PhilHealth Benefits For Seniors: What You Need To Know

Various medical institutions emphasize that people over the age of 60 are more prone to health risks than younger individuals. This is the reason why seniors are encouraged to take better care of themselves by minding their diet, performing exercises that are appropriate to their condition, and having regular check-ups. For check-ups and other healthcare needs, especially when there’s a need for hospital confinement, seniors can claim their PhilHealth benefits. So, what medical needs can PhilHealth cover and how can seniors process their claims?

The PhilHealth Benefits for Senior Citizens

What benefits can senior citizens get from their PhilHealth membership?

Inpatient Benefits

In this package, a certain amount will be deducted from the total private hospital bill. The bill includes hospital charges and the doctor’s fees. The amount to be deducted (case rate) depends on the patient’s disease or condition. For example, a senior citizen who’s admitted due to pneumonia can get a total deduction of Php32,000.

No-Balance Billing Policy

A senior citizen who is confined in an accredited public hospital will be able to avail of the No-Balance Billing Policy (NBBP). Generally, this means that in a public hospital, seniors need not pay anything upon discharge. Of course, this is subject to some rules.

Outpatient Benefits

PhilHealth benefits also cover outpatient services or those packages you can avail even without hospital confinement. Examples of these services are:

• Hemodialysis sessions
• Outpatient blood transfusion
• Radiotherapy sessions
• Tuberculosis Direct Observed Treatment Short-course TB-DOTS
• Animal Bite Package

TSeKaP (Tamang Serbisyo para sa Kalusugan ng Pamilya)

These PhilHealth benefits cover services like:

• Consultations
• Digital Rectal Exam
• Regular BP monitoring
• Lifestyle modification counseling
• Smoking cessation counseling
• Some laboratory tests, such as urinalysis, fecalysis, complete blood count, fasting blood sugar, chest x-ray, lipid profile, and sputum microscopy.

The Z Benefits Package

Now, if a doctor diagnoses a senior citizen with a disease that could be medically and economically catastrophic, they can ask for PhilHealth assistance. Essentially, these diseases might require seniors to undergo long-term and expensive treatments.

Examples of diseases under the Z package are:

• The early stage of breast cancer
• The early stage of cervical cancer
• Standard risk for coronary artery bypass graft surgery
• Prostate cancer with low to intermediate risks

How Can Senior Citizens Become PhilHealth Members?

Senior citizens can claim their PhilHealth benefits in two ways:

• They become lifetime members. These are employed people aged 60 and above or retired individuals who paid no less than 120 months of contributions. Moreover, lifetime members get a free lifetime coverage premium, meaning there’s no longer a minimum payment requirement for them to claim their benefits.
• They become “automatic” members. Under the Expanded Senior Citizen Act or RA 10645, all senior citizens aged 60 and above automatically become PhilHealth members even if they didn’t pay for monthly contributions. Like lifetime members, non-paying senior citizens get a free lifetime coverage premium.

The Process of Registration

To register, lifetime members need to:

• Fill up two copies of PMRF or the PhilHealth Member Registration Form, 2 valid IDs, 2 pcs of 1×1 ID pictures, along with other documents that pertain to the nature of your work (government, private, uniformed) or membership (Survivorship, Disability, etc.).
• Submit the requirements to the PhilHealth Local Health Insurance Office (LHIO)
• Finally, wait for the MDR or Member Data Record and PhilHealth ID card.

Automatic senior citizen members need to proceed to either LHIO or the Office for the Seniors Citizens Affairs (OSCA) in the vicinity where they reside.

• In OSCA they only need to submit two copies of PMRF.
• In LHIO, they need to prepare 2 copies of accomplished PMRF together with the senior citizen ID or any valid ID, as well as 1×1 pictures.
• Lastly, wait for the MDR and PhilHealth ID card

Claiming PhilHealth Benefits for Seniors

To claim the PhilHealth benefits, some hospitals have a Health Care Institution (HCI) portal. There, the seniors can submit their senior citizen ID, MDR, or any ID to prove their identity and age. The hospital will then print the PhilHealth Benefit Eligibility Form (PBEF). If the PBEF says “YES,” the hospital will automatically process the deductions in the total bill.

If there is no portal, or if the PBEF says “NO,” they need to attach the following documents to their claims documents:

• Accomplished PMRF
• Proof of status as a senior citizen. This includes, but is not limited to, their senior citizen ID.

Now, here’s a question that many unenrolled senior citizens would like to ask: What if I’m not yet registered and then I got hospitalized? Will I still be able to claim my PhilHealth benefits?

The answer is YES. You just need to submit the accomplished PMRF and acceptable proof of your senior citizenship to the PhilHealth Office.

Reminders for Claiming PhilHealth Benefits

In claiming PhilHealth benefits for senior citizens, the patient and their family or caretaker should be aware of the following:

• Various illnesses have different case rates. This means that while one disease may give you quite a huge deduction from hospital bills, other illnesses may only give you small deductions.
• The case rate system also applies to outpatient services. For instance, a hemodialysis session has a case rate of Php2,600, while an outpatient blood transfusion has a case rate of Php3,640.
• Yearly, seniors only have 45 days of hospitalization allowance. This shall cover the fees for the board or hospital room. PhilHealth will not cover the exceeding days.
• Seniors can combine their PhilHealth coverage with other benefits. In most cases, the private hospitals will apply the VAT exemption and senior citizen discount first before the PhilHealth benefits.
• Seniors need to look for accredited clinics or hospitals. If not, you will not be able to claim your PhilHealth benefits.

Key Takeaways

There’s no doubt that availing the PhilHealth benefits is a huge help to lessen the seniors’ financial burden, especially in times of hospitalization. For this reason, the best course of action is to always research the aspects of your medical needs and how various government institutions can be of help.

Learn more Healthy Aging here.