Thursday, June 21, 2012

Philhealth Maternity Benefits


Philhealth will start implementing its Case Rates Payment system for maternity cases and certain other medical/surgical cases for patients admitted starting September 1, 2011.
For Normal Spontaneous Delivery (NSD) in Level 1hospitals and in lying-in facilities, maternity clinics, RHUs and birthing facilities, the total Philhealth payment will be 8,000 pesos (6,500 for the facility and health professional and 1,500 for prenatal care).
For NSD in Levels 2 to 4 hospitals, the total Philhealth payment will be 6,500 pesos (5,000 for the facility and health professional and 1,500 for prenatal care).
For delivery by Caesarian Section (CS) in accredited Levels 2 to 4 hospitals and performed by accredited health professionals, the Philhealth fixed payment will be 19,000 pesos.
The Newborn Care Package (NCP) has been increased from 1,000 to 1,750 pesos. NCP includes physical examination, eye prophylaxis, Vitamin K administration, BCG Vaccination, first dose of Hepatitis B immunization, newborn screening tests, and breastfeeding advice.
Several readers are asking about Philhealth maternity benefits.  Based on recent Philhealth circulars and advisories, here are some bits of info:
Q: How much is the total maternity benefit?
The total benefit is 6,500 pesos for normal delivery or normal childbirth. But usually, you enjoy only a deduction of 5,000 pesos from your total hospital/clinic bill. You’ll know why in the next questions. For admissions starting September 1, 2011, the benefit has been increased to 8,000 pesos in Level 1 hospitals and in lying-in and maternity clinics. It remains at 6,500 pesos, however, for normal deliveries at Levels 2 to 4 hospitals.
Q: Can I receive this maternity benefit for all my normal deliveries?
No.  Only the first 4 births are covered under the normal delivery package.
Q: Can I automatically receive the total benefit of 6,500 pesos or 8,000 pesos?
Not always.  The benefit of 8,000 pesos pays for the following:
- hospital costs
– for the attending doctor
– 1,500 pesos for prenatal care
For lying-in clinics or midwife-managed facilities:
6,500 pesos for midwife and facility services
1,500 pesos for prenatal care
So if you didn’t avail of prenatal care, you get only 5,000 pesos or 6,500 pesos, and if your doctor is not Philhealth-accredited, your benefit is reduced.
Q: If I’m one month pregnant now, can I apply for Philhealth membership so I can avail of the maternity benefits when I give birth?
No and yes. For Voluntary Members or Individually Paying Members, nine months of prior contributions is required for receiving the maternity benefit package. Count 9 months within the 12-month period prior to child delivery. Let’s say your expected delivery month is September 2011. For the period from September 2010 to August 2011, you should have paid 9 monthly contributions. If Philhealth allows you to pay for December 2010 so you can reach the 9-month total, then you can avail. This depends on your prior Philhealth membership, meaning if you have been a Philhealth member before.
If you’re an OFW or an OFW dependent, yes, you can avail of the benefit as long as your delivery date is within the time frame indicated in the receipt paid by the OFW member. The same condition for Sponsored Members.
For Employed Members, 3 months of payments within the 6-month period prior to delivery are required.
Q. If the hospital is Philhealth-accredited, can I be sure that I get the maximum hospital benefit?
No. You have to make sure that your doctor is also Philhealth-accredited.
Q: How do I get my pre-natal care benefit?
Keep your official receipts for paid prenatal consultation and care, and then submit them to your accredited hospital/clinic/lying-in/maternity facility, so the receipts will be included in the Philhealth claim.
Q: When should I file my claims?
Submit your documents to your accredited health facility before discharge so the 5,000 pesos or newborn test cost benefits will be deducted from your hospital/clinic bill. If you’re unable to submit your papers before discharge, file your claim within 60 days from date of discharge. Waiting for reimbursement can take months.
Q. What are the documents needed to enjoy maternity benefits?
1. Your Philhealth Member Data Record (MDR). Get this in advance from any Philhealth branch.
2. Philhealth Claim Form. You can ask for this form from your employer, the hospital or from any Philhealth branch. Ask for two copies, the other is for your baby’s newborn care package.  If you’re employed, ask for a certificate of Philhealth premium payments.
3. Bring your ID, in case the hospital asks for identification.
4. If you’re voluntary or individually paying, or OFW dependent, bring original and copies of your Philhealth payment receipts.
5. If you’re a dependent of your husband, bring your marriage certificate, in case the hospital asks.
6. If you have pre-natal care receipts, bring them to the hospital/clinic and attach them to the claim forms. Pre-natal care benefit is 1,500 pesos.
Q. Are there other reasons why I can’t avail of Philhealth’s Normal Maternity Care Package (NCP) of benefits?
You CAN NOT avail of certain maternity-related care in non-hospital facilities such as lying-in and maternity clinics. Avail of these maternity services in hospitals.
Here are exclusions  (both hospital and non-hospital facilities):
- fifth normal delivery and subsequent deliveries
- normal delivery after 1 breech delivery and 3 normal deliveries
- normal delivery after 1 cesarean delivery and 3 normal deliveries
- normal delivery after 1 preterm delivery and 3 normal deliveries
- normal delivery after 1 stillbirth and 3 normal deliveries
- normal delivery after 1 normal delivery, 1 abortion and 3 normal deliveries
- normal delivery after 3 abortions and 4 normal deliveries
Exclusions in non-hospital facilities:
- you’re younger than 19
- you’re already 35 years old or older and this is your first time to give birth
- multiple pregnancy
- uterine or ovarian abnormalities, such as ovarian cysts and myoma uteri
- placental abnormality, such as placenta previa
- abnormal fetal presentation, such as breech
- history of 3 or more miscarriages or abortion
- history of 1 stillbirth
- history of cesarean section (CS), or uterine myomectomy, or other major gynecologic or obstetric operation
- history of hypertension, eclampsia, pre-eclampsia, diabetes, heart disease, asthma, epilepsy, bleeding disorders, renal diseases, thyroid disorder and morbid obesity
- risky conditions that may arise during pregnancy such as vaginal bleeding and premature contractions
Above exclusions are sourced from: Philhealth Circular signed by Philhealth President Rey Aquino on November 10, 2008.
Q:  If my child is delivered via Cesarean Section (CS), will Philhealth cover my expenses?
Philhealth will cover a portion of your expenses, using the chart ofPhilhealth benefits for regular surgeries.  A portion of the costs of your room, medicines, doctor’s fees, operating room and laboratory fees will be paid by Philhealth, and the balance will be paid by you.
Philhealth has announced that it will soon implement its Case-Rate-Basisprogram for CS and 21 other medical/surgical cases. If this is implemented, every delivery via CS will be paid by Philhealth at a fixed rate of 15,000 pesos, and you pay the balance. The amount is still a proposal, and it may change.
Update:  Philhealth has announced that the payment for CS is fixed at 19,000 pesos in Levels 2 to 4 hospitals, under the new Case Rates payment scheme, for admissions starting September 1, 2011.
Q: What is the Newborn Care Benefit?
This is a Philhealth benefit worth 1,000 pesos for your newborn baby:
- 250 pesos for umbilical cord care, eye prophylaxis, thermal care, Vitamin K, BCG vaccine administration, and newborn resuscitation
- 250 pesos for first dose of Hepatitis B immunization
- 500 pesos for newborn screening tests
- Available for all normal deliveries, even for fifth and succeeding deliveries
Ask your doctor about it beforehand because the newborn tests must be performed within 3 days of your child delivery in order for the tests to be paid by Philhealth.
This benefit has been increased to 1,750 pesos, for admissions starting September 1, 2011.
Q: What’s the best way to get the maximum Philhealth maternity benefits?
Find an obstetrics-gynecologist who is Philhealth-accredited, who works in a Philhealth-accredited hospital, and who is willing to help you get the maximum benefit starting from prenatal care up to newborn care.
Or find a midwife’s clinic or a lying-in clinic which is Philhealth accredited and willing  to help you get the maximum benefit starting from prenatal care up to newborn care. Make sure that your midwife is also Philhealth-accredited.


2 comments:

  1. thanks..it was very informative..:-)

    ReplyDelete
  2. my first baby was born last 2010 but the lying in where i admitted is not accredited of Philhealth, can i still file the benefit from Philhealth although its already 4 years now? I'm 7 years member now of Philhealth.

    Thanks

    ReplyDelete