Question & AnswerQ&A (PROCLAMATION NO. 490)
The purpose is to include an Outpatient Anti-tuberculosis or Directly Observed Treatment Short-course (DOTS) Benefits Package in PhilHealth's Benefits Package to provide accessible quality health care services to all its members.
The total benefit amount is 4,000 pesos per case, paid in two separate payments.
The first payment of 2,500 pesos is given after completion of the intensive phase of DOTS treatment, and the final payment of 1,500 pesos is given after the end of the maintenance phase.
The provider must cover diagnostic work-up, consultation services, and anti-TB drugs required by the patient in an outpatient set-up.
All members and qualified dependents of the National Health Insurance Program (NHIP) who satisfy benefit eligibility criteria and are not disqualified by exclusion criteria may avail of the DOTS benefit package.
A 'New Case' is a patient who has never had treatment for tuberculosis or who has taken anti-tuberculosis drugs for less than one month.
Failure cases, relapse cases, and return after default (RAD) cases are excluded from PhilHealth coverage under the DOTS benefit.
Employed members must have paid three (3) months of contributions within the immediate six (6) months prior to enrollment at the DOTS center.
All beneficiaries, regardless of membership type, should have their monthly premiums paid during the duration of DOTS treatment.
Accredited DOTS centers must submit a copy of the NTP Treatment Card or register the patient in the TB Management Information System within 60 days of enrollment, and submit updated treatment cards along with DOTS Claim Forms within 60 days after completion of each treatment phase. PhilHealth will pay claims within 60 days upon submission of complete requirements.
Only outpatient clinics duly accredited by PhilHealth and certified by the Philippine Coalition Against Tuberculosis (PhilCAT) may provide the DOTS benefit.
No, claims for cases where the intensive phase was completed prior to the accreditation of the DOTS facility shall not be compensated.
They took effect for all DOTS care where the date of treatment of the intensive phase is on or after May 21, 2003.