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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 members 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
Availment condition: Member must have at least three (3) months premium contributions within the immediate six (6) months
prior to the month of availment
Documents needed: copy of Member Data Record or PhilHealth Benefit Eligibility Form (PBEF) and duly accomplished
PhilHealth Claim Form 1
1. 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
Payments for these procedures are made to the accredited facility through All Case Rates
The case rate amount shall be deducted by the HCI from the members 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
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45 days benefit limit: One session for each procedure is equivalent to one day deduction from the 45 allowable days per year
Exempted from the SPC rule
1. Consultation
2. Visual inspection with acetic acid
3. Regular BP measurements
4. Breastfeeding program education
5. Periodic clinical breast examinations
6. Counseling for lifestyle modification
7. Counseling for smoking cessation
8. Body measurements
9. Digital rectal examination
Payments for these services are made to the primary care provider through Per Family Payment Rate (PFPR)
Availment condition: Indigent and Sponsored Members, as well as migrant workers and their legal dependents should avail of
these benefits within the effectivity of their coverage as indicated in their PhilHealth ID cards or Member Data Records. iGroup
(Gold) members may avail themselves of these benefits within the validity of their group policy contracts, while DepEd personnel
may avail themselves of the benefits as long as they are still active members of PhilHealth
Where available: accredited rural health units, health centers or outpatient departments of selected government hospitals where
members are enlisted
Acute Lymphocytic / Lymphoblastic Leukemia a. Signed Member Empowerment (ME) Form; NCR
(standard risk) Philippine Children's Medical Center
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Region V
Bicol Medical Center
Region VI
Corazon Locsin Montelibano Memorial Hospital
Region VII
Vicente Sotto Memorial Medical Center
Region X
Northern Mindanao Medical Center
Region XI
Davao Regional Hospital
Region V
Batangas Medical Center
Bicol Medical Center
Region VI
Western Visayas Medical Center
Region VII
Vicente Sotto Memorial Medical Center
Region X
Northern Mindanao Medical Center
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a. Signed ME Form
a. Signed ME Form
PD First - for End-Stage Renal Disease a. Signed ME Form (to be submitted annually NCR
Requiring Peritoneal Dialysis together with the pre-authorization) National Kidney Transplant Institute
P270,000 per year
b. Patients must have a permanent Tenckhoff Kidney Solutions, Inc.
peritoneal dialysis catheter properly placed in the
abdominal cavity; Region VI
Corazon Locsin Montelibano Memorial Regional
c. Patients must have completed PD initiation in an Hospital
accredited healthcare institution so that the patient
is no longer uremic, with stable vital signs and St. Paul's Hospital of Iloilo, Inc.
adequately trained (patient himself/herself or a
caregiver) to perform PD at home using manual
exchanges;
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Preterm and Small Newborns The following benefits shall be available for
(24 to < 32 weeks) pregnant women who are in their 24 to 36 and 6/7
weeks of gestation, at risk of preterm delivery. The
1. Essential interventions for 24 to < 32 packages for the prevention of preterm delivery are
weeks - 35,000.00 availed exclusive of each other, with or without the
coordinated referral and transfer package.
2. Essential intervention with minor ventilator
support and Kangaroo Care for 24 weeks to
< 32 weeks - 85,000.00
Preterm and Small Newborns The following benefits shall be available for
(32 to < 37 weeks) premature newborns who are visually small or very
small, 24 weeks to < 37 weeks by fetal aging or
1. Essential interventions for 32weeks to < 500g to 2,499g fetal weight
37 weeks - 24,000.00
As of August, 2017
Outpatient Malaria Package Diagnostic malaria smears and other laboratory Initial providers Patients diagnosed with malaria
P600.00 procedures; drugs and medicines & consultation are the confirmed either through:
services, including patient education & counseling. accredited a. Microscopy-detection of
facilities for the malaria parasites in Giemsa-
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Globulin (HR1G) or
Purified Equine Rubies
Immune Globulin (pERIG)
Documents needed: copy of Member Data Record and PhilHealth Claim Form 1
2014 Philippine Health Insurance Corporation | Citystate Centre, 709 Shaw Boulevard 1603 Pasig City | Call Center (+632) 441-7442
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