By Shaine Pe
What is Philhealth Z Benefits
Unveiled during the term of former President Benigno Aquino III, the Z Benefits package addresses patients with catastrophic illnesses, identified as childhood acute lymphocytic leukemia (ALL), breast cancer, prostate cancer, cervical cancer, colon cancer, rectal cancer, end-stage renal disease requiring kidney
The package is called 'Z benefit,' for if we were to rank and classify all illnesses from A to Z, those illnesses that push patients into prolonged hospitalization and very expensive treatments would be the last letter or the Z illnesses. These illnesses are what the package will be addressing.
Here's how you can use PhilHealth's Z Benefits package
PhilHealth's Z Benefits package can alleviate some of the financial strain brought about by a serious illness. A serious illness can be devastating, not just to one's health but one's finances as well. With the cost of hospitalizations only rising as time passes, it's important that people have a financial safety net to turn to should something unfortunate happen.
This is exactly what PhilHealth's Z Benefits package was made for. Unveiled during the term of former President Benigno Aquino III, the Z Benefits package addresses patients with catastrophic illnesses, identified as childhood acute lymphocytic leukemia (ALL), breast cancer, prostate cancer, cervical cancer, colon cancer, rectal cancer, end-stage renal disease requiring kidney transplantation, coronary artery bypass graft, Tetralogy of Fallot, ventricular septal defect surgery, selected orthopedic implants, and peritoneal dialysis.
Initially covering P210,000 of the costs for ALL and P100,000 each for breast and prostate cancer, the Z Benefits package for breast cancer was recently raised to P1.4 million, a 1,400 percent increase.
There's no doubt that PhilHealth's Z Benefits package can be a big help to a person going through a catastrophic illness. But how does one go about applying for such a package?
Who can avail of the Z Benefits package?
Any Filipino citizen who is a member of Phil Health can avail of the Z Benefits if their illness is part of the list covered by the package and they pass the pre-authorization required by Phil Health.
What is pre-authorization?
Pre-authorization is the process by which Phil Health determines whether the patient has been diagnosed and qualifies for the Z Benefits. Pre-authorization has to be submitted by the hospital to Phil Health before the Z Benefits can be released. Processing for this usually takes up to seven working days.
What are the documents needed from patients?
For their part, patients will need to submit their PhilHealth Member Data Record (MDR), a Member Empowerment Form, a pre-authorization form, their PhilHealth ID, and Claim Form 1 or CF1. Contracted healthcare providers may also ask for additional documents depending on the patient's illness.
Contracted healthcare providers will also have a PhilHealth coordinator on hand to guide patients in fulfilling and processing other requirements that may be needed from them.
How much of the treatment is covered by the Z Benefits package?
Amounts vary depending on the patient's disease. As mentioned earlier, the Z Benefits package now covers up to P1.4 million for breast cancer treatments. Some of the amounts listed on the PhilHealth website include P500,000 coverage for ALL; P600,000 for end-stage renal disease requiring kidney transplantation; P550,00 for coronary artery bypass graft; and P175,000 for cervical cancer, just to name a few. The package covers room and board fees, drugs and laboratory exams, operating room, and professional fees during the entire course of treatment.
If the PhilHealth member is a senior citizen, lifetime member, indigent, sponsored, or household help, they are covered by the No Balance Billing policy. As such, they will not be asked to pay for anything when it comes to their treatment.
The benefits from the PhilHealth Z Benefits package are automatically deducted from the patient's hospital bill. However, should the member decide to undergo additional procedures or decide to upgrade hospital services, they would have to pay extra charges after the PhiHealth benefits have been deducted from their hospital bill.
Who are eligible for the Z-benefit packages?
Only standard-risk outpatients are eligible for this package as determined by the attending cardiologist who shall then refer the patient to the Nurse Case Manager for completion of requirements.
What are the requirements for eligibility for the Z-benefit packages?
An approved pre-admission assessment checklist, pre-authorization form, and other PhilHealth forms are necessary for approval of the application for the Z-benefit package. The pre-authorization from PhilHealth, based on the agreed selection criteria, is required for approval, for the Z-benefit package.
How much will our patients add to the PhilHealth Z-benefit package?
Eligible Sponsored/Indigent PhilHealth members and their qualified dependents will be under the "No Balance Billing (NBB)" policy and identified Charity patients by Social Service shall be classified under the No Co-Pay policy. Under this policy, the patient will not pay a single centavo during his/her admission that utilizes and strictly follows the approved clinical pathway for this procedure.
Private patients can avail of a negotiated fixed co-pay specified fee which shall not exceed the package rate after the assessment of the Pre-Admission Officer.
The Nurse Case Manager for the PhilHealth Z-Benefit Package is Miss Meliza Benatiro and her office is on the second floor of the Medical Arts Bldg.
For more info on Philhealth Z Benefits please log in to https://www.philhealth.gov.ph/benefits/
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