July 8, 2012 in health
By DELIA BAGNI
BAGUIO CITY — The Philippine Health Insurance Corporation or PhilHealth Regional Office Cordillera (Philhealth) launched new health insurance benefit packages for catastrophic illnesses primarily to benefit indigent PhilHealth members at the Baguio General Hospital and Medical Center Dietary (BGH-MC) Hall last July 1.
Philhealth identified BGH-MC accredited government hospitals in CAR that have signed a contract on the provision of specialized care. These contracted and reference hospitals throughout the country will provide the mandatory services and other necessary services to achieve high survival rates and best outcome for the patient based on the approved clinical protocols of the Corporation.
According to BGHMC Director Dr. Manuel Factora, these new benefit packages will be a good news for PhilHealth members, especially to poor families who have less or no financial capability for treatment for such expensive illnesses. The package will also cover payment for room, drugs and medicines, laboratory, operating room and professional fees
Case Type Z include illnesses and case rates as Acute Lymphocytic Leukemia in children less than 10 years old with P210,000 for three years of treatment, early stage of Breast Cancer (stage 0 to IIIA), P100,000; low to intermediate risk of Prostate Cancer P100,000 and end-stage renal disease requiring kidney transplant (low risk), P600,000.
However BGHMC caters only to patients with Breast Cancers. According to Doctor Glenn Cornelio Lamsis PhRO-CAR Medical Officer IV, BGH have the facilities to cater prostate Cancer and Leukemia but the problem is that they have not yet completed the protocols needed.
Lamsis added members and their qualified dependents apply for admission starting June 21 until December 31, 2012. They must pass clinical and other selection criteria approved by the corporation and a pre authorization clearance notification from PhilHealth prior to the provision of the service.
In order for the members and their qualified dependents to avail the benefit, premium contributions must be made for the next three years. Beginning January 1 of 2013 members are required for the 3-year-lock-in membership prior to availing of the benefit to ensure that the members or dependent continuously receive the benefit entitled for the entire duration of the treatment.
Members must have paid at least three months of the premium contributions within the immediate six months to the request for pre-authorization.
However, the lock-in membership does not apply to life time members and sponsored program members. Any gap in premium contributions will not qualify for the members/dependent to claim the Z benefit or other illnesses under PhilHealth current payment schemes, such as case rates and fee-for-service.
Sponsored members of Phil Health have 100% support while non-members have support value of at least 50%. up to 75%. the professional fee is 15% of the package.
The funds initially to be sourced from Reserves(3million) but eventually to be funded through the increased premium contribution. # nordis.net