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PhilHealth Benefits For Women: Covered Conditions And Procedures

PhilHealth Benefits For Women: Covered Conditions And Procedures

Interventions for various medical conditions affecting women may require a huge sum of money. More than check-ups and medicines, they might also need hospitalization or surgery. The good news is, the Philippine Health Insurance Corporation can cover some of the expenses. In this article, we’ll talk about PhilHealth maternity benefits and the other women-related conditions and procedures covered by the corporation.

For Cancers

PhilHealth classifies diseases from A (mildest and least expensive) to D (severe and costly). However, they acknowledge that some illnesses are beyond this classification. This is why they created the Z Package, which aims to cater to conditions requiring challenging and extensively costly treatment.

Included in the Z package are breast and cervical cancers. If you developed breast or cervical cancer, below are the benefits you can avail:

Breast Cancer

Women with breast cancer Stages 0 to IIIA, may get Php100,000 benefits under the Z Package. This amount covers payment for the hospital room, laboratory tests, medicines, doctor’s professional fee, operating room fee, and other services needed to treat breast cancer.

Cervical Cancer

Women eligible are those diagnosed with Stages IA to IIIB cervical cancer. Benefits depend on the treatment modality.

Coverage for chemotherapy, cobalt, and brachytherapy (low dose) is Php125,000. Benefits for chemotherapy, linear accelerator, and brachytherapy (low or high dose) is Php175,000.

For Medical Procedures

Before we talk about the PhilHealth maternity benefits and coverage for conditions occurring in pregnancy, let’s first highlight that women can also avail themselves other PhilHealth benefits for various medical procedures.

Below are the medical procedures along with their case rates or the maximum amount PhilHealth will cover.

  • Ligation or transection of fallopian tube – Php4,000
  • Mastectomy (removal of breast), with or without other procedures – Php22,000.
  • Breast reconstruction accompanied by other procedures – Php37,800 to Php55,000, depending on the type and other procedures involved.
  • Vaginal hysterectomy (removal of the uterus) with removal of fallopian tubes and/or ovaries – Php30,300.

For Conditions Occurring During Pregnancy

Besides PhilHealth maternity benefits, the corporation also has the Primary Care Package, which aims to improve the members’ financial risk protection from common conditions. Generally, if the following conditions occur in pregnancy, they are under the Primary Care Package:

  • Vomiting conditions – Php4,760
  • Infections of the kidney – Php4, 760
  • Infections of other parts of the urinary tract – Php4, 760
  • Bladder or urethral infection – Php2,800
  • Genital tract infection – Php2,800

Additionally, if the following conditions complicate pregnancy, childbirth, or puerperium (within six weeks postpartum), they are also covered by PhilHealth. Each has a case rate of Php4,760.

  • Threatened abortion
  • Preterm labor not resulting in delivery
  • Anemia
  • Diseases affecting the blood and blood-forming organs, as well as conditions that affect the immune system
  • Endocrine, nutritional and metabolic diseases
  • Mental disorders and diseases of the nervous system
  • Diseases of the circulatory, respiratory, digestive systems
  • Diseases of the skin and subcutaneous tissues

PhilHealth Maternity Benefits

Finally, let’s discuss the PhilHealth maternity benefits for mothers who are about to give birth.

First, they have the Maternity Care Package worth Php6,500 in accredited hospitals and Php8,000 in accredited birthing homes or maternity clinics. It covers prenatal care, Normal Spontaneous (vaginal) Delivery, and postpartum period services, including postpartum check-ups.

For women who need to undergo Cesarean Section, PhilHealth can cover up to Php19,000.

Key Takeaways

Women who are about to give birth can avail of the PhilHealth maternity benefits covering vaginal delivery or C-section. Moreover, many conditions complicating pregnancy, childbirth, or puerperium are also covered. There’s also the Z Package, which can cater to breast and cervical cancers.

Finally, if you want to know more about PhilHealth benefits that apply to your condition, please talk to your attending physician. Many healthcare facilities also have a dedicated office where you can discuss what PhilHealth can cover.

Learn more about Women’s Health here.

Ovulation Calculator

Ovulation Calculator

Tracking your period cycle, determines your most fertile days and increases your chance of conceiving or applying for birth control.

Ovulation Calculator

Tracking your period cycle, determines your most fertile days and increases your chance of conceiving or applying for birth control.

Ovulation Calculator

Cycle Length

(days)

28

Period Duration

(days)

7

Hello Health Group does not provide medical advice, diagnosis or treatment.

Sources

Top diseases that kill women in PH
https://www.pna.gov.ph/articles/1063773
Accessed July 27, 2021

Cancer and Universal Health Coverage in the Philippines
https://www.uicc.org/case-studies/cancer-and-universal-health-coverage-philippines
Accessed July 27, 2021

PhilHealth supports Breast Cancer Awareness Month
https://www.philhealth.gov.ph/news/2019/cancer_aware.php
Accessed July 27, 2021

Benefits
https://www.philhealth.gov.ph/benefits/
Accessed July 27, 2021

ANNEX 2. LIST OF PROCEDURE CASE RATES (REVISION 1.0)
https://www.philhealth.gov.ph/circulars/2015/annexes/circ08_2014/Annex2_ListofProcedureCaseRatesRevision1.pdf
Accessed July 27, 2021

List of Medical Case Rates for Primary Care Facilities/ Infirmaries/ Dispensaries
https://www.philhealth.gov.ph/circulars/2017/annexes/0019/AnnexB-MedicalCaseRatesforPrimaryCare.pdf
Accessed July 27, 2021

Women about to give birth may avail themselves of PhilHealth benefits
https://www.philhealth.gov.ph/news/2016/pregnancy_benefits.html
Accessed July 27, 2021

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Written by Lorraine Bunag, R.N. Updated Jul 29
Fact Checked by Hello Doctor Medical Panel
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