ACR) Duly notarized Joint Affidavit of Two (2) Disinterested Persons attesting to the veracity of the name of the person requesting for amendment

Original or CTC of birth certificate, or any two (2) of the supporting documents mentioned above except for PRC ID and joint affidavit.

Use the PhilHealth Member Registration Form (PMRF) to shift from one membership category to another. If currently waiting for another overseas contract or if no longer an active OFW: Register as an Individually Paying Member and pay the required premiums at any accredited payment center. If gaining formal employment in the Philippines: Provide your employer with your PhilHealth Identification Number (PIN) which they will use when remitting and reporting your premium contributions as an Employed Member. If already 60 years old, have contributed at least 120 monthly premiums, and not gainfully employed: Register as a Lifetime Member to enjoy continued coverage without having to contribute any premium anymore.

Eligibility Requirements Availment must be within the validity period as stated in the OFW's PhilHealth Member Registration Form (PMRF) or in the payment receipt The OFW-member's 45 days allowance per year for hospital room and board and the separate 45 days allowance shared among the dependents have not been consumed yet Post Availment Reminders After the automatic deduction or reimbursement of benefits, PhilHealth will send the Benefit Payment Notice or BPN to the address indicated in the member's claim form. The BPN is a report of actual payments made by PhilHealth relative to the member's the confinement/availment. Should there be discrepancies between the amounts reflected in the BPN and in the member's final billing statement issued by the hospital, or if the member has other concerns pertaining to benefit availment, he may contact PhilHealth or the health care provider. The member must bring the BPN as reference document.

Outright/Automatic Deduction Of Benefits 1. Submit to the billing section the following prior to discharge from the hospital: Duly accomplished PhilHealth Claim Form 1 (original) Clear copy of Member Data Record (MDR) If MDR is not available, submit official receipt of applicable premium payment. If qualified dependent is not listed in the MDR, submit applicable proof of dependency. 2. Agree with your attending physicians on how much is left to be paid for their services over the professional fee (PF) benefit. 3. Upon submission of all applicable documents, the billing section will compute and deduct your benefits from your total hospital bill. Direct Filing/Reimbursement Submit the following to PhilHealth or through the hospital in addition to the documents mentioned earlier within 60 calendar days after discharge: PhilHealth Claim Form 2 (to be filled up by the hospital and attending physicians) Official receipts or hospital and doctor's waiver Operative record for surgical procedures performed

Confinements Abroad
Submit the following within 180 days after discharge. Overseas confinements shall be paid based on Level 3 hospital benefit rates. PhilHealth Claim Form 1 MDR or supporting documents Proof of applicable premium payments Original official receipt or detailed statement of account (written in English) Medical certificate (written in English) indicating the final diagnosis, confinement period and services rendered

PhilHealth Membership Registration Form PMRF

PhilHealth Membership Registration Form PMRF

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PhilHealth Membership Registration Form

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PhilHealth Membership Registration Form

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PhilHealth Membership Registration Form

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PhilHealth Identification Card (PIC)

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website: www.philhealth.gov.ph

THANK YOU!