Social Health Insurance for OFW

BENEFITS and SERVICES

1. Inpatient coverage
Subsidy for hospital room and board, drugs and medicines, laboratories, operating room and professional fees for confinements of not less than 24 hours to PhilHealth accredited hospital here in the Philippines and hospitals overseas. Members are entitled to 45 days benefits for room and board while another 45 days will be shared by the declared dependents. 

2. Outpatient coverage 

Covers day surgeries, dialysis and cancer treatment procedures such as chemotherapy and radiotherapy. 

3. Special Benefit Packages:

• Coverage for normal spontaneous deliveries
Covers uncomplicated normal spontaneous delivery or NSD of the first four births done either in PhilHealth accredited hospital or duly accredited lying-in clinics, birthing homes or midwife-managed clinics 

• Newborn Care Package
Covers eye prophylaxis, umbilical cord care, Vitamin K, thermal care, administration of BCG vaccine and resuscitation of the newborn, first dose of Hepatitis B immunization and Newborn screening tests for newborn. This can be availed in duly accredited hospitals and non-hospital facilities

• TB treatment through DOTS
Covers treatment of new cases of pulmonary and extra-pulmonary tuberculosis in children and adults are covered through the Directly Observed Treatment Shortcourse or DOTS.

• Out-Patient Blood Transfusion
Covers blood transfusion procedures in cases that do not require confinements

• SARS and Avian Influenza (Influenza Pandemic or Bird Flu) Package
Covers up to P50,000 for members/dependents and P100,000 for private and public health workers

• Influenza A (H1N1) Package
Covers up to P75,000 for non-health worker-members. and maximum of P150,000 for health worker-members. This can be availed in hospitals designated by DOH as referral centers (national, sub-national and satellite) for Influenza A (H1N1) and other emerging and re-emerging diseases with the exception of confinements abroad. Admissions in private hospitals may be covered if confirmatory tests were coordinated with or confirmed by the RITM, DOH-CHD or other DOH certified laboratories 

• Malaria Package
Has a case payment of P600. It includes diagnostic malaria smears, other laboratory procedures, drugs and medicines, consultation and patient education and counseling.

• Cataract Package

Has a case payment of P16,000 - P8,000 for charges on room, drugs, meds, supplies including intraocular lens, x-ray, laboratory & ancillary procedures and use of OR complex and machines while the other P8,000 is paid to the doctor.

• Voluntary Surgical Contraception Procedures

Has a case payment of P4,000. The component of which is P3,000 for the facility services and P1,000 for physician to cover family planning counseling and client assessment, intraoperative service services including provision of anesthesia and postoperative consultation procedures including management of complications.

4. Enhanced Outpatient Benefit Package for OFWs and their Families A comprehensive out patient package of benefits that can be availed in selected DOH participating hospitals in the Philippines.

A. Consultation

B. Diagnostic services

• Complete blood count (CBC) 

• Routine urinalysis 

• Fecalysis 

• Fasting blood sugar 

• Blood typing 

• Hemoglobin/Hematocrit 

• Electrocardiogram (ECG) 

• Anti-streptolysin O (ASO-Titer) 

• Hepatitis B Screening Test 

• Treponema pallidum hemaglutination assay (TPHA) 

• Potassium hydroxide (KOH) 

• Erythrocyte sedimentation rate (ESR) 

• Pregnancy test 

• X-ray (Skull, Chest, Lower and Upper Extremities) 

• Sputum Microscopy 

• Pap Smear 

C. Visual acuity examination

D. Psychological evaluation and debriefing

E. Promotive/preventive health services:

• Visual acetic acid screening for cervical cancer 

• Periodic digital rectal examination 

• Periodic clinical breast examination (CBE) 

• Counseling for cessation on smoking 

• Lifestyle modification (regular blood pressure measurement and nutritional or dietary counseling) 

• Counseling for reproductive health particularly breastfeeding 

• Nutritional or dietary counseling 

F. Auditory evaluation

G. Treatment of the following diseases based on PhilHealth-adopted clinical practice guidelines:

• Urinary tract infection (UTI) 

• Upper respiratory tract infection (URTI) 

• Acute gastroenteritis (AGE)