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Philhealth to roll out “KONSULTA” package by July

The PhilHealth MIMAROPA has announced it will start the roll out of its KONsultasyong SULit at TAma or KONSULTA package across the country by July after its pilot implementation in nine provinces and two cities during the first two quarters of 2021.

Donna Marie Mitra, Clerk III of Membership Section, said in a virtual press conference on Monday (April 5) that the program is still under its transitional phase and based on Circular No. 2020-0021. The identified pilot sites are the provinces of Bataan, Biliran, Eastern Samar, Leyte, Northern Samar, Samar, Sorsogon, Southern Leyte, South Cotabato, and the cities of Ormoc and Tacloban.

“This is still in a transitional phase and will be initially implemented in pilot areas in the first two quarters of 2021. Gusto natin na bago ito i-roll out sa buong bansa ay handang-handa tayo,” Mitra said.

PhilHealth said that the KONSULTA Package will provide the primary care for every Filipinos, which will also help change the health care seeking behavior of members.

Members can avail of medical services such as consultation and case management, 13 types of laboratory tests, and 21 medicines.

Eugene Coronel, Social Insurance Officer I of Accreditation and QA Section, said that while there is no designated area of pilot testing in Palawan, the expansion of the program may also be expected by the month of July.

“Sa mga nagnanais na ma-accredit ng KONSULTA provider ay maaaring mag-apply na this coming May or June this year para kung matuloy ay ma-process ang documentary requirements,” Coronel said.

The targeted services of primary care also vary with the age group and the KONSULTA Package can be availed from providers such as Rural Health Units (RHUs), Ambulatory Surgical Clinics, Infirmary or Primary Care Facilities, Private Medical Clinics, and Outpatient Department of hospitals.

The providers shall perform preventive health services such as health screening and assessment according to life stage and health risk of individuals; and may charge fees for services or commodities not included in the benefit package.

The “no balance billing or no co-payment policy” shall apply to eligible beneficiaries registered in a government PhilHealth Konsulta provider.

Filipinos can avail the package from providers after their registration to the National Health Insurance Program (NHIP) administered by PhilHealth prior to registration with a KONSULTA provider.

The registration may through self-registration under online KONSULTA registration system; nearest Local Health Insurance Office (LHIO), PhilHealth Express, or PCares; or through third party agencies and organizations like local government units (LGUs), Office of Senior Citizens Affairs (OSCA) employers.

“So far wala tayong na-set na bilang para sa mga interesado (KONSULTA provider), lahat ng qualified na facilities ay maaraing mag-aply sa ating KONSULTA maliban sa ating hospitals na levels 1, 2, and 3 hospitals. Kasi sila ang dalahan ng pasyente lalo na ‘di kaya tugunan ng ating konsuklta provider. As long as qualified ay go lang,” he said.

Meanwhile, PhilHealth said that it will soon release a new circular where additional subgroups that may benefit from the expanded testing for COVID-19 will be included.

As of the moment, the priority individuals and health care workers for SARS-CoV-2 testing are only classified from subgroups A to F.

It is classified as patients or healthcare workers with severe or critical symptoms, relevant history of travel or contact for subgroup A; patients or healthcare workers with mild symptoms, relevant history of travel or contact and those considered as vulnerable for subgroup B; patients or healthcare workers with mild symptoms, relevant history of travel or contact for subgroup C; patients or healthcare workers with no symptoms but relevant history of travel or contact for subgroup D; frontliners indirectly involved in health care provision in the response against COVID-19 for subgroup E; and other vulnerable patients for subgroup F.

The benefits that can be availed are P3,409, P2,077, and P901 depending on the condition for payment and services covered.

“Sa ngayon ay kailangan nasa priotity individual, under revision na po, sa mari-revise ay marami na makakasama, naghihintay na lang tayo ng revised circular,”Dianne Ebe, Clerk III, Team Leader of Reach Out Team said.

While the COVID-19 package of PhilHealth is classified into four conditions which are mild pneumonia at P43 997 for Levels 1-3 hospital, private room; moderate pneumonia at P143,267 for Levels 2-3 hospitals, private room; severe pneumonia at P333,519 for Levels 2-3 hospitals, private room and Intensive Care Unit (ICU); and critical pneumonia at P786,384 for Levels 2-3 hospitals, private room, ICU and capable of Extracorporeal Membrane Oxygenation and Renal Replacement Therapy.

Most of the COVID-19 packages paid by PhilHealth in Palawan are classified under moderate pneumonia condition, PhilHealth stated.

PhilHealth has now a total number of 13 accredited Community Isolation Units (CIUs) in Palawan as per its latest update provided during the virtual press conference.

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