WELCOME TO PHILHEALTH ORIENTATION

FOR COMMUNITY HEALTH TEAM

PARTNERS

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Kalusugang Pangkalahatan (KP)

“Bawat Pilipino...Miyembro; Bawat Miyembro...Protektado; Kalusugan Natin...Segurado.”

 

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Ano ang PhilHealth?• Government Owned and Controlled

Corporation

• May mandatong ipatupad ang National Health Insurance Program o NHIP na ipinalit sa dating Medicare.

• Tagapangasiwa ng dating Medicare program ng SSS, GSIS at OWWA

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Ano ang layunin ng PhilHealth?

• Iseguro ang kalusugan ng bawat Pilipino sa pamamagitan ng social health insurance

• Tiyaking may kakayahang gumamit ang bawat Filipino ng de-kalidad na serbisyong pangkalusugan

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Konsepto ng Social Health Insurance

Social solidarity o “bayanihan”, kung saan:

• Tinutulungan ng mayayaman ang mahihirap

• Tinutulungan ng mga bata ang matatanda

• Tinutulungan ng malulusog ang may karamdaman

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Name and address of members

List of legal dependents

Ano ang Katibayan na ikaw ay PHILHEALTH Member

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YOUR DEPENDENT/SLegal spouse/s

Children below 21 years oldLegitimateIllegitimateAdoptedStep-children

Parents 60 years old and above

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Reminders:Upang maka-avail ng benepisyo sa Philhealth, seguraduhin lamang na:

• Accredited ang Hospital• Accredited ang Doctor• Ang Medicines ay nasa listahan ng

PNDF • 45 Days Hospitalization bawat taon kada

Miyembro at dependents• Na Confine ng 24 hours (medical case)

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Anu-ano ang mgabenepisyo para sa miyembro?

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Simula September 2011, may magandang balitang handog para sa mga sponsored members ang PhilHealth.

Sila ay maaring makapag avail ng benepisyong libre mula sa mga govt. facilities sa mga ward type na accommodation tulad ng:

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11 Medical

Case Ratesapplies NBB for sponsored members per Circular 24, s 2011

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Case Rates – Medical CasesCases Rates

1 Dengue I (Dengue Fever and DHF Grades I & II) 8,000

2 Dengue II (DHF Grades III & IV) 16,0003 Pneumonia I (Moderate Risk) 15,0004 Pneumonia II (High Risk) 32,0005 Essential Hypertension 9,0006 Cerebral Infarction (CVA I) 28,0007 Cerebral Hemorrhage (CVA II) 38,0008 Acute Gastroenteritis (AGE) 6,0009 Asthma 9,000

10 Typhoid Fever 14,000

11 Newborn Care Package in Hospitals and Lying-in Clinics 1,750

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12SURGICAL

PROCEDURES applies NBB for sponsored members per Circular 24, s. 2011

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Case Rates – Surgical ProceduresCases Rates

1 Radiotherapy 3,0002 Hemodialysis 4,000

3Maternity Care Package (MCP) 8,000

NSD Package in Level 1 Hospitals 8,000NSD Package in Levels 2 to 4 Hospitals 6,500

4 Cesarean Section 19,0005 Appendectomy 24,0006 Cholecystectomy 31,0007 Dilatation & Curettage 11,0008 Thyroidectomy 31,0009 Herniorrhapy 21,000

10 Mastectomy 22,00011 Hysterectomy 30,00012 Cataract Surgery 16,000

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Case Type Z Benefits PackageA. Standard Risk Acute Lymphocytic

(lymphoblastic) Leukemia for children P 210,000.00

Mode of Payment Amount Filing Schedule

1st tranche P 140,000.00 Within 60 days upon discharge after 1st induction

2nd tranche P 35,000.00 Within 60 after the 3rd maintenance cycle

3rd tranche P 35,000.00 Within 60 after the 8th maintenance cycle

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B. Early Stage Breast Cancer P 100,000.00

Mode of Payment Amount Filing Schedule

1st tranche P 75,000.00 Within 60 After discharge of the surgery

2nd tranche P 25,000.00 Within 60 upon completion of last cycle of chemotheraphy for stage I to III A or upon completion of surgery for stage 0

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C. Low to Intermediate Risk prostate Cancer requiring Prostatectomy

P 100,000.00

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D. End Stage Renal Disease Eligible for Kidney Transplant (low Risk)

P 600,000.00

Mode of Payment Amount Filing Schedule

1st tranche P 550,000.00 Within 60 days upon discharge of recipient after the transplantation

2nd tranche P 50,000.00 Ninety (90) days after transplantation

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Inpatient Benefits

Kabilang dito ang subsidy para sa:• Room and board• Drugs at medicines• X-ray, at iba pang laboratory exams• Operating room fees• Professional fees

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Ano ang ibig sabihin ng Case A, B, C at D?

Case type:• A –ordinary cases / simple illnesses• B – intensive cases• C – catastrophic cases• D – morbid illnesses

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Inpatient BenefitsLevel 1 hospital • Primary hospitals

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Inpatient BenefitsLevel 2 hospital• Secondary hospitals

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Inpatient BenefitsLevels 3 & 4 hospitalsLevel 3 • Tertiary hospitals

Level 4• Tertiary hospitals na

may training program at specialty

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Magkano ang maaaring ma-avail?

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Inpatient Benefits

Confinement Case : Surgery - Intracranial Aneurysm

Case Type : DDays Confined : 30 daysHospital Level : TertiaryRelative Value Unit : 600

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Inpatient BenefitsConfinement Case: Surgery - Intracranial Aneurysm

Case Type : DDays Confined : 30 daysRelative Value Unit : 600 Room and Board = P 33,000Drugs and Medicines = P 40,000X-ray, Lab & Others = P 30,000

Estimated Max. Benefit Allowance

Specialist Fee = P 8,000

Operating Room = P 12,000

Surgeon’s Fee = P 48,000Anesthesiologist’s Fee = P 19,200

P190K

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Outpatient ServicesAng mga sumusunod ay may benepisyo kahit isinagawa ng outpatient:

• Day surgeries• Chemotheraphy

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New Born Care PackageImmediate Drying of the Newborn, Eye prophylaxis, umbilical cord care (Cord Clamping), Vit K & thermal, New Born Hearing Test

Php 1,750.00

First dose of Hepatitis B immunization

Newborn Screening Tests

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Special Benefit Packages

P4,000 coverage para sa TB-DOTS na

ina-admister ng mga accredited health centers

P600 coverage para sa malaria

treatment sa mga accredited rural health units

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Special Benefit Packages

P4,000Para sa vasectomy and

tubal ligation

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Animal Bite Package Dog bites, cats, cows, pigs, horses, goats, bats,

monkeys except rodents, guinea pigs and rabbits at 3,000 per case

i. Rabies vaccineii. Rabies Immune Globulin (TUG)iii. Local wound careiv. Tetanus toxoid and anti-tetanus scrum (ATS)v. Antibioticsvi. Supplies: syringes, cotton, alcohol and other antiseptics

Effective May 3, 2012

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Special Benefit Packages

BENEFIT ITEM LEVEL 1HOSPITALS

LEVEL 2HOSPITALS

LEVEL 3 & 4

HOSPITALS

Drugs and Medicine 9,000 11,200 14,000

X-ray, Lab and Others 5,000 7,350 10,500

Operating Room 500 750 1,200Outpatient package para

sa Blood Transfusion

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Special Benefit Packages

P30,000 Coverage para sa Outpatient treatment

ng HIV/AIDS

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Outpatient Benefits para sa

Sponsored Program Members sa mga accredited Rural Health Unit kung saan naka- assign ang SP member

Primary Care Package

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Free Primary Preventive Services

- Primary consultation- Visual inspection with acetic acid- Regular BP Measurement- Breastfeeding program education- Periodic clinical breast examination- Counselling for lifestyle modification- Counselling for Smoking cessation- Body Measurement- Digital Rectal Examination(prostate)

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Free Diagnostic Services

- Complete Blood Count (CBC)- Urinalysis- Fecalysis- Sputum Microscopy- Fasting Blood Sugar- Lipid Profile- Chest X-ray

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Free Drugs and Medicines

- Asthma including nebulisation services- Acute Gastroenterisis with no/mild dehydration- URTI/Pneumonia (Minimal & Low Risk)- Urinary Tract Infection

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Paano ang pag-avail ng

benepisyo?

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Ang mga ito lamang ang ipakita sa Hospital: Sponsored Identification Card (SIC) at Member Data

Record (MDR)

Pangalan at address ng miyembro

Listahan ng legal dependents

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Benefit Exclusionsx Hindi binabayaran ng PhilHealth ang mga

sumusunod:× Ika-lima at susunod pang normal spontaneous

delivery;× Non- prescription drugs;× Alcohol abuse at drug dependency treatments;× Cosmetic surgeries; at× Optometric services.

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Mga paalala:

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Remember• Number of days

allowed per year– 45 for the

member– Another 45

for all dependents

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Remember• Number of days

allowed to file claim from date of discharge

• Number of days allowed to comply with returned claim

• Number of days allowed for PhilHealth to process claims

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Mga dapat tandaan!

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Itago ang SIC at MDR sa ligtas na lugar at madaling makita

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Mag-update ng Records Mag submit ng PhilHealth Member

Registration Form (PMRF) kung magpapalit ng civil status, apelyido, o

magdadagdag ng legal dependent. Ilakip sa Form ang kaukulang marriage at birth certificate.

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http://www.philhealth.gov.ph

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DXMD RMN-GENSAN 927 KhzSunday 10-11 am

www.rmngensan.weebly.com

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RAMON F. ARISTOZA, JR.Regional Vice President

PhilHealth Regional Office XIIKoronadal City, South Cotabato

083-228-9734

Local Health Insurance Office-General Santos City

hw.One Bldg., Santiago Blvd.,GSC T/F:083-302-2558T:083-554-6893

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Maari din kayong magtungo sa: • PhilHealth Regional

Office XII Plaza de Español Bldg., Cor. Posadas & Abad Santos Sts., Koronadal City

• LHIO-Kidapawan City 2/F Apol-J Bldg., Quezon Blvd., Kidapawan City

• LHIO-Cotabato City F/A Tan Bldg., S.K. Pendatun Avenue, Cotabato City

• LHIO-Isulan R.E.R Commercial Bldg., Nat’l Highway, Isulan, Sultan Kudarat

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LIST OF HOSPITALSHospital Address Tel. No.

GSC Doctors Hospital National Highway, GSC 552-3141

St. Elizabeth Hospital National Highway, GSC 552-2813

Mindanao Medical Center Mabuhay Road, GSC 552-4629

SOCSARGEN County Hospital

Lagao – Bula Road, GSC 553-8906

R. Diagan Cooperative Hospital Quezon Ave., GSC 552-3842

GSC District Hospital Fernandez ST, GSC 301-6864 to 76 or 169

Labella Hospital First Road, Calumpang

SOCIAL HYGIENE CLINIC GSCH Compound

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ILHZ MINIMUM PACKAGE OF SERVICESPRIMARY HEALTH CARE SERVICES

  Pre-natal Care Normal Delivery; postpartum care Immunization Family Planning Nutrition Growth Monitoring Control of Communicable Diseases (CARI, TB, DP, STD, Malaria,

Dengue, etc.) Control of Non-Communicable Diseases (e.g. Health diet, alcohol,

tobacco). Minor Surgery (Suturing, drainage of abscess, circumcision) Appropriate referral of District Environmental Health Services Basic Laboratory Services Management of Public Health Services, Coordination with NGOs and

Private Medical Sector Training of Human Resources Supervision of Health Services and Human Resource in the ILHZ

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Daghang Salamat!