Guide to the OFW’s Philhealth Membership Part 2

10 - 09

What are the benefits that OFWs can enjoy as bona fide PhilHealth members?  Are their dependents entitled to the same benefits as well?

Below are the latest case rates applicable to OFW members.  The amount stated in this summary is PhilHealth’s participation in the member’s hospital and medical expenses.  Any amount over the stated coverage will be shouldered by the member or by his Health Maintenance Organization (HMO).

1. Examples of Case Rates

ILLNESS AMOUNT OF BENEFIT
Pneumonia Moderate Risk (Pulmonya) P15,000
Pneumonia High Risk P32,000
Stroke – Infarction P28,000
Stroke – Hemorrhagic or Stroke with Bleeding P38,000
Hypertensive Emergency/Urgency P9,000
Dengue (Severe) P16,000
Acute Gastroenteritis (AGE) or Diarrhea with Dehydration P6,000
Asthma in Acute Exacerbation (Hika) P9,000
Newborn Care Package or Services for Newborn Babies P1,750
SURGERIES AMOUNT OF BENEFIT
Hemodialysis P4,000
Maternity Care Package (Normal delivery in lying-in clinics) P8,000
Normal Spontaneous Delivery Package (Normal delivery in a hospital) P6,500
Cesarean Section P19,000
Radiotherapy Linear Accelerator (Linac) P3,000
Cataract Package P16,000
Dilatation and Curettage (Raspa) P11,000
Cholecystectomy P31,000
Appendectomy P24,000

1.1 Z Benefits

These types of packages are for those stricken by diseases that need long and continuous medication.  These normally entail costs beyond one’s usual hospitalization budget.  Z Benefit packages have pre-conditions and selection criteria that need to be met in order to qualify for the benefits at selected government hospitals.

ILLNESS / SURGERY AMOUNT OF BENEFIT
Acute Lymphocytic Leukemia or ALL P210,000
Breast Cancer (Stage 0 to 3) P100,000
Prostate Cancer (Low to Intermediate Risk) P100,000
Kidney Transplant (Low Risk) P600,000
Coronary Artery Bypass Graft Surgery P550,000
Surgery of Tetralogy of Fallot in Children P320,000
Surgery for Ventricular Septal Defect in Children P250,000
Cervical Cancer Chemoradiation with Cobalt and Brachytherapy (Low Dose)

Linear Accelerator and Brachytherapy (High Dose)

P120,000

P175,000

External Lower Limb Prostheses P15,000

1.2 Outpatient Benefits under All Case Rates

SERVICES AMOUNT OF BENEFIT
Tuberculosis – Directly Observed Treatment Short-course administered at accredited TB-DOTS centers P4,000
Malaria treatment administered at accredited rural health units. P600
Outpatient HIV/AIDS Treatment P30,000
Treatment package for animal bites administered at accredited government animal bite centers. P3,000
Vasectomy and Tubal Ligation P4,000

Important Reminder: A member is allotted 45 days of hospitalization in one year and another 45 days to be divided among his qualified dependents.

What are the conditions before an OFW member or dependent may avail of PhilHealth benefits?

  1. Updated contributions as shown in the member’s MDR.
  2. Make sure you are seeking consultation or treatment at a PhilHealth-accredited hospital and by a PhilHealth-accredited doctor.
  3. You have not yet used up the 45-day hospitalization period (OFW or dependents).

How does an OFW member and his dependents avail of PhilHealth benefits?

  1. Before checking out of the hospital, submit the following documents at the Billing Section of the hospital:
  • Duly accomplished PhilHealth Claim Form 1. You may request for a form at the hospital, PhilHealth offices and branches, or download from the PhilHealth website at philhealth.gov.ph
  • Health Insurance ID Card and or Updated Member Data Record (photocopies).
  • Proof of contributions (photocopies).
  1. Medicines purchased outside of the hospital while member is confined may be reimbursed at the hospital if the patient has not yet used up the allocated benefit amount. Make sure that PhilHealth benefits have been deducted from the total hospital bill and professional fees before signing the Claim Form 2.

What if the OFW member is confined in a hospital abroad?  Can he still use his PhilHealth benefits?

 A member confined abroad may file for benefits claim in the Philippines by submitting the following documents to any PhilHealth office, within 180 days after he has been discharged from the hospital abroad:

  1. Copy of Medical Certificate where the following are clearly stated:
    • Final diagnosis
    • Confinement period
    • Services rendered
  2. Duly accomplished PhilHealth Claim Form 1
  3. Copy of Official Receipt or detailed Statement of Account
  4. Updated Member Data Record or proof of payment.

For further information on OFW’s PhilHealth membership, claims, and benefits, you may call the PhilHealth call center at 02-441-7442.  They are available to take your calls, 24/7.

Source: www.philhealth.gov.ph

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