PhilHealth Benefits: List of Illness and Amount Covered

PhilHealth is one of the mandatory contributions every Filipino employee gets charged every month. The benefit that one can get from PhilHealth is huge even if the contribution is just a small amount.

The flip side is, many are unaware of how much PhilHealth covers for each illness that employees may incur.

Are you eligible to be covered on PhilHealth? To be eligible make sure you have at least three months premium contributions within the immediate six months before the month that you will avail it. If you have contributed your premiums for at least three months then you need to submit a copy of your Member Data Record or PhilHealth Benegit Eligibility Form (PBEF) and accomplished Philhealth Form 1 Claim.

The member and qualified dependents are entitled to: benefit for medical expenses for every sickness and operation; get equal benefits; an allocated 45 days hospitalization allowance for the member and 45 days to be divided to all qualified dependents.

Take not that any hospitalization days beyond 45 days would not be covered by PhilHealth. Make sure that the hospital you went to is PhilHealth accredited and you have updated monthly contributions.

Here’s how much PhilHealth covers for every specific illness:

• Ovarian Cystectomy (Unilateral or Bilateral) 23,300 pesos
• Case Rate for Hemodialysis 2,600 pesos per session
• Case Rate for Outpatient Blood Transfusion 3,640 pesos per session
• Thyroidectomy (Total or Complete Cash Benefits) 31,000 pesos

Pneumonia

• Moderate Risk: 15,000 pesos
• High Risk: 32,000 pesos
• Primary Care Moderate Risk: 10,500 pesos

Tonsillectomy (Primary or Secondary): 18,000 pesos

Normal Spontaneous Delivery (NSD)

• Lying in 6,500 pesos
• Hospitals 5,000 pesos
• Pre-Natal 1,500 pesos

Tubal Ligation 4,000 pesos

Intrauterine Device Insertion or IUD 2,000 pesos

Vasectomy (Unilateral or Bilateral) 4,000 pesos

Vital Hepatitis 11,800 pesos

Rheumatic Fever 10,100 pesos

Breech Extraction 12,120 pesos

Appendectomy 24,000 pesos

Cerebral Infarction 28,000 pesos

Cerebral Palsy 9,500 pesos

Cellulitis 9,600 pesos

Cataract Surgery 16,000 pesos

Cholecysectomy 31,000 pesos

Cholecystitis 11,300 pesos

Caesarian Section 19,000 pesos

Congenital Anemia 15,200 pesos

Newborn Care Package 1,750 pesos

Emphysema 11,400 pesos

Dengue

• Dengue Fever: 10,000 pesos
• Severe Case of Dengue: 16,000 pesos

Upper Respiratory Tract Infection (URTI)

• Hospitals: 4,000 pesos
• Primary Care Facilities: 2,800 pesos

Congenital Syphilis 12,800 pesos

Chronic Obstructive Pulmonary Disease (COPD): 12,200 pesos

Asthma

• Astma in acute exacerbation for hospitals: 9,000 pesos
• In primary care facilities: 6,300 pesos

Diabetes Mellitus

• With complications other than Coma and Ketosis: 12,600 pesos

Congenital Hypothyroidism: 9,900 pesos

There are also diseases classified as “economically and medically catastrophic” aside from the illnesses mentioned above due to their seriousness. They are under type Z. The farthest end of the spectrum. Usually, they trigger expensive treatments.

List of Diseases Covered Under PhilHealth Z Benefits:

Z001 Acute Lymphocytic Leukemia, standard risk for children

Z002 Early Breasst Cancer, Stage 0 to IIIA

Z003 Prostate Cancer, Low to intermediate risk

Z004 Kidney Transplantation for end stage Kidney Disease, standard risk

Z005 Coronary artery bypass graft surgery, standard risk

Z006 Total Correction of Tetralogy of Fallot for Children

Z007 Closure of Ventricular Septal Defect for Children

Z008 Cervical Cancer, Stage I to IV

Z009 The Z MORPH or Mobility, Orthosis, Rehabilitation and Prosthesis Help

PhilHealth will cover Operating Room fee, Drugs, Laboratory exams, Hospital room, board fees, and professional fees for the entire course of treatment.

Know your eligibility, requirement and coverage to take advantage of your PhilHealth benefits. Don’t hesitate to share this information to your loved ones. Sharing is caring.