PhilHealth Outpatient Anti-Tuberculosis Directly Observed Treatment Short-Course (TB-DOTS) Benefit Package

The Anti-Tuberculosis Directly Observed Treatment Short-Course or more commonly known as TB-DOTS is a benefit package under the case payment scheme being implemented by PhilHealth since 2003. The said benefit amounts to Php 4,000.00 per case where payment of Php 2,500 will be given after completion of the intensive phase and the remaining Php 1,500 at the end of the maintenance phase.

Eligibility requirements for utilization of this package are:

• All primary members and valid dependents who meet the required number of premium contributions for employed and individually paying members;


• All primary members and valid dependents whose enrollment in the DOTS center is within the coverage or validity period of membership effectivity for sponsored, lifetime and Overseas Filipino Workers (OFWs);


• Treatment of new cases of pulmonary and extrapulmonary tuberculosis for children and adults. New cases denotes that a patient has never had a treatment for TB or taken anti-tuberculosis drugs for less than one month.

PhilHealth shall not pay for:

• Failure case;


• Relapse case;


• Return after default (RAD) case;


• Additional services or extension of treatment.

Outpatient Services covered for the package:

• Diagnostic work-up;


• Consultation services;


• Anti-TB drugs.

Documents required by PhilHealth:

• Claim Form 1;


• Claim Form 2;


• NTP Treatment Card (to be submitted upon registration to TB Management Information System and an updated NTP card upon claiming of benefit).

Date of filing: 60 days from end of every treatment phase

Payable to: PhilHealth accredited TB-DOTS facility

Submit to: Any PhilHealth office corresponding to your area

Other references:

1. PhilHealth Circular No. 19 s-2003


2. How to fill-out the Claim Forms


3. TB-DOTS Benefit

PhilHealth Benefit Packages - Case Payment Rates

This post contains a list of benefit packages, under the case payment scheme, that are available to active PhilHealth members.

Name of Benefit Package	Case Rate (Php)
Maternity Care Package (MCP)	6,500.00
Normal Spontaneous Delivery (NSD) Package	6,500.00
TB-DOTS Package	4,000.00
SARS Package	50,000 - 100,000
Avian Influenza Package	50,000 - 100,000
New Born Care Package (NCP)	1,000.00
Bilateral Tubal Ligation (BTL) Package	4,000.00
Vasectomy Package	4,000.00
Malaria Package	600.00
Influenza A (H1N1) Package	75,000 - 100,000
NSD with BLT Package	10,500.00
Outpatient HIV / AIDS Treatment Package	30,000.00
Dengue I (dengue fever and DHF Grades I and II)*	8,000.00
Dengue II (dengue hermorrhagic fever grades III and IV)*	16,000.00
Pneumonia I (moderate risk)*	15,000.00
Pneumonia II (high risk)*	32,000.00
Essential Hypertension*	9,000.00
Cerebral Infarction (CVA I)*	28,000.00
Cerebro - vascular Accident with Hemorrhage (CVA II)*	38,000.00
Acute Gastroenteritis (AGE)*	6,000.00
Typhoid Fever*	14,000.00
Asthma*	9,000.00
Cesarian Section (CS)*	19,000.00
Dilatation and Curettage (D&C)*	11,000.00
Hysterectomy*	30,000.00
Mastectomy*	22,000.00
Appendectomy*	24,000.00
Cholecystectomy*	31,000.00
Herniorrhaphy*	21,000.00
Thyroidectomy*	31,000.00
Radiotherapy*	3,000.00
Hemodialysis*	4,000.00
Cataract Package*	16,000.00

* PhilHealth will be directly paying the health care facility inclusive of the professional fee, hence, this is directly deducted to the bill of the eligible PhilHealth member. Will also take effect for claims with admission date September 1, 2011.

This list will be updated once additional benefit packages become available. We shall also be discussing each of these packages in detail in succeeding posts so stay tuned.

What is a PhilHealth MDR (Member Data Record)?

Whenever you need to avail of your PhilHealth benefits, you will always be asked to provide the health care institution (hospital) a copy of your MDR to be attached to the claim forms. For those who are new to the term, an MDR, short for the Member Data Record is a system-generated document being issued by PhilHealth as a primary attachment to the Claim Form 1.

What does the MDR contain?

The document contains the member's basic information such as the PhilHealth Identification Number, full name, address (local and/or foreign), civil status, date of birth, contact information and for those employed or under the KaSAPI Program the PhilHealth number, name and address of the employer or organized group is reflected.

Aside from the basic information of the member, a list of valid dependents (with their complete name, birth date and other info) who may avail PhilHealth benefits are also displayed along with payment information for OFW members and the validity or effectivity date for sponsored members.

What is the purpose of the document?

With the release of PhilHealth Circular No. 07 s-2007, the Member Data Record (MDR) was made a primary document for claim applications which aims to:

• Reduce incidents of returned claims due to lacking supporting documents;
• Lessen claims that are doubtful in nature.

In addition to this, prior the implementation of the MDR requirement, members are required to submit supporting documents (e.g. birth certificate of dependent who was confined, marriage contract etc.) to be attached to their claim form in order to avail PhilHealth benefits. Supporting documents are necessary for PhilHealth to establish the relationship of the member and the patient or the person that was confined to prevent unauthorized usage of the member's annual 45-days allowable period. Hence, there is no need for a member with an updated MDR to attach several supporting documents to avail PhilHealth benefits as hospitals may refer to the MDR to establish the relationship of the patient to the member.

What to do if you are not able to get the document?

Although the MDR is a primary document, PhilHealth does not say that a member cannot avail benefits if this document was not provided. For those members that are unable to provide the MDR, the corresponding supporting documents must be attached to the claim forms in order to avail the benefits.

Where do you get this document?

Any PhilHealth Office (with system access) can provide or issue the MDR.

For purposes of consistency and to prevent any problems during availment of benefits, ensure that the MDR is always updated. To update your PhilHealth record refer to this post "How to Update Your Membership Record with PhilHealth".

Directory: Accredited Hospital Under PhilHealth Regional Office Batangas

Accredited hospitals listed below with their corresponding accreditation period are under the area of jurisdiction of PhilHealth Regional Office IV B - Batangas City, hence, submission and processing of your claim applications will be handled by this PhilHealth Branch. To know the status of your claim, you may coordinate with their Claims Section.

• Asumpta Medical Hospital (Level 1), to expire on April 30, 2012;
• Batangas Health Care Hospital (Level 3), to expire on April 30, 2012;
• Batangas Regional Hospital (Level 4), to expire on April 30, 2012;
• Bauan Doctors General Hospital (Level 3), to expire on April 30, 2012;
• Calatagan Medicare Hospital (Level 1), to expire on April 30, 2012;
• Central Azucarera Don Pedro Hospital (Level 2), to expire on April 30, 2012;
• Daniel O. Mercado Medical Center (Level 4), to expire on April 30, 2013;
• Divine Care Hospital (Level 2), to expire on April 30, 2012;
• Divine Love General Hospital (Level 2), to expire on October 31, 2011;
• Dr. Mario D. Bejasa General Hospital (Level 2), to expire on October 31, 2011;
• Dra. Araceli D. Mendoza Memorial Medical Clinic (Level 1), to expire on April 30, 2013;
• Golden Gate General Hospital (Level 3), to expire on April 30, 2012;
• Gonzales Medical & Children's Hospital (Level 2), to expire on April 30, 2012;
• H.M. Corachea General Hospital (Level 2), to expire on April 30, 2012;
• Hospital De San Juan Bautista (Level 2), to expire on April 30, 2012;
• Laurel Memorial District Hospital (Level 2), to expire on April 30, 2012;
• Lemery Doctors Medical Center (Level 3), to expire on April 30, 2012;
• Lipa City District Hospital (Level 2), to expire on April 30, 2012;
• Lipa Medix Medical Center (Level 3), to expire on April 30, 2014;
• Little Angels Medical Center (Level 1), to expire on April 30, 2012;
• Lobo Municipal Hospital (Level 2), to expire on April 30, 2012;
• Madonna General Hospital (Level 2), to expire on April 30, 2012;
• Mahal na Virhen Maria Sto. Rosario District Hospital (Level 2), to expire on April 30, 2013;
• Martin Marasigan Memorial Hospital (Level 2), to expire on April 30, 2012;
• Mary Mediatrix Medical Center (Level 4), to expire on April 30, 2013;
• Metro Lemery Medical Center (Level 3), to expire on April 30, 2013;
• Metro Lipa Medical Center (Level 3), to expire on April 30, 2012;
• Metropolitan Medical Center Nasugbu Branch (Level 2), to expire on October 31, 2011;
• N.L. Villa Memorial Medical Center (Level 3), to expire on April 30, 2012;
• Our Lady of Caysasay Medical Center (Level 3), to expire on April 30, 2013;
• Palma-Malaluan Hospital (Level 2), to expire on April 30, 2012;
• Queen Mary Hospital (Level 2), to expire on April 30, 2012;
• Saint Andrew Hospital (Level 2), to expire on April 30, 2012;
• Saint James the Greater General Hospital (Level 2), to expire on April 30, 2012;
• Saint Patrick's Hospital Medical Center (Level 4), to expire on April 30, 2012;
• Saint Vincent De Paul Hospital (Level 2), to expire on April 30, 2012;
• Salazar Polyclinic (Level 2), to expire on April 30, 2012;
• San Jose District Hospital (Level 2), to expire on April 30, 2013;
• San Juan District Hospital (Level 2), to expire on October 31, 2011;
• San Juan Doctors Hospital (Level 2), to expire on October 31, 2011;
• Santo Tomas General Hospital (Level 2), to expire on April 30, 2012;
• Silva's Medical Clinic (Level 1), to expire on April 30, 2012;
• Sto. Rosario Hospital (Level 2), to expire on April 30, 2012;
• Taal Polymedic Hospital and Medical Center (Level 3), to expire on April 30, 2012;
• Untalan General Hospital (Level 2), to expire on April 30, 2012;
• Zigzag Hospital (Level 1), to expire on April 30, 2012;
• Abra De Ilog Municipal Hospital (Level 1), to expire on October 31, 2011;
• Occidental Mindoro Provincial Hospital (Level 2), to expire on October 31, 2011;
• San Sebastian District Hospital (Level 1), to expire on April 30, 2012;
• St. Martin's Mission Hospital (Level 1), to expire on April 30, 2012;
• Westmin United Doctor's Hospital (Level 1), to expire on April 30, 2012;
• Bongabong Community Hospital (Level 1), to expire on April 30, 2012;
• Bulalacao Community Hospital (Level 1), to expire on October 31, 2011;
• Children's Medical Clinic (Level 1), to expire on April 30, 2012;
• Gloria Medicare Hospital (Level 1), to expire on April 30, 2012;
• Grace Mission Hospital (Level 1), to expire on April 30, 2012;
• Hospital of the Holy Cross (Level 2), to expire on April 30, 2012;
• MMG Hospital & Health Services Coop. of Oriental Mindoro (Level 3), to expire on April 30, 2012;
• Oriental Mindoro Provincial Hospital (Level 2), to expire on April 30, 2012;
• Roxas District Hospital (Level 1), to expire on April 30, 2012;
• Sta. Maria Village Clinic (Level 2), to expire on April 30, 2012;
• Palawan Adventist Hospital (Level 3), to expire on April 30, 2012.

Previous accredited hospitals whose accreditation period has lapsed as per listing in PhilHealth website is no longer included in this post. This will be updated as soon as the other hospitals have renewed their accreditation period.

Ontario, Canada-based OFWs PhilHealth Payment thru Mabini Express, Inc.

A PhilHealth Advisory has been issued informing the public that Overseas Filipino Workers (OFWs) based on Ontario, Canada may pay through the Mabini Express Inc., a tie-up of the Philippine Veterans Bank (PVB) with the following branches:

• Sheppard Centre (subway station)
• Location: 4841 Yonge St. Unit 133, 2nd Flr. North York Ontario (see map)
• Mabini Contact no: 416-222-1178
• Store hours: Mon-Wed (9:30am-7pm), Thu-Fri (9:30am-9m), Sat (9:30am-6pm) and Sun (11:30am-5pm)


• T & T Promenade
• Location: Prominade Circle, Thornhill Ontario M2N5X2 (see map)
• Store hours: Mon-Fri (9am-10pm), Sat-Sun (9am-10pm)


• T & T Milliken (Middlefield & Steels)
• Location: 5661 Steeles Avenue East, Scarborough Ontario M1V 5P6 (see map)
• Store hours: 9am-10pm


• T & T Ottawa (Hunt Club Rd. & Riverside Drive)
• Location: 224 Hunt Club Rd. Ottawa Ontario ON K1V 1C1 (see map)
• Store hours: 9am-10pm

The Official Receipt issued by the Mabini Express Inc. shall serve as your proof of payment for the paid applicable period. You would need to continue paying your premium contributions based on the current premium rate for the year prior end of your effectivity period. Please note that you would need to indicate your PhilHealth Identification Number (PIN). You may refer to the linked Advisory for the image of the official receipt.

Sample PhilHealth Request Letter

Due to numerous requests for a sample request letter that may be used for PhilHealth transactions, we have devised this template for requesting:

• Issuance of PhilHealth ID Card;
• Issuance of Member Data Record (MDR);
• Certificate of Premium Payment (CPP);
• Certification for lost payment receipt.

This is free to download and use, however, note that this template did not come from nor is it mandated or required by PhilHealth. The letter is in PDF format so you may need a PDF reader if your PC doesn't have one installed like Adobe Reader.

You may download the template here or click the image below.

Directory: Accredited Hospital Under PhilHealth Regional Office V - Legazpi

Accredited hospitals listed below with their corresponding accreditation period are under the area of jurisdiction of PhilHealth Regional Office V - Legazpi City, hence, submission and processing of your claim applications will be handled by this PhilHealth Branch. To know the status of your claim, you may coordinate with their Claims Section.

• Ago General Hospital (Level 3), to expire on April 30, 2012;
• Albay Doctor's Hospital (Level 3), to expire on April 30, 2012;
• Aquinas University Hospital Foundation Inc. (Level 3), to expire on April 30, 2014;
• Bicol Regional Training and Teaching Hospital (Level 4), to expire on October 31, 2011;
• Dr. Amando D. Cope Memorial Hospital (Level 2), to expire on April 30, 2012;
• Jaime B. Berces Memorial Hospital (Level 2), to expire on April 30, 2012;
• Lumbis-Rances General Hospital (Level 2), to expire on October 31, 2011;
• Rico's Hospital (Level 1), to expire on April 30, 2012;
• Leon D. Hernandez Memorial Hospital (Level 3), to expire on April 30, 2012;
• Our Lady of Lourdes Hospital (Level 3), to expire on October 31, 2011;
• Rosary of Virgin Mary Hospital (Level 1), to expire on April 30, 2012;
• Santissima Trinidad Hospital of Daet (Level 3), to expire on April 30, 2012;
• Naga City Hospital (Level 1), to expire on October 31, 2011;
• Ocampo Municipal Hospital (Level 1), to expire on October 31, 2011;
• Ragay District Hospital (Level 1), to expire on October 31, 2011;
• Salvacion Clinic (Level 1), to expire on April 30, 2012;
• San Jose Medicare Community Hospital (Level 1), to expire on October 31, 2011;
• St. Jude Clinic and Hospital (Level 1), to expire on April 30, 2012;
• St. Raphael Hospital (Level 1), to expire on April 30, 2012;
• Dr. Robosa Hospital (Level 2), to expire on April 30, 2012;
• Lourdes Hospital (Level 2), to expire on April 30, 2012;
• Our Lady of Mediatrix Hospital (Level 2), to expire on October 31, 2011;
• St. John Hospital (Level 2), to expire on October 31, 2011;
• Sta. Maria Josefa Hospital Foundation Incorporated (Level 2), to expire on October 31, 2011;
• St. John Hospital Inc. (Level 3), to expire on April 30, 2012;
• USI - Mother Seton Hospital (Level 4), to expire on April 30, 2012;
• Balud Municipal Hospital (Level 1), to expire on April 30, 2012;
• Cawayan Municipal Hospital (Level 1), to expire on April 30, 2012;
• De Castro Hospital Foundation Inc. (Level 1), to expire on April 30, 2012;
• Masbate Doctor's Hospital (Level 2), to expire on April 30, 2012;
• Masbate Provincial Hospital (Level 3), to expire on April 30, 2012;
• Donsol District Hospital (Level 1), to expire on April 30, 2012;
• Pantaleon G. Gotladera Memorial Hospital (Level 1), to expire on April 30, 2012;
• Prieto Diaz Municipal Hospital (Level 1), to expire on October 31, 2011;
• Irosin District Hospital (Level 2), to expire on October 31, 2011;
• Sts. Peter and Paul Hospital (Level 2), to expire on April 30, 2012;
• Dr. Fernando B. Duran, Sr. Memorial Hospital (Level 3), to expire on October 31, 2011;
• Sorsogon Med. Mission Group Hosp. and Health Services Coop. (Level 3), to expire on April 30, 2012.

Previous accredited hospitals whose accreditation period has lapsed as per listing in PhilHealth website is no longer included in this post. This will be updated as soon as the other hospitals have renewed their accreditation period.

Emailed Questions: PhilHealth Benefits for Outpatient Surgery

Would like to inquire what/how much are the benefits/rates I can get for the outpatient surgery from PhilHealth.

Surgeon, anesthesiologist, actual procedure, OR, etc.

I may need to undergo arthroscopic surgery.

Thanks.

Name withheld

---

We cannot give you the actual amount that you will receive from PhilHealth since it varies depending on a number of factors. However, you may use the benefit table here http://www.philhealth.gov.ph/forms/others/lifetime_benefits.pdf to compute for the approximate amount. Same PhilHealth benefits are being provided for all member categories.

Hope this helps.

PhilHealth 101

---

How about if I can be reimbursed even if the hospital is not yet accredited?

I read in the site:

What if the hospital is not accredited? Will I still get paid?

Claims of members confined in non-accredited hospitals shall not be compensated unless all of the following conditions are met:

Case is emergency as determined by PhilHealth

The hospital or facility has a current DOH license

Physical transfer/referral to an accredited facility is impossible as determined by PhilHealth.

The hospital PGH FMAB is still undergoing the Philhealth accreditation. Will I still be reimbursed even if they are not yet accredited?

---

If the hospital or doctor is not accredited PhilHealth may not reimburse the doctor's fee or the hospital charges. You can try to call the PhilHealth Office or call center for the status of the accreditation of your hospital or doctor. If you are to call the PhilHealth Office, directly look for the accreditation department and inquire the new accreditation period of your hospital. Moreover, if the hospital/doctor has submitted all required documents and PhilHealth approves the renewal, the start date of the accreditation period will be the date of submission of the document or the expiry date and since filing of the renewal application is before the expiration of the accreditation period, there is a chance of continuity of the accreditation and if this happens then you will be paid for hospital charges or professional fees.

PhilHealth 101

Note: Emailed questions may sometimes be edited for brevity and/or clarity.