Guide to PhilHealth's Z Benefit Packages for Kids With Disabilities
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  • It's finally here! The Philippine Health Insurance Corporation (PhilHealth) has recently launched benefit packages for kids with special needs, specifically those with developmental disabilities and mobility impairment

    PhilHealth announced the plan to create benefit packages that cater to children with special needs last year in February. Below is an overview of both packages. 

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    Z Benefit Package for children with developmental disabilities
    According to PhilHealth, there are around 1.6 million children below 19 years old with a developmental disability in the Philippines. Autism spectrum disorder, attention deficit hyperactivity disorder (ADHD), cerebral palsy, and global developmental delay are examples of developmental disability. 

    Early intervention is key, said PhilHealth, so that “children can attain their highest level of development, optimize their capacities and increase participation in education and the community.”

    Who’s eligible for coverage
    Children 0 to 17 years old who experience limitations or restrictions in cognitive, behavioral, communication, and motor areas due to delays, loss or regressions in their development. The developmental disability can be neurological or non-neurological. 

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    What’s included and how much is covered

    1. Assessments, tests and plans 

    Php3,626 - Php5,726

    PhilHealth can cover assessment including discharge assessments and plans by a medical specialist. The rates will go higher if there is a need for additional health professionals or therapists who conducted assessments for the case. 

    PhilHealth has listed 15 assessments and tests covered by the package. These include developmental assessments, functional tests, and tests conducted by occupational, physical and speech therapists. If the test recommended by your child's doctor or therapist is not in the list, it will not be covered. Find the list here.

    2. Rehabilitation therapy 
    Php5,000 per set

    According to PhilHealth, “eligible children with developmental disability can only avail of a maximum of nine (9) sets of therapies. Each set of therapies has a maximum of ten (10) sessions.”

    What’s not included

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    • Laboratory tests and diagnostic procedures (e.g., brain scans, x-rays, blood tests)
    • Medications prescribed by the medical specialists/s 

    Note: You can avail of a 20% discount on medicine, diagnostic and laboratory fees, and professional fees with a PWD ID. Find out how you can get one for your child here

    Where it’s offered

    As of now, only tertiary government health care institutions (HCI) provide services for the benefits package. “Other capable government and private HCIs will eventually be contracted to expand the benefit utilization,” said PhilHealth.

    All the specifics of this package is detailed in PhilHealth Circular No. 2017-0029 found here.

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    Z Benefit Package for children with mobility impairment
    In the Philippines, around 137,470 children below 19 years old need mobility devices, according to PhilHealth. Cerebral palsy and clubfoot are the two most common disorders in Filipino kids that call for management. 

    Mobility devices and rehabilitative therapy can “halt the progression of conditions/complications that limit mobility,” said PhilHealth, and in turn provide more freedom and independence to the children. 

    Who’s eligible for coverage
    Children 0 to 17 years old that present with mobility impairment due to:

    • musculoskeletal conditions - characterized by limb loss (amputation), limb deficiency, limb deformity, spine deformity, etc. 
    • neuromuscular conditions - characterized by weakness or paralysis, imbalance, incoordination, sensory deficits, etc.
    • behavioral, cognitive or cardiopulmonary conditions that impair a child’s mobility

    “The eligibility of a patient is determined through a pre-authorization checklist, which remains a mandatory requirement before the Z Benefit is dispensed,” said PhilHealth. 

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    What’s included and how much is covered
    The mandatory services for each availed package include assessment and prescription; rehabilitation service; measurement, casting, fabrication, and fitting of a prosthesis; and training for the safe and functional use of a seating device or wheelchair.   

    1. For children requiring assistive devices for upper and lower extremity prosthesis, lower extremity orthosis, and spinal bracing or orthosis

    Php13,110 - Php163,540

    The amount covered is dependent on the part of the body that needs the device. For example, coverage for an ankle orthosis is Php13,110 and coverage for a hip disarticulation prosthesis are Php163,540. 

    Rates are per body side. If two sides of the body require an assistive device (for example, the right and left arms), the package rate can be multiplied by two (exceptions are cases like spinal bracing). But PhilHealth also states, “For cases involving more than one amputation, the patient is not allowed to claim two prostheses simultaneously with the same laterality in either the upper or in the lower limb.” It means if you have two affected limbs on one side of your body, Philhealth can only cover one affected limb.    

    2. For children requiring seating devices, and basic and intermediate wheelchairs

    Php12,730 - Php29,450

    For children 6 months to 6 years old who need a seating device, coverage is Php15,470. For children 7 to 17 years old who need wheelchairs, coverage for a basic wheelchair package is Php12,730 and for an intermediate wheelchair package is Php29,450. 

    Annual services and replacement for seating devices and wheelchairs are also offered with rates from Php1,590 to Php13,690. You can avail of yearly services for a seating device for a maximum of six years and a maximum of 10 years for an intermediate wheelchair. Basic wheelchair replacement is every three years. For seating devices, a one-time replacement is offered. 

    Note:
     “Patients should keep their used or replaced devices and are discouraged from selling or donating them,” said PhilHealth. 

    Where it's offered

    PhilHealth is planning to offer the benefit package in tertiary government healthcare institutions (HCI). But, as of now, “PhilHealth has yet to contract interested HCIs,”  they said. 

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    All the specifics of this package is detailed in PhilHealth Circular No. 2017-0031 found here.

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