List of PhilHealth Cash Benefits for Specific Illness

This article will give you the complete and comprehensive list of PhilHealth cash benefits for specific illness. Along with this list will be the coverage, eligibility and guidelines for that specific illness or disease.

Requirements to Claim the PhilHealth Cash Benefits

  • The member must have at least three (3) months’ premium contributions within the immediate six (6) months before the month of availment.
  • One (1) copy of Member Data Record or PhilHealth Benefit Eligibility Form (PBEF)
  • A duly accomplished PhilHealth Claim Form 1

Illness Covered by PhilHealth and the Corresponding Benefits Coverage

ILLNESS COVERAGE
Case Rate for Hemodialysis Php2, 600.00 per session
Case Rate for Outpatient Blood Transfusion Php3, 640.00 (one or more units)
Thyroidectomy (Total or Complete Cash Benefits) Php31, 000.00
Ovarian Cystectomy (Unilateral or Bilateral) Php23, 300.00
Pneumonia • Moderate Risk Pneumonia: Php15, 000.00
• High-Risk Pneumonia: Php32, 00.00
• Primary Care Moderate Risk Pneumonia: Php10, 500.00
Tonsillectomy (Primary or Secondary) Php18, 000.00
Normal Spontaneous Delivery (NSD) •  Lying in: Php6, 500
• Hospitals: Php5, 000.00
• Pre-Natal: Php 1, 500.00
Tubal Ligation Php4, 000.00

For IN PATIENTS Benefits

  • These benefits are paid to the accredited Health Care Institution (HCI) through All Case Rates
  • The case rate amount shall be deducted by the HCI from the member’s total bill, which shall include professional fees of attending physicians, prior to discharge
  • The case rate amount is inclusive of hospital charges and professional fees of attending physician
ILLNESS COVERAGE
Intrauterine Device Insertion or IUD Php2,000
Vasectomy (Unilateral or Bilateral) Php4,000
Viral Hepatitis Php11,800
Rheumatic Fever Php10,100
Breech Extraction Php12, 120
Appendectomy Php24, 000
Cerebral Infarction Php28, 000
Cerebral Palsy Php9, 500
Cellulitis Php9, 600
Cataract Surgery Php16, 000
Cholecysectomy Php31, 000
Cholecystitis Php11, 300
Caesarian Section Php19, 000
Congenital Anemia Php15, 200
Newborn Care Package Php1, 750
Emphysema Php11, 400
Upper Respiratory Tract Infection (URTI) • Hospitals: Php4, 000
• Primary Care Facilities: Php2, 800
 Dengue • Dengue Fever: Php10, 000
• Severe Case of Dengue: Php16, 000
Chronic Obstructive Pulmonary Disease (COPD) Php12, 200
Congenital Syphilis Php12, 800
Diabetes Mellitus **With complications other than Coma and Ketosis: Php12, 600
 Asthma • Asthma in acute exacerbation for hospitals: Php9, 000
• In primary care facilities: Php6, 300
Congenital Hypothyroidism Php9, 900

For OUT PATIENTS Benefits

  • Day Surgeries (Ambulatory Or Outpatient Surgeries) Are Services That Include Elective (Non-Emergency) Surgical Procedures Ranging From Minor To Major Operations, Where Patients Are Safely Sent Home Within The Same Day For Post-Operative Care
  • Radiotheraphy
  • Hemodialysis
  • Outpatient Blood Transfusion
  • Primary Care Benefits
    • Preventive Services
    • Diagnostic Examinations
    • Drugs and Medicines

MDG Related

  • Outpatient Malaria Package (P600.00)
  • Outpatient HIV-AIDS Package (P30,000.00 per year or P7,500/quarter)
  • Outpatient Anti-Tuberculosis Treatment through Directly-Observed Treatment Short-course (DOTS) Package (P4,000)
    • P2,500 – Intensive phase
    • P1,500 – Maintenance Phase
  • Voluntary Surgical Contraception Procedures (P4,000.00)
  • Animal Bite Treatment Package
    P3,000.00

PhilHealth Z Benefits

There are expensive treatments that can also be covered through the PhilHealth Z Benefits. The following are the type of illnesses or diseases that are covered:

  • Z001 Acute lymphocytic leukemia, standard risk (for children)
  • Z002 Early breast 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 (Mobility, Orthosis, Rehabilitation and Prosthesis Help)

Who can avail the PhilHealth Z Package?

All members and their dependents are eligible for this package regardless if the member is employed, individually paying (voluntary), lifetime member program, sponsored program or overseas worker program.

PhilHealth Z Package can also cover (a) operating room expenses, (b) drugs and laboratory exams, (c) hospital room and board fees, and (d) professional fees for the entire course of the treatment.

Please refer to this article published by the PhilHealth official website for the list of selection criteria and the partner hospitals for the PhilHealth Z Package.

You can contact the nearest PhilHealth Regional Office if you have questions regarding the details of the requirements. Read: PhilHealth Regional Offices Directory

Read Also: Updated PhilHealth Contribution Table 2018

Source: philhealth.gov.ph

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16 Comments

    • naaksidente p oak osa ebike last november. pero hindi po nahonor ang philhealth k osa aman rodriguez memorial hospital. nagpa ctscan, xray, attinahi din po ako sa ulo one stitch lang naman.. at umuwi na din ako ng kinagabihan… may benefits po ba makukuha sa philhealth pag ganun…ang sabi kasi sa ospital wala daw po dahil ang philhealth ay in patient lang. tama po ba iyon? naiatabi ko pa rin po lahat ng bills ko pati yung mga resibo ng gamot. salamat po sa pagreply

  1. WHEN MY WIFE DELIVER OUR FIRST BABY IN SEPTEMBER 2014 IN A NORMAL DELIVERY,MY WIFE FILED HER USE HER PHILHEALTH AND FORWARDED TO THE CLINIC WHERE SHE ADMITTED, WE PAID P15,000.00 FOR THE SERVICES THEY HAVE RENDERED IN HER DELIVERY. THE CLINIC STAFF INFORMED US THAT THE AMOUNT WE PAID, PHILHEALTH BENEFITS WAS ALREADY DEDUCTED IN OUR BILL THAT IS WHY THEY COME UP WILL BILL OF 15,000.00. HOW CAN WE CHECK IF THE AMOUNT WE PAID ACCURATE AND NO DOUBLE CHARGES IS BEING DONE DURING THE PAYMENT. I HEARD THAT THE HOSPITAL OR CLINIC COLLECT PAYMENT AT PHILHEALTH AND AT THE SAME CHARGE THE PATIENT. HOPING FOR YOUR KIND REPLY TO THIS QUERY.

    • Hi Mr. Javier, please contact the nearest PhilHealth Regional Office. They will answer all your inquiry po. You can also send an email. Check the directory here.

  2. Gudpm poh ask q poh…how about nman poh katulad q my goiter nagpaparadiation aq out patient…my makukuha b aq s philhealth?

  3. Paano po magkakaroon ng philhealth ang 16 years old na teenager wala na po xang magulang..orphan po at lola lang ang kasama..pregnant po xa

    • May PhilHealth po ba si Lola? Pwede po iyon ang maging guardian niya para magkaroon ng PhilHealth. Punta rin po kayo sa inyong munisipyo para makahingi ng tulong. Under pa po iyan sa DSDW.

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