Not all senior citizens are eligible to avail PhilHealth benefits unless one becomes a Philhealth enrollee - a voluntary member, a lifetime member or a dependent of a PhilHealth member.
“There are membership programs which are being provided for our elderly, for them to avail our PhilHealth benefits”, said Regional Vice President Alberto C. Manduriao.
Voluntary members under the Individually Paying program remit the monthly premium contributions while Lifetime members no longer need to pay. And some can be a dependent of their spouse or children.
Eligible members and their dependents avail benefits when confined at any accredited health care facilities for reasons of illness or injury and for undergoing compensable out-patient procedures.
According to Dr. Royce S. Reyes, Chief of Benefit Administration Section of PhRO VI, the commonly filed claims applications for them were illnesses of renal, cardio-vascular and respiratory. Cases like hypertension, diabetes which sometimes resulted to a chronic renal disease and require dialysis sessions.
“Other patients were admitted because of complications like pneumonia and chronic obstructive pulmonary disease”, Reyes noted, “and these are classified under the New PhilHealth Inpatient Benefit Schedule as case Type C”.
When admitted at a Tertiary Hospital under case type C, a member in a single period of confinement may avail a maximum of P28,000 for drugs and medicines; P21,000 for laboratory and supplies. The accredited doctor’s visit is paid at a maximum of P4,000 for General Practitioner and P5,600 when the physician is a Specialist.
Other examples of Case Type C are cerebro vascular disease or stroke, carcinomas with metastasis or even undergoing chemo and radio therapy. The OR fee is pegged at P1,200 per session and Professional Fee for accredited Specialist is at P560 per session.
This ceiling of benefit can also be availed in case of death without a specified caused during confinement. Payment will depend on the actual compensable items incurred by the patient.
However, there are conditions specified by PhilHealth (National Health Insurance) law and this must be construed in relation to other special laws. To become a Lifetime member, one must meet the twin requirements - the age and the contribution factors.(Larry T. Tabsing)