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PhilHealth’s Maternity Care Package and Newborn Care Package
13

PhilHealth's Maternity Care Package and Newborn Care Package

Dec 28, 2016

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Page 1: PhilHealth's Maternity Care Package and Newborn Care Package

PhilHealth’s Maternity Care Package

and Newborn Care Package

Page 2: PhilHealth's Maternity Care Package and Newborn Care Package

• Members and Qualified Dependents

• Up to 4th delivery only

Who can avail

• Non-hospital facilities

• Engaged Maternity and Lying-in Clinics

• Engaged physicians and midwives Who provides

• Prenatal care

• Delivery

• Post natal care What services

• P 1,500 pre-natal care fee

• P 6,500 facility fee including professional fee

• No balance billing

Important Features

Maternity Care Package

Page 3: PhilHealth's Maternity Care Package and Newborn Care Package

Maternity Care Package

Applicable to Normal spontaneous vaginal deliveries performed in a non-hospital facility (birthing homes, lying-in, midwife managed clinics)

Covers first 4 normal spontaneous deliveries

• Inclusion

– Normal (uncomplicated) vaginal deliveries

• Low risk at the start and throughout labor and delivery

• Infant in vertex position

• Infant in 37 to 42 weeks AOG

– 1st pre-natal check-up must not exceed 16 weeks AOG

Page 4: PhilHealth's Maternity Care Package and Newborn Care Package

Maternity Care Package

• Exclusion

– 5th and subsequent deliveries not covered

– Maternal conditions that are considered high risk as enumerated in Circular 20, s 2008

Page 5: PhilHealth's Maternity Care Package and Newborn Care Package

Maternity Care Package Excluded Maternal Conditions

1. Age less than 19y/o

2. First pregnancy at the age of 35 or greater

3. Multiple pregnancy

4. Ovarian abnornality (ovarian cyst)

5. Uterine abnormality (myoma uteri)

6.Placental abnormality (placenta previa)

7. Abnormal fetal presentation (ie breech)

8. History of 3 or more abortions/miscarriage

9. History of 1 stillbirth

10. History of major obstetric/gynecologic surgical operations (ie CS, uterine myomectomy)

11. History of medical conditions (hypertension, pre-eclampsia, thyroid disorder)

12. Other risk factors that warrant referral for further management (ie premature contractions, vaginal bleeding)

Page 6: PhilHealth's Maternity Care Package and Newborn Care Package

Maternity Care Package

• Eligibility

– Members and qualified dependents

– Contribution requirements

• Amount P 8,000 (as case rate)

– P 6,500 for the actual delivery including professional fee

– P 1,500 for the prenatal care fee

• No Balance Billing Policy

– Applies to all

Page 7: PhilHealth's Maternity Care Package and Newborn Care Package

Benefit Availment – Maternity Care Package

• Requirements:

– Claim form 1

– Claim form 2

– Claim form 3 (Part II)

– Member Data Record

– Proof of eligibility

• Sponsored – ID

• OWP – ID

• IPP – proof of premium payments

• File within 60 days after the delivery

Page 8: PhilHealth's Maternity Care Package and Newborn Care Package

• Qualified dependents (newborn) of members

• No limit as to number of births

Who can avail

• Non-hospital facilities

• Maternity and Lying-in Clinics

• Hospitals Who provides

• Newborn care

• Screening tests – newborn screening and hearing

• Vaccination – hepatitis B and BCG

• EINC protocol

What services

• P 1,750

• No balance billing

Important Features

Newborn Care Package

Page 9: PhilHealth's Maternity Care Package and Newborn Care Package

Components of Newborn Care Package

• Immediate drying of the newborn

• early skin-to-skin contact

• cord clamping

• non-separation of mother/baby for early breastfeeding initiation

• eye prophylaxis

• Vitamin K administration

• Weighing

• BCG Vaccination

• Hepatitis B Vaccination

• Newborn Hearing Test

• Newborn Screening Test

• Professional Fee

Page 10: PhilHealth's Maternity Care Package and Newborn Care Package

Components of Newborn Care Package

500 500 550 200

EINC and vaccines

Professional Fee

P 1750

Newborn Screening

Test

Hearing Test

Newborn Care

Page 11: PhilHealth's Maternity Care Package and Newborn Care Package

Benefit Availment – Newborn Care Package

• Eligibility

– 3/6 contribution

– Even if 5th delivery and beyond

• Requirements

– Claim Form 1

– Claim Form 2 all services must be enumerated

– Member Data Record

– Certificate of live birth

– Proof of contribution

• File within 60 days after delivery

Page 12: PhilHealth's Maternity Care Package and Newborn Care Package