PhilHealth Z Benefit for Heart Valve Surgery

The Philippine Health Insurance Corporation, or PhilHealth, has introduced a new benefits package to assist Filipinos suffering from Valvular Heart Disease (VHD). PhilHealth Circular No. 2025-0005 establishes the Z Benefits Package for Heart Valve Repair and/or Replacement, a significant step forward in making critical heart surgeries more accessible to those in need.

Valvular Heart Disease is a serious condition where one or more of the heart's valves do not function correctly, disrupting blood flow. This can lead to severe health complications and is a leading cause of cardiac-related deaths in the Philippines. Treatment often involves complex and costly surgical procedures to repair or replace the affected valves.

What the New Z Benefit Package Covers

This Z Benefit Package is designed to provide comprehensive support for patients undergoing heart valve surgery. Key features of the package include:

• Financial Coverage: The benefit package covers a predetermined rate for the entire course of treatment, including the hospital stay, professional fees, and other necessary medical services.

• Essential Health Services: The package includes not only the surgical procedure for valve repair or replacement but also essential cardiac rehabilitation services to aid in the patient's recovery.

• No 45-Day Limit: The standard 45-day annual benefit limit will not apply to patients availing this specific Z Benefit package, ensuring continuous coverage for the required treatment.

Who Can Avail of the Benefit

All PhilHealth members who are clinically diagnosed with Valvular Heart Disease and are recommended for heart valve repair or replacement surgery are eligible to avail of this benefit. Patients will need to consult with their physician and the accredited hospital to understand the specific requirements and processes.

How PhilHealth Pays for the Service

PhilHealth will utilize a case-based payment mechanism. This means that accredited health facilities will be reimbursed a fixed amount for each patient's case, from diagnosis to treatment and rehabilitation. This approach aims to ensure efficiency and predictability in healthcare spending.

This new PhilHealth circular is a welcome development for many Filipinos and their families who are burdened by the high cost of treating heart disease. It underscores PhilHealth's commitment to providing financial risk protection and improving access to quality healthcare for all. For more detailed information, members are encouraged to visit the official PhilHealth website or inquire at any PhilHealth office or accredited hospital.

Reference: PC2025-00005