PHIC PHILHEALTH CIRCULAR NO. 77-a, s. 2000, January 31, 2000

[ PHIC PHILHEALTH CIRCULAR NO. 77-a, s. 2000, January 31, 2000 ]

NEW BENEFIT SCHEDULE FOR INDIGENT MEMBERS

Please be informed that in view of the recent equalization of medical care benefits for government and private sector employees and their dependents, the benefit schedule for indigent sector members has also been upgraded to the same level to ensure that all members of the National Health Insurance Program (NHIP) enjoy one Medicare benefit package. Following is the latest schedule of benefits for ALL members:

UNIFIED BENEFIT SCHEDULE For Government Indigent and Private Sector Members, including OWWA and Individually Paying Members and their Dependents

BENEFIT ITEMS

PRIMARY

SECONDARY

TERTIARY

ROOM AND BOARD 120

220

345

not exceeding 45 days for each member & another 45 days to be shared by his dependents)

DRUGS & MEDICINES (per single period of confinement)

Ordinary 1,165

1,595

2,670

Intensive 2,430

3,280

7,660

Catastrophic 0

6,575

11,885

X-RAY, LAB, ETC. (per single period of confinement)

Ordinary 305

760

1,625

Intensive 590

1,680

3,405

Catastrophic 0

3,405

9,810

PROFESSIONAL FEES (per single period of confinement shall not exceed:) P105/day for General Practitioner P150/day for Specialist

Ordinary

General Practitioner 540

540

540

Specialist 810

810

810

Intensive/Catastrophic

General Practitioner 810

810

810

Specialist 1,350

1,350

1,350

OTHERS

Hospital (OR)

a. RUV 5 & Below 385

670

1,060

b. RUV 1.5 to 10 0

1,140

1,350

c. RUV Above 10 0

2,160

3,490

SURGEON Maximum of 15,390 @ 420/Relative Unit Value

ANESTHESIOLOGIST Maximum of 4,785 @ 420/Relative Unit Value

Outpatient Benefits

Chemotherapy Radiotherapy Hemodialysis

Cataract extraction Minor surgical procedure

SURGICAL FAMILY PLANNING PROCEDURE

Vasectomy 900 900 900

Tubal Ligation 1,125 1,125 1,125

Benepisyong Medicare Para sa Lahat

Adopted: 31 Jan. 2000

(SGD.) ENRIQUE M. ZALAMEA President and CEO