OVER a year ago, the Philippines failed to achieve its target of reducing neonatal mortality caused by prematurity and low birth weight conditions by an estimate of two-thirds of 6.3 million. Since these conditions require a certain degree of specialized care, some families encounter financial constraints, which prevent timely administration of cost-effective interventions. To help address this need, Philhealth recently developed the Z benefit package, also known as Z016, for premature and small babies under Philhealth Circular 2017-0009.
The Z benefit package intends to capture preventive and curative approaches for patient care and to complement the other Philhealth benefit packages for mothers and newborns, namely the expanded normal spontaneous delivery package, maternity care package, and social health insurance coverage and benefits for women about to give birth.
Pregnant women who are in their 24 to 36 6/7 weeks of gestation and who are at risk of pre-term delivery may avail themselves of the benefit package for prevention of preterm delivery. On the other hand, premature newborns who are 24 to less than 37 weeks by fetal aging or who attain 500 to 2,499 grams of fetal weight may avail themselves of the benefits for preterm and small newborns.
The circular also provides the list of services to be provided by health care institutions (HCIs) and the package rates of the Z benefits as summarized below:
1. Benefit packages for the prevention of preterm birth which range from P600 – P4,000;
2. Benefit packages for preterm and newborns (24 to less than 32 weeks) which range from P35,000 – P135,000; and
3. Benefit packages for preterm and newborns (32 to less than 37 weeks) which range from P24,000 – P71,000.
In order to avail of the Z benefits, the following general rules shall apply:
1. All claims shall be filed by the contracted HCIs in behalf of the patients and no direct filing shall be made by Philhealth members;
2. Rules in late filing shall apply unless the delay is due to natural calamities or fortuitous events in which an extension of 60 calendar
days is given;
3. Z satisfaction questionnaire shall be administered prior to discharge from the HCI;
4. Contracted HCIs providing the services for premature and small newborn shall be monitored; and
5. Although the results of diagnostic and laboratory test are not required as attachments to the claim, these shall be attached to the
patient’s chart which shall be checked during the monitoring.
PhilHealth shall contract with government and private hospitals capable of providing the services. As patients’ guide on where they can avail themselves of the Z benefits for premature and small newborns, the list of HCIs shall be posted in the Philhealth website once available.
It shall be noted that HCIs are not required to submit applications for pre-authorization before the patients can avail themselves of the said benefits. Instead, HCIs shall submit a Checklist of Eligibility Criteria to their corresponding Philhealth Regional Office after admission of the patients but prior to the filing of claims for availment.
A separate issuance shall be disseminated by Philhealth for the policies and implementing guidelines of this circular. Please refer to the circular for more details.
Source: P&A Grant Thornton
As published in Sunstar Cebu dated 31 July 2017.