Updated PhilHealth record required in availing benefits

 

Updated PhilHealth record required in availing benefits

March 16,2013 12:18 AM

 

PHILHEALTH members and dependents seeking confinement in any accredited health care provider are required to submit their updated Member Data Record (MDR) to facilitate availment of National Health Insurance Program benefits.

PhilHealth reiterates this policy to their members, most especially to indigent members enrolled by their respective Local Government Unit (LGU) under the Sponsored Program (SP) of the corporation.

PhilHealth reports show that almost 430,000 poor households in Region-6 are covered under the LGU-Sponsored Program yet less than 50% have updated their records.

“All PhilHealth members must possess with them their MDR and make sure that it is updated,” said Dr. Dennis S. Mas, PhilHealth-6 head VI.

Dr. Mas said the policy of PhilHealth on updated MDR as a primary document will facilitate and ensure easy availment of benefits by members or its dependents when confined.

“Updating of MDR should not only happen when there is already confinement, but must be done as soon as there is a need for change in the member’s record,” Mas said.

Legitimate spouse, children below 21 years old and parents who are 60 years old and above are considered qualified dependents of a PhilHealth member. These qualified dependents are entitled to enjoy of the same benefits a bonafide member can avail with no additional cost on the member’s premium contribution.

Starting January 13, 2013, PhilHealth will no longer distribute PhilHealth IDs to LGU-SP members until the May 2013 election. However the Corporation assured that availment of benefits by indigent members will not be compromised even without their ID.

“We advise our members to request for a Certificate of Eligibility (CE1) and updated MDR from the nearest PhilHealth Office and submit the said documents to the hospital in order that PhilHealth benefits will be deducted from their total hospital bill upon discharge,” Dr. Mas added.

Along with PhilHealth’s campaign for updating of member’s record is the enhancement of its benefits as the corporation recently launched five new benefit packages under Case Type Z.

PhilHealth now covers nine catastrophic illnesses under Case Type Z with the addition of these five new benefit cases.

 

PhilHealth will be paying for coronary artery bypass graft surgery (CABG) at P550,000, surgery for tetralogy of fallot (TOF) at a package rate of P350,000 while surgery for ventricular septal defect (VSD) will be paid at P250,000 for the whole course of treatment.

PhilHealth has also included treatment for the second leading cause of cancer death in women, the cervical cancer.

With its growing incidents, patients with cervical cancer undergoing chemoradiation with cobalt or primary surgery is guaranteed with P120,000 benefit package and P175,000 if treatment for cervical cancer requires linear accelerator.

Case Type Z is a catastrophic condition that is life threatening and requires prolonged hospitalization, extremely expensive therapies or other care that would deplete one’s financial resources unless covered by special health insurance policies. (PhilHealth-6/PAU)

 

 

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