FY 2018 ALLOCATION

FOR THE NATIONAL HEALTH INSURANCE PROGRAM (NHIP)

P 60.6 BILLION is allocated to PhilHealth’s National Health Insurance Program which aims to
provide affordable and accessible health care for all Filipinos.

For Indigent Families

Allocation:
P 37,060,440,000
Target:
15,441,850 families
Premium per family:
P 2,400

Indigent families identified by the Department of Social Welfare and Development (DSWD) under the NHTS-PR
are enrolled in the National Health Insurance Program as a Sponsored Program Member and are automatically
entitled to inpatient and outpatient services in PhilHealth-accredited hospitals and health care facilities.

INPATIENT COVERAGE
Indigent families are provided with free health care at any PhilHealth-accredited
government facility or hospital for the following conditions:

Surgical cases Medical cases

1. Maternity Care Package
2. Appendectomy
3. Cataract surgery
4. Cesarean Section
5. Cholecystectomy
6. Dilatation and Curettage
7. Hemodialysis
8. Herniorrhaphy
9. Hysterectomy
10. Mastectomy
11. Radiotherapy
12. Thyroidectomy
1. Acute Gastroenteritis
2. Asthma
3. Cerebral Infraction (CVA I)
4. Cerebral Hemorrhage (CVA II)
5. Dengue I (Dengue Fever and DHF Grades I & II)
6. Dengue II (DHF Grades III & IV)
7. Essential Hypertension
8. Newborn Care Package in Hospitals and Lying in Clinics
9. Pneumonia I (Moderate Risk)
10. Pneumonia II (High Risk)
11. Typhoid Fever

OUTPATIENT BENEFITS
Indigent families are also provided with free outpatient health care services at any
PhilHealth-accredited government hospitals and healthcare facilities.
1. Outpatient Benefit Package (OPB) Surgical Cases
*Consultation/Check-up, blood pressure monitoring, 1. Voluntary Surgical Contra-
periodic breast examination, body measurement, counselling ception
for cessation of smoking, counselling for lifestyle change *Vasectomy, including
*Sputum microscopy screening for TB, visual acetic acid no-scalpel vasectomy (NSV)
screening for cervical cancer for females 35 years old above, *Ligation or transection of
digital rectal examination for males 40 years old above for fallopian tube(s), abdominal
prostate screening or vaginal approach
*Urinalysis, fecalysis, chest x-ray and complete blood count 2. Outpatient Blood Transfu-
2. Outpatient TB treatment through DOTS sion Benefit (available only
3. Outpatient Malaria Package in hospitals)
4. Outpatient HIV/AIDS Package
For Senior Citizens
Allocation:
P 16,958,567,000; (Released by the Department
of Budget and Management as of March 31,
2018: P 14,904,542,640)

Target:
5,435,438 senior citizens

Premium:
P 3,120 per senior citizen

The target 5.4 million senior citizens and their qualified dependents are enti-
tled to free health services which include:
1. Inpatient hospital care
2. Day/ambulatory services
3. Special benefits for catastrophic cases (referred to as Z-benefits)
4. Tuberculosis Directly Observed Treatment Short-course (TB-DOTS) package
5. Animal bite package
6. Malaria package
7. Outpatient HIV/AIDS treatment package
8. Normal spontaneous delivery package
9. Ante-natal care package
10. Benefits for voluntary contraceptive surgical procedures

Universal Health Care

Allocation:
P 3,000,000,000

Through a Point of Service (POS) Program, Filipino citizens, who are non-
PhilHealth members but are classified by a Medical Social Welfare Officer or
a Social Welfare Development Officer as financially incapable to pay his/her
PhilHealth membership at point of admission in the hospital may immediately
avail of PhilHealth benefits such as in-patient/out-patient All Case Rates,
special benefits for catastrophic cases (referred to as Z-benefits), and No
Balance Billing (NBB). NBB is only available at government facilities.
Special Purpose Coverage (Locally-funded Projects)

Allocation:
P 108,535,000

PAMANA and BANGSAMORO beneficiaries are entitled to all benefits under the
National Health Insurance Program.

PAMANA (Payapa at
Masaganang BANGSAMORO
Pamayanan Program)

Target: 25,514 families Target: 22,709 families

Allocation: P 54 million Allocation: P 54 million
P 2,400 per family P 2,400 per family
PAMANA covers families in communities Families in Bangsamoro areas are covered as
affected by conflict and former combatants Sponsored Members.
such as Cordillera People’s Liberation Army
(CPLA), Moro National Liberation Front
(MNLF), New People’s Army (NPA), and
Revolutionary Proletarian Army (RPA).

PhilHealth Supplemental Benefits / PhilHealth Plus

Allocation:
P 3,500,000,000

Government employees in the Executive branch will have PhilHealth Supplemental

Benefits, or “PhilHealth Plus”, a healthcare plan that will allow them to avail of
supplemental health benefits – services ranging from preventive and curative,
inpatient and outpatient, and other medical expenses in excess of contributions-
based case rates.

The PhilHealth membership contribution of indigent families, senior citizens, and point-of-service patients are
sourced from incremental revenues of Republic Act No. 10351, or more commonly known as the Sin Tax Law.

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