PhilHealth Z Benefits for Heart Valve Surgery

Valvular Heart Disease (VHD) is a serious condition affecting many Filipinos. To help patients with this condition, the Philippine Health Insurance Corporation (PhilHealth) has introduced a Z Benefits Package for heart valve repair and replacement. This initiative aims to make treatment more accessible and affordable for everyone.

This new benefit package from PhilHealth provides comprehensive coverage for surgical procedures and cardiac rehabilitation services for VHD. It is designed to improve the quality of life for patients and ensure they can return to being productive members of society.

What the Z Benefits Package Covers

The package includes coverage for essential health services related to heart valve surgery. This includes:

• Surgical Procedures: It covers mitral and aortic valve repair or replacement surgeries.

• Cardiac Rehabilitation: The package also includes a maximum of four sessions of cardiac rehabilitation to help patients recover after surgery.

• Hospital Services: This includes room and board, medicines, laboratory tests, and professional fees.

Who Can Avail the Z Benefits Package?

All Filipinos are entitled to avail of this benefits package, provided they meet the clinical criteria for eligibility. Patients must undergo a pre-authorization process to determine if they qualify based on the selection criteria set by PhilHealth.

How to Avail the Z Benefits Package

Availing the package involves a few key steps:

1. Consultation: Patients must consult with a contracted health facility to determine if they are eligible for the Z-benefit package.

2. Pre-authorization: The health facility will assist the patient in submitting a pre-authorization request to PhilHealth.

3. Approval: Once approved, the patient can undergo the necessary surgery and treatment.

4. Claims: The contracted health facility will be responsible for filing the claims with PhilHealth on behalf of the patient.

This Z Benefits Package for Heart Valve Repair and/or Replacement for Valvular Heart Disease is a significant step towards achieving universal healthcare in the Philippines. It provides much-needed financial support to patients and their families, ensuring that they can get the life-saving treatment they need without worrying about the cost.

Reference: PC2025-0009