The Philippine Health Insurance Corporation (PhilHealth) understands the challenges families need to face when one of their female relatives will get the dreaded “big C”. That is why to further aid breast cancer patients in the Philippines through their medical treatments, PhilHealth increased its coverage by Php 1.4 million, more than a hundred percent increase from its previous package of P100,000.
Under the PhilHealth Circular 2024-0007, which took effect on March 30, 2024, PhilHealth’s Z Benefit Package now covers Stages 0 to 4 of breast cancer which previously covers Stage 0 to IIIA only.
Based on the guidelines of the circular, Php 1.4 million is the maximum amount a patient can avail for one cycle of care, from diagnostic tests to monitoring after a successful surgery.
In terms of coverage, the mandatory services differ in package rates depending on the doctor’s recommendation, and patient’s condition.
Diagnostic tests and prognostication range from Php 1,000 to Php 10,000; surgical procedures and partial mastectomy to modified radical mastectomy range from Php 30,000 to Php 140,000; hormonotherapy coverage is Php 2,700 or Php 18,000, while cytotoxic chemotherapy ranges from Php 43,000 to Php 185,010.
The bulk of the package falls to targeted therapy amounting to more than Php 1 million coverage, which translates to Php 333,336 for 18 maximum cycles.
The surveillance or monitoring is divided into basic and specific services, ranging from Php 5,000 and Php 9,000 respectively.
For all PhilHealth members or qualified dependents, it is important that you know the process to avail these benefits. You may visit any contracted health facilities near you.
Two of which are in Metro Manila, East Avenue Medical Center (EAMC) in Quezon City and Philippine General Hospital (PGH) in Manila. Contact the Z Benefits Coordinator of any of the current contracted health facilities to guide you on the availment of the procedures.
Upon the submission of documentary requirements and approval of PhilHealth, the doctor may proceed to provide all mandatory services.
All contracted health facilities are required to have a Z Benefits Coordinator that will guide breast cancer patients throughout the process. This is PhilHealth’s way to unburden the patient and their families to the process of availing the benefit.
A Z Benefits Coordinator is responsible to explain the process to the patient, coordinate with PhilHealth on matters pertinent to the availability of the patient, and remind of lacking requirements and scheduled check-ups.
Added to the relief, PhilHealth also requires contracted hospitals to submit the patient’s documentary requirements, and not the patient or family themselves.
At present, PhilHealth continues to beef up their information dissemination, not just to promote the significance of prevention through free consultations, but also encourage hospitals and other health facilities to be contracted under the package to make it more accessible to patients needing treatment.
To know more about PhilHealth Circular 2024-0007, visit: https://www.philhealth.gov.ph/circulars/2024/PC2024-0007.pdf.
Full list of contracted health facilities or hospitals may be accessed here: https://www.philhealth.gov.ph/partners/providers/institutional/accredited/ZBEN_013123.pdf
With additional report: www.pia.gov.ph, Jumalynne, Doctolero
