The Philippine Health Insurance Corporation (PhilHealth)

With Recent Z-Benefit Packages

The Philippine Health Insurance Corporation (PhilHealth) is a government-owned and controlled corporation (GOCC) established in 1995 under the National Health Insurance Act of 1995. Its primary goal is to ensure a sustainable national health insurance program for all Filipinos, providing universal health coverage and making healthcare more accessible and affordable[1][2].

Background

PhilHealth's roots trace back to the 1960s with the MARIA Project, which aimed to provide medical assistance to rural indigents. This initiative evolved into the Medicare program under the Philippine Medical Care Act of 1969. In 1995, PhilHealth was formally created to administer and expand health insurance coverage across the country[2]. Over the years, PhilHealth has grown to cover nearly the entire population, with significant improvements in its benefit packages and delivery systems[1].

Current Patient Benefits and Packages

PhilHealth offers a wide range of benefits for both outpatient and inpatient services. Here are some of the key packages available:

Outpatient Benefits

·         Outpatient Emergency Care Benefit: Covers urgent care that does not require hospitalization for at least 24 hours, including treatment for life-threatening emergencies[3].

·         Preventive Oral Health Services: Includes dental check-ups and treatments to promote oral health[4][3].

·         Outpatient Mental Health Services: Provides access to mental health care without the need for hospitalization[4].

·         Optometric Services for Children: Offers eye care services for children aged 0-15 years[4].

·         Physical Medicine, Rehabilitation, and Assistive Mobility Services: Supports patients needing physical therapy and rehabilitation[4].

Read more: https://www.hospitalnews.ph/philhealth/the-out-patient-benefits-of-philhealth

Inpatient Benefits

·         Case Rates for Various Conditions: PhilHealth has increased case rates for over 9,000 packages by 50%, including significant increases for treatments like hemodialysis and kidney transplantation[4][3].

o Hemodialysis Package: Increased to PHP 6,350 from PHP 2,000 for 156 sessions per year[4].

o Kidney Transplantation (Z Benefit): Increased to PHP 2.1 million from PHP 600,000[4].

o Peritoneal Dialysis (Z Benefit): Increased to PHP 1.2 million from PHP 270,000[4].

·         Ischemic Heart Disease Packages: Includes benefits for percutaneous coronary intervention (PCI), fibrinolysis, emergency medical services, and cardiac rehabilitation[3].

Read more: https://www.hospitalnews.ph/philhealth/the-in-patient-benefits-of-philhealth

Requirements for Patients

To avail of PhilHealth benefits, patients must complete the following requirements:

1.   Claim Form 1 (CF1): Properly filled out with member/patient information and employer certification (if applicable)[5].

2.  Claim Signature Form (CSF): Completed with member/patient information and employer certification (if applicable)[5].

3.  Updated Member Data Record (MDR): Ensures that patient details are current[5].

4.  Certificate of PhilHealth Contribution: For employed members, or Official Receipt of Premium Payment for individually paying or self-employed members[5].

5.   Proof of Dependency: Required for undeclared dependents, along with a PhilHealth Membership Registration Form (PMRF)[5].

These documents must be submitted at least two days before any scheduled procedure or surgery[5].

Requirements for Accredited Institutions and Providers

Healthcare institutions seeking accreditation with PhilHealth must follow these guidelines:

1.   Accreditation Process: Institutions can apply for initial, continuous, or re-accreditation. The process involves submitting required documents and meeting specific standards for quality healthcare services[6].

2.  Automatic vs. Non-Automatic Accreditation: Some institutions may be automatically accredited based on their status, while others require a more detailed application process[6].

3.  Basic Participation: Involves ensuring compliance with PhilHealth policies and providing quality healthcare services[6].

4.  Continuous Accreditation: Requires periodic updates and re-accreditation to maintain status[6].

PhilHealth's accreditation process aims to ensure that healthcare providers meet high standards of care, thereby enhancing the quality of services available to its members[6].

In summary, PhilHealth plays a crucial role in providing comprehensive health insurance coverage to Filipinos, with a focus on expanding benefits and improving access to quality healthcare services. 

References

1.  https://en.wikipedia.org/wiki/Philippine_Health_Insurance_Corporation 

2.   https://financialassistance.ph/philhealth-philippine-health-insurance-corporation/ 

3.   https://www.pna.gov.ph/articles/1241535

4.   https://pia.gov.ph/philhealth-expands-medical-benefit-packages-in-2025/   

5.   https://www.myhealth.ph/philhealth-requirements/ 

6.   https://www.philhealth.gov.ph/downloads/accreditation/MOP_PEACHeS.pdf