Philhealth Benefits — Case Rates Payments for Certain Medical and Surgical Cases

Updated June 2, 2014:

Since January 2014, all hospitalizations and outpatient treatments eligible for Philhealth coverage are already being covered under the Philhealth Case Rate system.  Each medical or surgical case is covered by a fixed amount.

For medical cases, 30% of the fixed amount is for Doctors’ Professional Fees  (PF) and 70% is for hospital costs.

For surgical cases, it’s 40% for PF and 60% for hospital costs.

You can no longer file your Philhealth claims directly with Philhealth.

Submit your Philhealth documents to the hospital BEFORE DISCHARGE, so the hospital will deduct the Philhealth coverage from your bill.  It will be to the hospital that Philhealth will send the check.

If the hospital asks you to sign a waiver, READ the waiver.

You can see the coverage amounts here: Procedure Case Rates and Medical Case Rates.

The coverage amounts listed in the charts below, posted in August 2011, are still correct, but the list below includes only the first procedures and conditions covered under the Case Rate program.
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Article below was posted on August 2011:

Last September 1, 2011, Philhealth started implementing its policy of paying fixed rates or fixed amounts to accredited hospitals and clinics for 11 medical cases and 11 surgical cases under its reimbursement scheme called Case Rates Payment.

If we count 9 case rates payment packages implemented since 2003, there are now 31 medical and surgical cases paid by Philhealth under its Case Rates Payment scheme. Other cases are paid under the regular Fee-for-Service scheme.

The fixed Philhealth payments are made directly to the hospitals or clinics. The fixed Philhealth payment is deducted from the total hospital bill and the balance will be paid by the patient.

Philhealth said that the Case Rates basis of payments for SURGICAL CASES  is applied to cases managed at Levels 2 to 4 hospitals (bigger hospitals), with certain exceptions.

For sponsored members and their dependents, the No Balance Billing Policy will apply when they are confined in government hospitals or clinics. It means the Philhealth payments will be adequate to cover their expenses for these 22 medical and surgical cases and they don’t need to pay anything. In cases where patients are asked to buy certain drugs or supplies, they will be reimbursed.

These are the selected medical and surgical cases and the fixed amounts that Philhealth is going to pay to hospitals or clinics, implemented for patients admitted starting September 1, 2011:

MEDICAL CASES

Medical cases Case Rates in Pesos
1.  Dengue 1
Dengue Fever and DHF Grades 1 and 2 8,000
2.  Dengue 2
DHF Grades 3 and 4 16,000
3.  Pneumonia 1 – Moderate Risk 15,000
4.  Pneumonia 2 – High Risk 32,000
5.  Essential hypertension 9,000
6.  Cerebral infarction (CVA I) 28,000
7.  Cerebro-vascular accident
hemorrhage (CVA II) 38,000
8.  Acute gastroenteritis (AGE) 6,000
9.  Asthma 9,000
10.  Typhoid fever 14,000
11.  Newborn care package (NCP) 1,750
SURGICAL CASES

Surgical Cases Case Rates in Pesos
1.  Radiotherapy 3,000
2.  Hemodialysis 4,000
3.  Maternity care package (MCP) 8,000
Normal spontaneous delivery (NSD)
in Level 1 Hospitals 8,000
NSD in Levels 2 to 4 Hospitals 6,500
4.  Delivery by caesarian section (CS) 19,000
5.  Appendectomy 24,000
6.  Cholecystectomy 31,000
7.  Dilatation and curettage 11,000
8.  Thyroidectomy 31,000
9.  Herniorrhapy 21,000
10.  Mastectomy 22,000
11.  Hysterectomy 30,000
PHILHEALTH PACKAGES launched from 1993 to 2010

Medical or Surgical Case Fixed Payments Year Implemented
TB-DOTS 6,500 2003
SARS 50 to 100k 2003
Avian Influenza 50 to 100k 2006
Bilateral Tubal Ligation (BTL) 4,000 2008
Vasectomy 4,000 2008
Cataract 16,000 2008
Malaria 600 2008
Normal Spontaneous Delivery
(NSD) with BTL 10,500 2009
Outpatient HIV/AIDS Treatment 30,000 per year 2010
Note:
Treatment for influenza A (H1N1) is now paid as Case Type A under the Fee-for-Service scheme. It was previously paid at a package rate of from 75k to 100k since 2009.

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  597. Jocelyn Magallanes September 25, 2015
  598. Nora September 24, 2015
  599. Helen Mae P. Mayhew September 24, 2015
  600. Nora September 24, 2015
  601. Helen Mae P. Mayhew September 23, 2015
  602. Nora September 23, 2015
  603. elaine joy panggat September 23, 2015
  604. Nora September 23, 2015
  605. Nicky ang September 23, 2015
  606. Nora September 22, 2015
  607. Nora September 22, 2015
  608. Nora September 22, 2015
  609. may marinas September 22, 2015
  610. Nicky ang September 21, 2015
  611. Ceya September 21, 2015
  612. Nora September 15, 2015
  613. veronica September 15, 2015
  614. Nora September 14, 2015
  615. rosario September 13, 2015
  616. Nora September 10, 2015
  617. sam September 10, 2015
  618. Nora September 4, 2015
  619. Lilian pabilona September 2, 2015
  620. Nora September 1, 2015
  621. SYLVIA G. TAMAYO August 31, 2015
  622. Nora August 27, 2015
  623. Demri August 26, 2015
  624. Nora August 20, 2015
  625. Divina L. Ingaran August 19, 2015
  626. Nora August 19, 2015
  627. Nora August 18, 2015
  628. Ricky dela Pena August 18, 2015
  629. Ivy August 18, 2015
  630. Nora August 15, 2015
  631. Nora August 15, 2015
  632. Benjamin R. Alimorong August 15, 2015
  633. Betj August 15, 2015
  634. Nora August 13, 2015
  635. Nora August 13, 2015
  636. Lilet August 13, 2015
  637. Lilet August 12, 2015
  638. Nora August 12, 2015
  639. Arlene Jorque August 11, 2015
  640. cecil August 8, 2015
  641. kurt July 28, 2015
  642. Nora July 24, 2015
  643. Nora July 23, 2015
  644. Nora July 23, 2015
  645. sheila July 23, 2015
  646. paul July 22, 2015
  647. Arled July 21, 2015
  648. melody July 21, 2015
  649. Nora July 20, 2015
  650. Nora July 20, 2015
  651. Joanna Rellermo July 20, 2015
  652. Nora July 20, 2015
  653. pearl July 18, 2015
  654. Dissa July 18, 2015
  655. Nora July 17, 2015
  656. Dissa July 17, 2015
  657. Nora July 15, 2015
  658. Sheila July 15, 2015
  659. Nora July 15, 2015
  660. Ana Mary O. Quirante July 13, 2015
  661. Nora July 13, 2015
  662. Merlyn July 13, 2015
  663. Nora July 5, 2015
  664. Delia Pereña July 5, 2015
  665. Evelyn July 4, 2015
  666. Leo July 3, 2015
  667. Nora July 2, 2015
  668. Paul Cuenca July 2, 2015
  669. Miles June 3, 2015
  670. Nora June 1, 2015
  671. Nora June 1, 2015
  672. Froscie May 31, 2015
  673. joy May 31, 2015
  674. Nora May 31, 2015
  675. Nora May 31, 2015
  676. ELLEN May 30, 2015
  677. lorna donna May 29, 2015
  678. jon May 27, 2015
  679. Nora May 24, 2015
  680. marife oreta May 21, 2015
  681. agnes cabantog May 20, 2015
  682. Nora May 20, 2015
  683. nanneth rivera May 17, 2015
  684. Nora May 5, 2015
  685. bryoj May 4, 2015
  686. kat manansala April 25, 2015
  687. kat manansala April 25, 2015
  688. jovie marasigan April 24, 2015
  689. Manny Padrigo April 24, 2015
  690. Nora April 24, 2015
  691. Jessy April 23, 2015
  692. Nora April 21, 2015
  693. jennifer April 21, 2015
  694. lorina vilchez April 21, 2015
  695. cecille April 14, 2015
  696. Nora April 13, 2015
  697. Nora April 13, 2015
  698. che April 13, 2015
  699. boss April 13, 2015
  700. albert April 12, 2015
  701. Nora April 12, 2015
  702. Rozaline April 10, 2015
  703. Nora April 9, 2015
  704. Nora April 9, 2015
  705. Rozaline April 8, 2015
  706. Emil April 8, 2015
  707. jocelyn novelo April 6, 2015
  708. lauriz April 6, 2015
  709. lorie April 5, 2015
  710. Kaye March 27, 2015
  711. sarah certeza March 27, 2015
  712. ian March 24, 2015
  713. ian March 24, 2015
  714. Nora March 19, 2015
  715. Emil March 19, 2015
  716. Nora March 14, 2015
  717. simon delmundo March 13, 2015
  718. Nora March 6, 2015
  719. kenneth March 6, 2015
  720. Nora February 21, 2015
  721. Nora February 20, 2015
  722. Mylene Mae Palmes February 20, 2015
  723. gennifer February 19, 2015
  724. Nora February 14, 2015
  725. MYLENE MAE PALMES February 13, 2015
  726. Nora January 29, 2015
  727. girlie January 28, 2015
  728. abigail January 21, 2015
  729. rex ann January 11, 2015
  730. Nora January 11, 2015
  731. Alli January 9, 2015
  732. thed January 9, 2015
  733. Nora December 4, 2014
  734. ilyn de guzman December 3, 2014
  735. Nora November 22, 2014
  736. Nora November 22, 2014
  737. dexter carlo medel November 22, 2014
  738. emma November 21, 2014
  739. gemma omana November 21, 2014
  740. Nora November 19, 2014
  741. Tomas November 19, 2014
  742. Tomas November 19, 2014
  743. Nora November 19, 2014
  744. Sarah Rodriguez November 17, 2014
  745. Nora November 15, 2014
  746. Jerico Allano Moral November 15, 2014
  747. Nora November 10, 2014
  748. Nora November 10, 2014
  749. Regine Camille Coupon November 9, 2014
  750. Irineo November 9, 2014
  751. Nora November 9, 2014
  752. Magdalena November 9, 2014
  753. Nora November 9, 2014
  754. reuben November 8, 2014
  755. Nora November 8, 2014
  756. Edna Zamora November 7, 2014
  757. Nora November 6, 2014
  758. jhoan November 6, 2014
  759. Nora November 3, 2014
  760. Nora November 3, 2014
  761. Nora November 3, 2014
  762. tess November 3, 2014
  763. tesa November 2, 2014
  764. Nora October 31, 2014
  765. Gretchen Aligarbes October 31, 2014
  766. rommel October 26, 2014
  767. rommel October 26, 2014
  768. Nora October 23, 2014
  769. kath October 22, 2014
  770. Nora October 19, 2014
  771. elvie October 18, 2014
  772. Nora October 17, 2014
  773. Jay-Jay Trono October 17, 2014
  774. Nora October 15, 2014
  775. Raju Radhakrishnan October 15, 2014
  776. Nora October 14, 2014
  777. jennifer de leon October 14, 2014
  778. Nora October 9, 2014
  779. zoila October 7, 2014
  780. Nora October 5, 2014
  781. Emily October 4, 2014
  782. Nora October 2, 2014
  783. sylvia September 30, 2014
  784. jingelbells September 29, 2014
  785. Nora September 25, 2014
  786. Josie September 24, 2014
  787. Nora September 20, 2014
  788. ariel September 19, 2014
  789. Nora September 17, 2014
  790. Nora September 17, 2014
  791. evangeline solino September 17, 2014
  792. Rose Maquirang September 16, 2014
  793. Cesar P. Arique Jr. September 15, 2014
  794. Nora September 11, 2014
  795. rom September 10, 2014
  796. Nora September 9, 2014
  797. Nora September 9, 2014
  798. shania September 9, 2014
  799. Cesar P. Arique Jr. September 8, 2014
  800. Nora September 8, 2014
  801. Nora September 8, 2014
  802. Ernesto Austria September 8, 2014
  803. jenny September 7, 2014
  804. Nora September 3, 2014
  805. Fel mar boloron September 3, 2014
  806. Nora August 29, 2014
  807. Lanie August 28, 2014
  808. Nora August 28, 2014
  809. jingelbells August 28, 2014
  810. Nora August 28, 2014
  811. rosalyn August 27, 2014
  812. emy August 27, 2014
  813. Nora August 26, 2014
  814. marilou livado August 25, 2014
  815. Nora August 25, 2014
  816. mark August 24, 2014
  817. Nora August 18, 2014
  818. Maria Thelma C. Barrios August 18, 2014
  819. Diane August 18, 2014
  820. Nora August 16, 2014
  821. Maritess August 15, 2014
  822. Nora August 11, 2014
  823. vench August 10, 2014
  824. Joset August 9, 2014
  825. Nora August 8, 2014