Written by MSD in the Philippines
According to a recent report by the Philippine Statistics Authority (PSA), cancer ranked as the second leading cause of mortality in 2022, with lung, breast, and liver cancers topping the mortality list. When one is afflicted with such life-threatening illnesses, not only is it physically and mentally taxing on the mind and body of the patient, but also financially draining.
An article by the Philippine Institute for Development Studies stated that the cost of cancer treatment can range from P120,000 to as much as over P1 million. The estimated price of chemotherapy cost per session, depending on the cancer type, starts at P20,000 up to over P120,000.
With the need to provide better financial assistance in healthcare, the Philippine Health Insurance Corporation (PhilHealth) introduced Z benefits in 2012. Z benefits provide financial risk protection against illnesses perceived as “medically and economically catastrophic”. With the Z benefits, every patient enrolled in the program is provided quality care that is at par with current standards of practice.
If you or someone you know has cancer, you must be able to maximize the health benefits available to you, especially those provided by the government to alleviate the financial drain associated with this illness. Here’s everything you need to know about PhilHealth’s Z package– how to apply for the Z package, what are the benefits, and more.
Am I Eligible to Apply for the Z Package?
You’re eligible to apply for the Z benefits package if you’re a Filipino citizen, a member of PhilHealth, and if your illness is part of the list covered by the package. If you have cancer you are most likely eligible–but keep in mind that you’d still need to pass the pre-authorization required by PhilHealth. For more information on the list of covered illnesses and other qualifications, click here.
What is Pre-Authorization?
PhilHealth uses pre-authorization to ascertain whether a patient has been diagnosed and is eligible for Z Benefits. Before Z Benefits can be made available, the hospital must submit pre-authorization to PhilHealth. Processing usually takes up to seven working days.
What Documents Should I Provide to Get Pre-Authorization?
The contracted hospital itself will process the pre-authorization request of its patient. The following documents need to be submitted to the nearest PhilHealth Regional Office (PRO):
- Original copy of the pre-authorization checklist and request
- Photocopy of Member Empowerment (ME) Form
The PhilHealth Benefit Eligibility Form (PBEF) with a marked “Yes” entails that the patient is eligible to receive benefits. You no longer need to submit your Member Data Record (MDR) and Claim Form 1.
However, if your PBEF is marked with “No,” it means that you need to update your information with PhilHealth. Submit your MDR and/or Claim Form 1 as proof of paid contributions and membership with PhilHealth.
You would also need to have at least 1 day left from your 45-day annual benefit limit before enrolling in Z benefits.
Where Should I Go If I Want to Enroll in the Z Benefits Package?
All contracted hospitals under Z benefits have a dedicated Z benefits coordinator who can help guide you through eligibility and enrollment. The Z benefits coordinator will also be your primary point person to ask regarding the status of your pre-authorization request.
How Much Is Covered Under the Z Benefits Package?
The amount covered varies per illness. Here are some of the covered illnesses and their equivalent amounts:
- Acute Lymphocytic / Lymphoblastic Leukemia (standard risk)- P500,000
- Breast Cancer (Stage 0 to IV)- P1.4 million
- Prostate Cancer (low to intermediate risk)- P100,000
- Cervical Cancer: [Chemoradiation with Cobalt and Brachytherapy (low dose) or Primary surgery for Stage IA1, IA2 – IIA1]- P120,000
- Cervical Cancer: [Chemoradiation with Linear Accelerator and Brachytherapy (high dose)]- P175,000
- Colon Cancer (Stage I-II (low risk) – P150,000
- Colon Cancer (Stage II (high risk) – III – P300,00
- Rectum Cancer: (Stage I (clinical and pathologic) – P150,000
- Rectum Cancer: Pre-operative clinical stage I but with post-operative pathologic stage II-III- using linear accelerator as mode of radiotherapy) – P400,000
- Rectum Cancer: Pre-operative clinical stage I but with post-operative pathologic stage II-II- using cobalt as mode of radiotherapy – P320,000
- Rectum Cancer: Clinical Stage II-III (using linear accelerator as mode of radiotherapy) – P400,000
- Rectum Cancer: Clinical Stage II-III (using cobalt as mode of radiotherapy) -P320,000
For a more comprehensive list of the benefit package and the amount, browse here.
[EMBED: https://www.facebook.com/Hopefromwithinph/posts/pfbid0Dix5A68sZ5omHwUSARebMT5cgLzjHC98tqDCsyrqNjiwKP6oYhqiPn4KGXA9WTwul?]The Z benefits package is covered by the No Balance Billing Policy. If you are a senior citizen, lifetime member, indigent, sponsored, or kasambahay (househelp), then you won’t have to pay anything under the Z benefit package.
The benefits from the PhilHealth Z Benefits package are automatically deducted from your hospital bill. Additionally, no co-payment is charged for basic ward accommodations. However, if you wish to undergo additional procedures or want to upgrade hospital services, you would have to pay additional charges out of pocket after the PhiHealth benefits have been deducted from your hospital bill.
Note that not all hospitals and healthcare providers are contracted under the Z benefits package. For a comprehensive list of partner healthcare providers and facilities, click here.
Explore Your Medical Benefits with PhilHealth
There have been earnest efforts from the government and the health sector to alleviate the financial burden various illnesses have had on patients afflicted with various life-threatening illnesses. The Z benefits package is just one of those benefits available. If you or someone you know is afflicted with any of the covered illnesses under the Z benefits package, you should apply to be covered under it. That way, your hospital bills will be covered and you can focus on getting better.
Explore your medical benefits with PhilHealth. Visit their website for more information and apply for the Z benefits package today.
PH-NON-01082
