Benefits

Effective December 1999, PhilHealth is implementing a unified benefit package for all PhilHealth members.

What this is For:

This benefit package includes the following categories of personal health services:

Inpatient hospital care:

Room and board;

Services of health care professionals;

Diagnostic, laboratory, and other medical examination services;

Use of surgical or medical equipment and facilities;

Prescription drugs and biologicals, subject to the limitations stated in Section 37 of RA 7875; and

Inpatient education packages.

Outpatient care:

Services of health care professionals;

Diagnostic, laboratory, and other medical examination services;

Personal preventive services;

Prescription drugs and biologicals, subject to the limitations described in Section 37 of RA 7875; and

Emergency and transfer services

UNIFIED MEDICARE BENEFITS

For all Members and Dependents under the National Health Insurance Program

BENEFITS HOSPITAL CATEGORY

PRIMARY SECONDARY TERTIARY

ROOM AND BOARD 200 300 400

Not exceeding 45 days for each member & another 45 days to be shared by his dependents

DRUGS & MEDICINES 1,5002,5000 1,7004,0008,000 3,0009,00016,000

Per single period of confinement

a. Ordinary b. Intensive c. Catastrophic

X-RAY, LAB, ETC. 3507000 8502,0004,000 1,7004,00014,000

Per single period of confinement

a. Ordinary b. Intensive c. Catastrophic

PROFESSIONAL FEES P 150/day for General PractitionerP 250/day for Specialist

Per single period of confinement shall not exceed:

a. Ordinary General Practitioner Specialist 6001,000 6001,000 6001,000

b. Intensive General Practitioner Specialist 9001,500 9001,500 9001,500

b. Catastrophic General Practitioner Specialist 9001,500 9001,500 9002,500

OTHERS 38500 6701,1402,160 1,0601,3503,490

Operating Room

a. RVU of 30 and below b. RVU of 31 to 80 c. RVU of 81 and above

Surgeon Maximum of 16,000

Anesthesiologist Maximum of 5,000

Compensable Outpatient Services: Ambulatory surgeries and procedures including dialysis, radiotherapy and chemotherapy TB DOTS

Fig. 1 PhilHealth Benefits (Last Update: February 21, 2005)

How to File:

MGB Form 29-11 (Series of 2000)

Department of Environment and Natural Resources

MINES AND GEOSCIENCES BUREAU

Mineral Economics, Information & Publications Division

North Avenue, Diliman, Quezon City

MONTHLY REPORT ON PRODUCTION, SALES AND INVENTORY OF QUARRY RESOURCES (EXCEPT SAND & GRAVEL) & SMALL SCALE NON-METALLIC

REPORT PERIOD: MONTH ________ YEAR ______

INSTRUCTIONS:

1. This form must be accomplished in duplicate

2. Submit the original copy to MGB Central Office through the Mineral Economics, Information & Publications Division (MEIPD) , copy furnished the Concerned Region

within 15 working days after the end of each calendar month.

3. Submission of this report is in compliance with SECTION 270, CHAPTER XXIX, OF DENR AO 96-40 or the implementing rules and regulations of REPUBLIC ACT NO. 7942.

4. Information to be supplied by the reporting Contractor/Operator/Permit Holder should cover the period from the first day to the last day of the report month.

5. This report form must be accomplished by Contractors/Operators/Permit Holder of Mineral Agreements, FTAAs or Mineral Processing Permits producing non-metallic minerals.

6. Fill-up production portion of this form on a per quarry resource produced.

7. For any non-metallic minerals not included in the list, please fill up the form and specify the mineral.

8. Do not leave any of the requirements unanswered. If a requirement does not apply, write NA (Not Applicable). If the question is applicable but you have no answer, write NONE.

9. This document should be signed by the resident manager or equivalent position thereof.

10. This report should be duly notarized.

11. Use additional sheet if necessary

12. For any comments, suggestions or clarifications regarding this form please consult your nearest MGB Regional Office in your area

DEFINITION OF TERMS:

Contractor/Operator is composed of one Head Office and one or more Quarry Sites

Quarry Site refers to the location where mineral extraction takes place (Barangay, Municipality, Province)

Capacity refers to the capacity of the mill or processing facility used by the permittee/operator expressed in Metric Ton Per Day (MTPD).

Rated Capacity refers to the maximum fixed output of a mill or processing facility expressed in Metric Tons Per Day (MTPD). It is also the measure of the theoretical amount of material that can be

handled/recovered in any given time by the mill.

Actual Capacity refers to the attained capacity of the mill or processing facility in Metric Tons Per Day (MTPD). It also refers to the constant amount of material that can be recovered/handled

in a given actual time per day

Number of days in operation refers to the total number of days the company is in operation during the reporting period

Grade Analysis refers to the grade composition of the most important components of the mineral.

Production quantity refers to the total volume of mineral extracted during the reporting period expressed in Metric Ton (MT).

Production value r efers to the total value or gross output of mineral extracted during the reporting period as defined in Chapter 1, Section 5 of the Revised IRR of the Phil. Mining Act of 1995. (under the term "Gross Output")

Estimated extraction fee payable refers to an estimate of the total extraction fee to be paid by the permittee covering the production during the reporting period and based on the prevailing extraction fee rate in the

province/city.

Sales quantity refers to the total volume of mineral sold during the reporting period expressed in Metric Tons (MT).

Sales value refers to the total value of mineral sold during the reporting period. This value includes all costs of production, taxes invoiced to purchasers, transport & trade mark-up.

Estimated excise tax payable refers to an extimate of the total excise tax on minerals to be paid by the permittee to the Bureau of Internal Revenue (BIR) covering the production during the reporting period and

based on the rate prescribed by Section 217 (b) of the Revised IRR of the Mining Act of 1995.

Page 1 of 3

MGB Form 29-11 (Series of 2000)

COVERAGE OF NON-METALLIC MINERALS

1.

2.

3.

4.

Asbestos

Barite

Bauxite

Bentonite

5.

6.

7.

8.

White clay or Kaolin

Dolomite

Feldspar

Gypsum

9. Magnesite

10. Mica

11. Limestone

12. Shale Clay

13. Silica Quartz

14. Silica Sand

15. Bull Quartz

16. Talc

17. Precious and Semi-Precious Stone

18. Pebbles

19. Others (pls. Specify) ___________

PROCESSED MINERAL PRODUCTS (Figures will not be included in totals)

1. Hydrated Lime or Slaked Lime

2. Quicklime

3. Processed Marble

4. Cement

I. ADMINISTRATIVE DATA

NAME OF CONTRACTOR/OPERATOR - If name of person, please write surname first

REPORT MONTH/YEAR

TAX IDENTIFICATION NO. (TIN)

OFFICE ADDRESS

TELEPHONE NO.

FAX. NO.

PROJECT NAME:

E-MAIL ADDRESS (if any)

DATE OF 1st OPERATION (if new)

CONTRACT NO(s)

MERIDIONAL BLOCK(s)

SITE ADDRESS: (State Barangay, Municipality, Province)

II. PRODUCTION DATA (Use additional sheet if necessary)

MINERAL PRODUCT : (Specify)

MILL CAPACITY

PRODUCTION

Quantity (M.T.)**

Value (P)

Rated

Actual

GRADE ANALYSIS

NO. OF DAYS

IN OPERATION

Content

Component

Content

Monthly Inventory

Component

Quantity (M.T.)

Value (P)

Reasons for increase or decrease in production this month compared to the previous month: (pls. check appropriate answer below and use additional sheet if necessary)

Increase was due to:

Decrease was due to:

1. Increased price of 1. Lesser operating days

the mineral being

produced

2.c Force Majeure (pls. specify)_______________________________

1.a Equipment breakdown (pls. specify)__________________________________________________

2.d Environmental Problems (pls. specify)______________________

1.b Unfavorable weather condition (state duration or other information)________________________

2.e Gov't preventive actions such as CDO (pls. specify)___________

2. Increased demand

1.c Collapse/slide in working areas (state area) )___________________________________________

2.f Financial Problems (pls. specify) ___________________________

3. Expansion

1.d Labor or other strikes (state duration)________________________________________________

3. Others (pls. Specify) ______________________________________________

4. More operating days 2. Suspension due to

5. Others (pls specify)

________________________

2.a Low price of the mineral commodity produced

2.b Market Problems (pls. specify)_____________________________________________________

Page 2 of 3

ESTIMATED EXTRACTION

FEE PAYABLE

MGB Form 29-11 (Series of 2000)

III. SALES/MARKETING DATA (Use additional sheet if necessary)

_____Export

CONSIGNEE/BUYER/ADDRESS

_____Local Sales

COUNTRY OF

MARKETING CONTRACT/

NAME OF

DESTINATION

SALES AGREEMENT NO.

VESSEL

AVERAGE GRADE

Content

Unit of Measure

VALUE

QUANTITY

(MT)**

PESO

ESTIMATED EXCISE

DOLLAR

TAX PAYABLE

Name

Address

Name

Address

TOTAL

**Use bags for cement and cubic meters for marble

IV. EMPLOYMENT DATA

Report the number of persons engaged in work at the head office and quarry site during this month

TYPE OF EMPLOYEES

HEAD OFFICE

MALE

FEMALE

MALE

1. MANAGERIAL

2. PRODUCTION

3. ADMINISTRATIVE

4. OTHERS

PREPARED BY:

OFFICIAL DESIGNATION

QUARRY SITE

TOTAL

FEMALE

MALE

FEMALE

ADDRESS

(Signature over printed name)

IV. CERTIFICATION

I hereby certify that all information in this report are complete, true and correct to the best of my knowledge and belief.

SIGNATURE OF REPORTING OFFICIAL

OFFICIAL POSITION

DATE

REPUBLIC OF THE PHILIPPINES)

) S.S.

)

Subscribed and sworn to before me this ______ day of ______________, 20 ___ , the affiant exhibiting his/her Community Tax Certificate No. ____________, issued at _______________,

on the ____________ day of __________________ 20______.

DOC NO.

PAGE NO

BOOK NO.

SERIES OF

NOTARY PUBLIC

My Commission Expires on Dec. 31, 20___

PTR No. _________

Page 3 of 3

Other Documentary Requirements:

Claims Processing

PhilHealth is about giving access to health services. In 2003, PhilHealth expanded its benefit package to cover services most needed by the members and would redound to better health services. As a result, PhilHealths benefit payments reached P10.9 billion in 2003.

A number of benefit enhancements were made in 2003 and these contributed to the phenomenal growth in benefit payments.

Increase in Room and Board Rates

PhilHealth started the year with an increase in room and board rates. Effective admissions on April 1, 2003, room and board rates for primary hospitals were increased from P150 to P200, secondary hospitals from P220 to P300 and tertiary hospitals to P400 per day of hospitalization.

TB Package

The Philippines has one of the highest incidence of tuberculosis in the world. In response to, this PhilHealth developed the TB-defined package which was made available starting April 1, 2003. The package follows the anit-TB treatment known as Directly-Observed Treatment Short-Course or DOTS which is reported to have a cure rate of as much 96%.

Normal Spontaneous Deliveries

Since Medicare started, normal deliveries were not being reimbursed. In a historic first, PhilHealth started to reimburse the first two Normal Spontaneous Deliveries (NSD) done in lying-in clinics, midwife-managed clinics, birthing homes, and rural health units (RHUs) effective May 1, 2003. The package which is paid with a case payment rate of P4,500 covers prenatal care, delivery care, newborn care and postpartum care to PhilHealth members and benificiaries.

Dialysis in Free Standing Clinics

Dialysis has long been reimbursed by PhilHealth but availment of such services are limited to hospital facilities. With the setting up of free standing dialysis centers offering services comparable to hospital- based facilities, PhilHealth saw the opportunity to expand PhilHealth services by reimbursing dialysis clinics effective April 1, 2003.

SARS Package

The global community grappled with a mysterious public health menace in 2003, the Severe Acute Respiratory Syndrome or SARS.

Members and their qualified dependents are given a maximum of P50,000 per case. This covers the payment for professional health services, drugs and medicines, radiographic services from the referring hospital to the DOH-designated hospital to the DOH-designated hospital for SARS. With our health workers facing greater risk of contracting the disease, their SARS benefit package was pegged at P100,000.

What You Need to Submit to Enjoy Your Benefits:

Fully-accomplished PhilHealth Claim Form I Claim Form 1 Members Data Record, Form II Claim Form 2 Hospital Data Record and Form III Claim Form 3 Patients Clinical Record.