From free medicines to eyeglasses: PhilHealth benefits you might be missing
Did you know PhilHealth offers several benefits beyond assistance for hospital bills?
These lesser-known perks cover more than members may expect, including maintenance medicines, dental care, prescription eyeglasses for children, and outpatient mental health services.
Going for a checkup soon? Here's a look at some of the PhilHealth benefits members and their dependents may be able to claim, along with their coverage and requirements:
Free checkups and laboratory tests under YAKAP
PhilHealth's Yaman ng Kalusugan Program is an expanded primary care benefit program aiming to help members maintain good health, detect illnesses early, and provide appropriate medications to prevent their conditions from worsening and requiring hospitalization.
Through this, members can get free medical consultations at accredited YAKAP clinics; access to 13 laboratory tests; selected medicines through GAMOT; and selected outpatient cancer screening tests.
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Keep in mind that the 13 laboratory tests are not automatically given to everyone, as the attending physician must assess the patient and recommend the tests based on their medical needs.
These include:
- Complete Blood Count with Platelet Count
- Lipid Profile
- Fasting Blood Sugar
- Oral Glucose Tolerance Test
- Hemoglobin Test
- Creatinine
- Chest X-Ray
- Sputum Microscopy
- Electrocardiogram
- Urinalysis
- Pap Smear
- Fecalysis
- Fecal Occult Blood Test
The cancer tests, meanwhile, cover mammogram, breast ultrasound, low-dose chest CT scan, alpha-fetoprotein test, liver ultrasound, and colonoscopy.
Public YAKAP clinics provide the covered services without charge, while private YAKAP providers may collect a payment of up to P900 per patient.
The benefits can be availed by all Filipinos and their qualified dependents who register with a YAKAP clinic. You can register through the eGovPH app, the PhilHealth Member Portal, a PhilHealth office, or an accredited YAKAP clinic.
Free medicines worth up to P20,000 under GAMOT
Free medicines can be availed through the Guaranteed and Accessible Medications for Outpatient Treatment program.
This was launched to ease the financial burden of medication expenses on Filipino families and expand access to medicines through partnerships with pharmacies, drugstores, and other partner providers.
Members are entitled to avail up to P20,000 worth of medicines per person, per year. It covers 75 types of medicines for various conditions, including hypertension, diabetes, high cholesterol, asthma, and more.
All Filipinos and their qualified dependents can benefit from this, provided they are registered with a YAKAP clinic and have undergone the necessary consultation.
Dental checkup and cleaning worth up to P1,000
If you're due for a visit to the dentist, you'd be pleased to know that PhilHealth has introduced the Preventive Oral Health Services benefit under its primary care package.
This allows up to P1,000 in coverage per beneficiary, per year.
Covered services include:
- Mouth examination or oral screening
- Dental prophylaxis or cleaning
- Fluoride varnish application
- Pit and fissure sealants
- Root surface protection or Class V restoration
- Emergency tooth extractions when necessary
Routine preventive oral care can be accessed through two visits per year, with at least four months between visits. Sealants and root surface protection are limited to two teeth annually.
Free eyeglasses for children worth P2,500
Parents whose children are already experiencing poor eyesight can find relief through PhilHealth's Optometry Benefit Package.
This caters to children aged 0 to 15 years old, providing up to P2,500 per case, once a year. The benefits include eye and vision assessment, including refraction, prescription eyeglasses including frames and lenses, and follow-up consultations.
The children must first be assessed and diagnosed by qualified health professionals before they can avail of the package.
Outpatient mental health care worth up to P16,000
Those seeking mental health support can also avail of PhilHealth's Outpatient Benefits Package for Mental Health.
It provides two levels of coverage: P9,000 for general mental health services and P16,000 for specialized care.
The services range from initial assessments and follow-up consultations to diagnostic tests and psychosocial support. It covers conditions such as depression, psychosis, epilepsy, child and adolescent mental and behavioral disorders, dementia, and self-harm or suicide risks, among others.
For general mental health services, members can access these benefits at any accredited facility that provides general mental health services. These facilities include rural health units, city or municipal health offices, level 1 and 2 hospitals, Department of Health Medicine Access Program-mental health access sites, and stand-alone mental health clinics.
On the other hand, specialized mental health services can be received at accredited Level 2 and 3 hospitals with specialized staff, custodial care facilities, and national specialty centers identified by DOH.
Members and dependents aged 10 and above are eligible for psychiatric services.
Emergency room visits, even without hospital admission
For PhilHealth members worried about the cost of emergency room treatment, the agency offers financial assistance through its Outpatient Emergency Care Benefit.
Depending on the patient's condition and the services required, coverage includes emergency room consultations, laboratory examinations, diagnostic and imaging services including eligible X-rays and CT scans, and medicines and other necessary medical supplies.
The benefit applies even if the patient does not need to be admitted to the hospital. However, they must be discharged within 24 hours of entering the emergency department, and the case must involve acute symptoms requiring emergency care.
This can be availed at PhilHealth-accredited Level 1, 2, and 3 hospitals.
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