Here are selected Outpatient Cases covered by Philhealth. These are covered under the Philhealth Case Rate Scheme — meaning the amounts of coverage are fixed rates.
|Illness or Treatment||Amount of Coverage|
|Avian Influenza||50,000 – 100,000|
|Bilateral Tubal Ligation (BTL)||4,000|
|Influenza A (H1N1)||75,000 – 100,000|
|Outpatient HIV/AIDS Treatment||30,000|
|SARS Package||50,000 – 100,000|
60% of the coverage is for the hospital
40% is for the surgeon or surgeons or for professional fees (PF)
For non-surgical treatments:
70% of the coverage is for the hospital
30% is for professional fees
3,500 pesos is for the medical facility
500 pesos is for the medical professional
Outpatient Radiotherapy and Outpatient Hemodialysis are excluded from the 90-day single-period-of-confinement rule.
They can be availed of on a per session basis, such as twice or thrice a week, up to 45 sessions per year.
Other outpatient surgeries are also covered, such as cyst removal, but they are covered under the Fee-for-Service payment scheme. Philhealth pays a portion of the medicines, lab, OR and PF.
This is Excluded from the 45-day limit per year, but it is covered by the period of confinement rule
If you need Philhealth coverage for a quick surgery, you should talk with your surgeon about Philhealth coverage before scheduling the surgery because there are some busy surgeons who do not have time filling up Philhealth claim forms, specially for quick low-cost surgeries.