cht training philhealth
TRANSCRIPT
WELCOME TO PHILHEALTH ORIENTATION
FOR COMMUNITY HEALTH TEAM
PARTNERS
PHILH
EALTH
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Kalusugang Pangkalahatan (KP)
“Bawat Pilipino...Miyembro; Bawat Miyembro...Protektado; Kalusugan Natin...Segurado.”
PHILH
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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
PHILH
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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
PHILH
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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)
PHILH
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Anu-ano ang mgabenepisyo para sa miyembro?
PHILH
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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:
PHILH
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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
PHILH
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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.
PHILH
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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!
PHILH
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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
PHILH
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DXMD RMN-GENSAN 927 KhzSunday 10-11 am
www.rmngensan.weebly.com
PHILH
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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!