PhilHealth covers 320T indigents in NegOr

By Roi Lomotan

PhilHealth-NegOr OIC/provincial director Maritess Que explains the agency’s case rate payment scheme and “Z” benefits payment during a Kapihan Forum on PhilHealth Updates held on Mar. 4, 2016 at Bethel Guest House, Dumaguete City. (ral/PIA7-NegOr)

DUMAGUETE CITY (PIA) – Around 320, 000 indigent residents in Negros Oriental are now members of PhilHealth.

PhilHealth-NegOr Officer in Charge Maritess Que disclosed in a Kapihan Forum today that the statistics are based on the September 2015 data of PhilHealth Central Office in Metro Manila.

These are 4Ps beneficiaries of the Department of Social Welfare and Development (DSWD) identified through its National Household Targeting System for Poverty Reduction (NHTS-PR) or Listahanan program.

The inclusion of the indigent residents in PhilHealth is part of the agency’s mandate to provide universal healthcare to all Filipinos, she added.

Que said indigent residents are covered with the “No Balance Billing (NBB)” Policy of PhilHealth which means members or their dependents should not be charged additional fees or expenses in any government hospital apart from the case rate packages they availed from PhilHealth.

The other members of PhilHealth who are covered by this policy include sponsored members which means their enrollment is sponsored by the local government unit, national government agency or any organized groups and the household helps.

The PhilHealth official discussed the case payment scheme and the Z benefit packages it offers during the forum.

“When we say case rate, a specific type of illness or operation has a fixed amount which incorporates doctor’s fee, room and board, drugs and medicines. The case rates shall be the amount to be paid to the health care institution,” she said.

PhilHealth has a list of all cases and the corresponding amount to be paid by the agency.

However, members cannot avail of these packages on the cases which are not part of the list.

Some outpatient treatment such as HIV/AIDs treatment, Tuberculosis-Directly Observed Treatment Short Course (TB-DOTS), vasectomy and tubal ligation, animal bite treatment package and malaria are also included in the case rate payment scheme.

On the other hand, the Z benefit packages refer to cases that need prolong confinement.

“We know that if there is a prolonged confinement, the member will experience financial difficulties. With this, PhilHealth gives benefits to those who will undergo operation on their kidneys, or those needing kidney transplant or those cancer patients,” she said.

Que added that the agency has assigned PhilHealth carers or nurses in the hospital that will assist patients in availing of their health packages.

Que also reminded members to update their member’s data record regularly so that the agency will also be informed on the changes of their  status and information on their dependents.

Meanwhile, Que announced that all Rural Health Units (RHUs) should be accredited by PhilHealth to a 3-in-1 health care facility.

This means RHUs are accredited for providing Primary Health Care Benefit (PCB), Maternity  Care Pacakge (MCP) and TB-DOTS. (rmn/ral/PIA7-Negros Oriental/This article was first published at PIA website on Mar. 4, 2016)


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