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WELCOME TO PHILHEALTH ORIENTATION FOR COMMUNITY HEALTH TEAM PARTNERS

PHILHEALTH ORIENTATION FOR CHT PARTNERS

Kalusugang Pangkalahatan (KP)
“Bawat Pilipino...Miyembro; Bawat Miyembro...Protektado; Kalusugan Natin...Segurado.”

Ano ang PhilHealth?
• Government Owned and Controlled Corporation

PHILHEALTH ORIENTATION FOR CHT PARTNERS

• 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

PHILHEALTH ORIENTATION FOR CHT PARTNERS

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

PHILHEALTH ORIENTATION FOR CHT PARTNERS

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

PHILHEALTH ORIENTATION FOR CHT PARTNERS Ano ang Katibayan na ikaw ay PHILHEALTH Member Name and address of members List of legal dependents .

PHILHEALTH ORIENTATION FOR CHT PARTNERS YOUR DEPENDENT/S Legal spouse/s Children below 21 years old Legitimate Illegitimate Adopted Step-children Parents 60 years old and above .

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) PHILHEALTH ORIENTATION FOR CHT PARTNERS .

PHILHEALTH ORIENTATION FOR CHT PARTNERS Anu-ano ang mga benepisyo para sa miyembro? .

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: .PHILHEALTH ORIENTATION FOR CHT PARTNERS Simula September 2011.

s 2011 .PHILHEALTH ORIENTATION FOR CHT PARTNERS 11 Medical Case Rates applies NBB for sponsored members per Circular 24.

000 9.000 1.000 9.000 15.000 16.000 38.000 32.000 6.000 28.750 .000 14.PHILHEALTH ORIENTATION FOR CHT PARTNERS Case Rates – Medical Cases Cases Dengue I (Dengue Fever and DHF Grades I & II) 2 Dengue II (DHF Grades III & IV) 3 Pneumonia I (Moderate Risk) 4 Pneumonia II (High Risk) 5 Essential Hypertension 6 Cerebral Infarction (CVA I) 7 Cerebral Hemorrhage (CVA II) 8 Acute Gastroenteritis (AGE) 9 Asthma 10 Typhoid Fever Newborn Care Package in 11 Hospitals and Lying-in Clinics 1 Rates 8.

2011 . s.PHILHEALTH ORIENTATION FOR CHT PARTNERS 12 SURGICAL PROCEDURES applies NBB for sponsored members per Circular 24.

000 4.000 6.500 19.000 8.000 8.000 31.Case Rates – Surgical Procedures Cases 1 2 Radiotherapy Hemodialysis Maternity Care Package (MCP) NSD Package in Level 1 Hospitals NSD Package in Levels 2 to 4 Hospitals Cesarean Section Appendectomy Cholecystectomy Dilatation & Curettage Thyroidectomy Herniorrhapy Mastectomy Hysterectomy Cataract Surgery PHILHEALTH ORIENTATION FOR CHT PARTNERS Rates 3.000 21.000 24.000 31.000 16.000 30.000 22.000 3 4 5 6 7 8 9 10 11 12 .000 11.

00 P 35.00 P 35.000.000.000. Standard Risk Acute Lymphocytic (lymphoblastic) Leukemia for children P 210.00 Mode of Payment 1st tranche 2nd tranche 3rd tranche Amount P 140.00 Filing Schedule Within 60 days upon discharge after 1st induction Within 60 after the 3rd maintenance cycle Within 60 after the 8th maintenance cycle .PHILHEALTH ORIENTATION FOR CHT PARTNERS Case Type Z Benefits Package A.000.

00 P 25. Early Stage Breast Cancer P 100.000.000.00 Mode of Payment Amount P 75.00 Filing Schedule Within 60 After discharge of the surgery Within 60 upon completion of last cycle of chemotheraphy for stage I to III A or upon completion of surgery for stage 0 1st tranche 2nd tranche .000.PHILHEALTH ORIENTATION FOR CHT PARTNERS B.

Low to Intermediate Risk prostate Cancer requiring Prostatectomy P 100.PHILHEALTH ORIENTATION FOR CHT PARTNERS C.000.00 .

00 P 50.000.000.PHILHEALTH ORIENTATION FOR CHT PARTNERS D.00 Mode of Payment Amount Filing Schedule Within 60 days upon discharge of recipient after the transplantation Ninety (90) days after transplantation 1st tranche 2nd tranche P 550. End Stage Renal Disease Eligible for Kidney Transplant (low Risk) P 600.000.00 .

at iba pang laboratory exams • Operating room fees • Professional fees .PHILHEALTH ORIENTATION FOR CHT PARTNERS Inpatient Benefits Kabilang dito ang subsidy para sa: • Room and board • Drugs at medicines • X-ray.

PHILHEALTH ORIENTATION FOR CHT PARTNERS 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 .

PHILHEALTH ORIENTATION FOR CHT PARTNERS Inpatient Benefits Level 1 hospital • Primary hospitals .

PHILHEALTH ORIENTATION FOR CHT PARTNERS Inpatient Benefits Level 2 hospital • Secondary hospitals .

PHILHEALTH ORIENTATION FOR CHT PARTNERS Inpatient Benefits Levels 3 & 4 hospitals Level 3 • Tertiary hospitals Level 4 • Tertiary hospitals na may training program at specialty .

PHILHEALTH ORIENTATION FOR CHT PARTNERS Magkano ang maaaring ma-avail? .

Inpatient Benefits Confinement Case : Surgery .Intracranial Aneurysm Case Type :D Days Confined : 30 days Hospital Level : Tertiary Relative Value Unit : 600 PHILHEALTH ORIENTATION FOR CHT PARTNERS .

Benefit Allowance P190K26 .000 : 600 Room and Board Drugs and Medicines = P 40.200 Estimated Max.000 = P 48.Inpatient Benefits Confinement Case: Surgery .Intracranial Aneurysm Case Type :D Days Confined : 30 days Relative Value Unit = P 33.000 = P 8.000 Operating Room = P 12.000 X-ray. Lab & Others = P 30.000 Specialist Fee Surgeon’s Fee Anesthesiologist’s Fee = P 19.

Outpatient Services Ang mga sumusunod ay may benepisyo kahit isinagawa ng outpatient: •Day surgeries •Chemotheraphy PHILHEALTH ORIENTATION FOR CHT PARTNERS .

PHILHEALTH ORIENTATION FOR CHT PARTNERS New Born Care Package Immediate Drying of the Newborn.00 Newborn Screening Tests . New Born Hearing Test First dose of Hepatitis B immunization Php 1.750. Vit K & thermal. Eye prophylaxis. umbilical cord care (Cord Clamping).

Special Benefit Packages P4.000 coverage para sa TB-DOTS na ina-admister ng mga accredited health centers PHILHEALTH ORIENTATION FOR CHT PARTNERS coverage para sa malaria treatment sa mga accredited rural health units P600 .

Special Benefit Packages P4.000 PHILHEALTH ORIENTATION FOR CHT PARTNERS Para sa vasectomy and tubal ligation .

monkeys except rodents. cows. cats.PHILHEALTH ORIENTATION FOR CHT PARTNERS Animal Bite Package Dog bites. bats. Antibiotics vi. Tetanus toxoid and anti-tetanus scrum (ATS) v.000 per case i. pigs. Rabies vaccine ii. alcohol and other antiseptics Effective May 3. horses. 2012 . guinea pigs and rabbits at 3. Rabies Immune Globulin (TUG) iii. Local wound care iv. goats. Supplies: syringes. cotton.

500 1.200 14.000 5. Lab and Others Operating Room 9.000 500 7.Special Benefit Packages BENEFIT ITEM LEVEL 1 HOSPITALS LEVEL 2 HOSPITALS LEVEL 3 & 4 HOSPITALS PHILHEALTH ORIENTATION FOR CHT PARTNERS Drugs and Medicine X-ray.350 750 10.200 Outpatient package para sa Blood Transfusion .000 11.

PHILHEALTH ORIENTATION FOR CHT PARTNERS Special Benefit Packages Coverage para sa Outpatient treatment ng HIV/AIDS P30.000 .

Primary Care Package Outpatient Benefits para sa Sponsored Program Members sa mga accredited Rural Health Unit kung saan nakaassign ang SP member PHILHEALTH ORIENTATION FOR CHT PARTNERS .

PHILHEALTH ORIENTATION FOR CHT PARTNERS 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) .

PHILHEALTH ORIENTATION FOR CHT PARTNERS Free Diagnostic Services - Complete Blood Count (CBC) Urinalysis Fecalysis Sputum Microscopy Fasting Blood Sugar Lipid Profile Chest X-ray .

URTI/Pneumonia (Minimal & Low Risk) .Acute Gastroenterisis with no/mild dehydration .PHILHEALTH ORIENTATION FOR CHT PARTNERS Free Drugs and Medicines .Asthma including nebulisation services .Urinary Tract Infection .

PHILHEALTH ORIENTATION FOR CHT PARTNERS Paano ang pagavail ng benepisyo? .

PHILHEALTH ORIENTATION FOR CHT PARTNERS 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 .

Benefit Exclusions x Hindi binabayaran ng PhilHealth ang mga sumusunod: × × × × × Ika-lima at susunod pang normal spontaneous delivery. PHILHEALTH ORIENTATION FOR CHT PARTNERS . Cosmetic surgeries. Non. at Optometric services. Alcohol abuse at drug dependency treatments.prescription drugs.

PHILHEALTH ORIENTATION FOR CHT PARTNERS Mga paalala: .

PHILHEALTH ORIENTATION FOR CHT PARTNERS Remember • Number of days allowed per year – 45 for the member – Another 45 for all dependents .

PHILHEALTH ORIENTATION FOR CHT PARTNERS 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 .

PHILHEALTH ORIENTATION FOR CHT PARTNERS Mga dapat tandaan! .

PHILHEALTH ORIENTATION FOR CHT PARTNERS Itago ang SIC at MDR sa ligtas na lugar at madaling makita .

PHILHEALTH ORIENTATION FOR CHT PARTNERS Mag-update ng Records  Mag submit ng PhilHealth Member Registration Form (PMRF) kung magpapalit ng civil status. apelyido. Ilakip sa Form ang kaukulang marriage at birth certificate. o magdadagdag ng legal dependent. .

gov.philhealth.PHILHEALTH ORIENTATION FOR CHT PARTNERS http://www.ph .

PHILHEALTH ORIENTATION FOR CHT PARTNERS DXMD RMN-GENSAN 927 Khz Sunday 10-11 am www.weebly.rmngensan.com .

Regional Vice President PhilHealth Regional Office XII Koronadal City.One Bldg.GSC T/F:083-302-2558 T:083-554-6893 . JR.PHILHEALTH ORIENTATION FOR CHT PARTNERS RAMON F. South Cotabato 083-228-9734 Local Health Insurance Office-General Santos City hw.. Santiago Blvd. ARISTOZA..

Cor.E. Posadas & Abad Santos Sts.K. Koronadal City •LHIO-Kidapawan City 2/F Apol-J Bldg. Pendatun Avenue... Nat’l Highway. Quezon Blvd. Isulan.PHILHEALTH ORIENTATION FOR CHT PARTNERS Maari din kayong magtungo sa: •PhilHealth Regional Office XII Plaza de Español Bldg.. Kidapawan City •LHIO-Cotabato City F/A Tan Bldg.R Commercial Bldg.. S. Sultan Kudarat . Cotabato City •LHIO-Isulan R...

GSC Quezon Ave. No.PHILHEALTH ORIENTATION FOR CHT PARTNERS LIST OF HOSPITALS Hospital Address Tel. GSC Doctors Hospital St. Diagan Cooperative Hospital GSC District Hospital National Highway. Calumpang GSCH Compound . Elizabeth Hospital Mindanao Medical Center SOCSARGEN County Hospital R. GSC Labella Hospital SOCIAL HYGIENE CLINIC First Road.. GSC Lagao – Bula Road. GSC Mabuhay Road. GSC National Highway. GSC 552-3141 552-2813 552-4629 553-8906 552-3842 301-6864 to 76 or 169 Fernandez ST.

DP.) Control of Non-Communicable Diseases (e. Minor Surgery (Suturing. TB.PHILHEALTH ORIENTATION FOR CHT PARTNERS ILHZ MINIMUM PACKAGE OF SERVICES PRIMARY HEALTH CARE SERVICES                Pre-natal Care Normal Delivery. drainage of abscess. STD. circumcision) Appropriate referral of District Environmental Health Services Basic Laboratory Services Management of Public Health Services. etc. Malaria.g. Dengue. Health diet. postpartum care Immunization Family Planning Nutrition Growth Monitoring Control of Communicable Diseases (CARI. Coordination with NGOs and Private Medical Sector Training of Human Resources Supervision of Health Services and Human Resource in the ILHZ . alcohol. tobacco).

PHILHEALTH ORIENTATION FOR CHT PARTNERS Daghang Salamat! .