One of the mandatory contributions that every Filipino employee gets charged every month is PhilHealth. Although the amount is just small, the benefit that one can get from it is huge. However, many are unaware of how much PhilHealth covers for specific illnesses that employees may incur.
First, let us check the requirements on how you can be eligible to be covered on PhilHealth. Make sure that you have at least three months premium contributions within the immediate six months before the month of availment. If so, you need to submit a copy of your Member Data Record or PhilHealth Benefit Eligibility Form (PBEF). You should also accomplish the PhilHealth Claim Form 1.
Here are the benefits that you are entitled to:
1. The member and his/her qualified dependents are entitled to benefits for medical expenses for every sickness and operation
2. The member and his/her legal dependents can get equal benefits
3. There is an allocated 45 days hospitalization allowance for the member and 45 days to be divided to all qualified dependents
Make sure that you have updated contributions and the hospital or clinic that you went to is PhilHealth accredited. Any hospitalization days beyond 45 days would not be covered by PhilHealth.
Here’s how much PhilHealth covers for every specific illness:
Case Rate for Hemodialysis – Php2,600/session
Case Rate for Outpatient Blood Transfusion– Php3,640/session
Thyroidectomy (Total or Complete Cash Benefits)– Php31,000
Ovarian Cystectomy (Unilateral or Bilateral) – Php23, 300
Pneumonia
*Moderate Risk Pneumonia: Php15, 000
*High Risk Pneumonia: Php32, 000
*Primary Care Moderate Risk Pneumonia: Php10, 500
Tonsillectomy (Primary or Secondary) – Php18, 000
Normal Spontaneous Delivery (NSD)
*Lying in: Php6, 500
*Hospitals: Php5, 000
*Pre-Natal: Php 1, 500
Tubal Ligation – Php 4,000
Intrauterine Device Insertion or IUD – Php2,000
Vasectomy (Unilateral or Bilateral) – Php4,000
Viral Hepatitis – Php11,800
Rheumatic Fever – Php 10, 100
Breech Extraction – Php 12,120
Appendectomy – Php 24,000
Cerebral Infarction – Php 28,000
Cerebral Palsy – Php 9,500
Cellulitis – Php 9,600
Cataract Surgery – Php 16,000
Cholecysectomy –Php 31,000
Cholecystitis – Php 11, 300
Caesarian Section – Php 19,000
Congenital Anemia – Php 15,200
Newborn Care Package – Php 1,750
Emphysema – Php 11,400
Upper Respiratory Tract Infection (URTI)
*Hospitals: Php4, 000
*Primary Care Facilities: Php2, 800
Dengue
*Dengue Fever: Php10, 000
*Severe Case of Dengue: Php16, 000
Chronic Obstructive Pulmonary Disease (COPD) – Php 12,200
Congenital Syphilis – Php 12,800
Diabetes Mellitus
*With complications other than Coma and Ketosis: Php12, 600
Asthma
*Asthma in acute exacerbation for hospitals: Php9, 000
*In primary care facilities: Php6, 300
Congenital Hypothyroidism – Php9,900
Aside from the illnesses mentioned above, there are also diseases classified “as economically and medically catastrophic”due to their seriousness. They are under type Z are the farthest end of the spectrum. They usually trigger expensive treatments.
Here is the list of diseases covered under PhilHealth Z Benefits:
Z001 Acute lymphocytic leukemia, standard risk (for children)
Z002 Early breast cancer, stage 0 to IIIA
Z003 Prostate cancer, low to intermediate risk
Z004 Kidney transplantation for end stage kidney disease, standard risk
Z005 Coronary artery bypass graft surgery, standard risk
Z006 Total correction of Tetralogy of Fallot (for children)
Z007 Closure of ventricular septal defect (for children)
Z008 Cervical Cancer, stage I to IV
Z009 The Z MORPH (Mobility, Orthosis, Rehabilitation and Prosthesis Help)
For the list of illnesses under the Z category, PhilHealth will cover Operating Room fee, Drugs and Laboratory exams, Hospital room and board fees, and professional fees for the entire course of treatment.
Take advantage of your PhilHealth benefits by knowing your eligibility, requirement and coverage. Share this to you loved ones so they will be informed, too!
