PhilHealth Benefits for Senior Citizens You Must Take Note Of

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The Philippine Health Insurance Corporation or PhilHealth was formed in 1995 to provide universal health coverage in the Philippines and with an objective to ensure a national sustainable national health program for all Filipinos.

Monthly PhilHealth contributions are part of the mandatory deductions for Filipino employees which entitles them to medical coverage in case of emergencies or confinement. But did you know that aside from employees with regular contributions, Senior Citizens are also entitled to certain inpatient and outpatient benefits?

In addition to the standard 20% Senior Citizen discount in hospitals, Filipinos over the age of 60 are also entitled to the following benefits:

Outpatient Benefits

Outpatient benefits are inclusive of radiotherapy sessions, hemodialysis sessions, and outpatient blood transfusions which are beneficial for senior citizens suffering from cancer or kidney disease.

Senior Citizens are also entitled to Animal Bite Package (worth P3,000), TB-DOTS Package (worth P4,000) and Cataract Extraction Package (worth P16,000).

In addition to these, the elderly may also avail of the Primary Care Benefits 1 or TSeKaP (Tamang Serbisyo para sa Kalusugan ng Pamilya).

This program includes preventive benefits such as consultations, regular BP measurements, lifestyle modification counseling, smoking cessation counseling, and digital rectal examinations.

Diagnostic exams like Complete Blood Count (CBC), Urinalysis, Fecalysis, Sputum Microscopy, Fasting Blood Sugar, Lipid Profiling, and Chest X-ray are also available.

DOTS (Directly Observed Treatment Short-course)

Patients who are requiring first-line drugs and those on anti-retroviral treatment for HIV/AIDS may avail of the DOTS package including consultation, diagnostic exams, and prescription medicine by going to the nearest PhilHealth-accredited DOTS center in your vicinity.

In-patient Benefits

Patients who are confined for 24 hours or more are entitled to the following benefits which vary per type of illness.

Illness Coverage
Pneumonia (moderate risk) P15,000
Stroke P28,000
Stroke-hemorrhagic P38,000
Hypertension P9,000
Asthma P9,000

Z Benefits

The Z Benefits Package covers illnesses that are classified under case type Z or illnesses that are both medically and economically catastrophic as these require expensive and extensive treatment.

Senior Citizens who need to undergo long and expensive treatments because of below illnesses can ask assistance from PhilHealth.

Illness / Procedure Coverage
Coronary Artery Bypass Graft Surgery (Standard Risk) P550,000
Breast Cancer (Early Stage to IIIA) P100,000
Prostate Cancer (Low to Intermediate Risk) P100,000
Cervical Cancer:
Chemoradiation with Cobalt and Brachytherapy or Surgery

Chemoradiation with Linear Accelerator and Brachytherapy

P120,000

 

P175,000

Acute Lymphocytic/Lymphoblastic Leukemia (Standard Risk) P210,000
Kidney Transplantation for End-Stage Renal Disease (Low Risk) P600,000
Z Morph External Lower Limb Prosthesis: Initial prosthesis from the knee down (left or right or both) P15,000 per lower limb
PD First Z Benefits
for End-stage Renal Disease requiring Renal Replacement Therapy
P270,000 per year
Implants for Hip Replacement:
Total Hip Prosthesis, cemented
P103,400
Total Hip Prosthesis, cementless P169,400
Partial Hip Prosthesis, bipolar P73,180
Implants for Fractures around the Hip:
Multiple Screw Fixation
 

P61,500

Compression Hip Screw Set P69,000
Proximal Femoral Locked Plate P71,000
Femoral Shaft Fractures:
Intramedullary Nail with Interlocking Screws
P48,740
Locked Compression Plate (LCP: Broad/Metaphyseal/Distal Femoral) P50,740

No Balance Billing Policy

If treatments or procedures are done in a government hospital, Senior Citizens are entitled to the No Balance Billing Policy which means that they no longer have to pay any additional amount for hospitalization.

How to Register:

There are two ways to register to the PhilHealth Senior Citizen program. Individuals may opt to go to their city or municipality's Office for Senior Citizen Affairs (OSCA) or for more urgent cases, go to a PhilHealth Local Health Insurance Office (LHIO).

Office for Senior Citizen Affairs (OSCA) PhilHealth Local Health Insurance Office (LHIO)
  1. Fill out two (2) copies of the PhilHealth Member Registration Form (PMRF).
  2. Submit duly accomplished PMRF to the OSCA in the city or municipality where the elderly resides.
  3. Await Member Data Record and Identification card issued by PhilHealth through OSCA.

 

 

  1. Fill out two (2) copies of the PhilHealth Member Registration Form (PMRF).
  2. Attach 1 x 1 photo taken within the last six months.
  3. Present Senior Citizens’ Identification Card issued by the OSCA in the city or municipality where the elderly resides or a valid government issued ID.
  4. Submit duly accomplished PMRF.
  5. Await Member Data Record and PhilHealth Identification Card

The basic qualifications based on RA 9994 (Expanded Senior Citizens Act of 2010) are as follows:

  • Must be a Filipino citizen who is a resident of the Philippines
  • Must be 60 years old or above
  • May apply to senior citizens with dual citizenship provided that they prove their Filipino citizenship and have at least six months residency in the Philippines

Read more articles below:
The Only Guide You'll Need For All Mandatory Employee Benefits In The Philippines
Para Saan Ba Ang Health Plan, At Kailangan Mo Ba Nito?

Written by

Stef Reyes