PhilHealth Z-Benefit Package Offered
The PhilHealth has recently issued Circular No. 002 s. 2013 "Governing Policies on PhilHealth Benefit Package for Case Type Z" to create a package that includes services and rates for some catastrophic illnesses, including Coronary Artery Bypass Graft (CABG) Surgery, Total Correction of Tetralogy of Fallot (TOF), Ventricular Septal Defect (VSD)Closure, and Cervical Cancer treatment.
What is Case Type Z?
Case Type Z conditions are catastrophic illnesses that usually warn of prolonged hospitalization and poor outcome if early intervention is not done.

For its second batch, the PhilHealth has selected standard-risk coronary artery disease requiring isolated CABG surgery, TOF correction-to be included in the Z-benefit package for eligible PhilHealth members. These conditions were chosen based on recent evidence that quality treatment significantly increases chances of survival and quality of life.
What is in the Z-Benefit Package?
The Phil Heart Center was appointed by PhilHealth to be the referral institution for creating and implementing the Clinical Pathways under the Z-benefit package. It includes: Hospital room-and-board fees, in-hospital medications, in-hospital laboratory exams, operating room fees and professional fees (for all services involved) for the entire course of treatment as specified in the approved pathways.
Who are eligible for the Z-benefit packages?
Only standard-risk outpatients are eligible for this package as determined by the attending cardiologist who shall then refer the patient to the Nurse Case Manager for completion of requirements.
What are the requirements for eligibility for the Z-benefit packages?
An approved pre-admission assessment checklist, pre-authorization form and other PhilHealth forms are necessary for approval of application for Z-benefit package. The pre-authorization from PhilHealth, based on the agreed selection criteria, is required for approval, for the Z-benefit package.
What are required for approval of application for Z-benefit package for CABG Surgery?
The patient must submit the following documents to the Nurse Case Manager:
  • MDR Form
  • Member Empowerment Form
  • Approved Pre-Admission Assessment Checklist (Signed by Attending Cardiologist & Surgeon)
  • Pre-Authorization Form (approved by Hospital Director)
  • Philhealth ID
  • Signed Patient Educational Brochure
  • CF1

All these forms should be in order and checked by the PHC Nurse Case Manager. These forms shall then be submitted to the Quezon City PhilHealth Benefits Office (Quezon Avenue). The approved pre-authorization form from PhilHealth will then be given back to the Nurse Case Manager who will process the request, inform the attending physicians, and schedule the date of admission and surgery.
How much will our patients add to the PhilHealth Z-benefit package?
Eligible Sponsored/Indigent PhilHealth members and their qualified dependents will be under the "No Balance Billing (NBB)" policy and identified Charity patients by Social Service shall be classified under No Co-Pay policy. Under this policy, the patient will not pay a single centavo during his/her admission that utilizes and strictly follows the approved clinical pathway for this procedure.

Private patients can avail of negotiated fixed co-pay specified fee which shall not exceed the package rate after the assessment of the Pre-Admission Officer.

The Nurse Case Manager for the PhilHealth Z-Benefit Package is Miss Dolly Minana and her office is on the second floor of the Medical Arts Bldg.
 
Last Modified: December 13, 2013