UNIVERSAL HEALTH CARE MODULE 6

The case rate for dengue fever based on the current medical case rate of PhilHealth:

a. P10,000.00
The primary care benefit package (KONSULTA package) for qualified beneficiaries includes the following laboratory tests
deemed necessary per physician’s recommendation, EXCEPT:

a. RT PCR test
Under the implementation guidelines of PhilHealth, “Z” in Z-benefits stands for:

a. None of the above

Under the UHC Act, every PhilHealth member and dependent are granted immediate eligibility for health benefit package.
However, the following conditions must be met:

a. All of the above are correct.

The following are covered under PhilHealth’s inpatient benefit package:

b. Only A and C are correct.

Factors to be considered in the reimbursement of Z claims:

a. All of the above are correct.

The following are considered in monitoring and evaluation of Z claims:

a. All of the above are correct.

Aside from consultations and laboratory tests, qualified beneficiaries of primary care benefit package (KONSULTA package)
may also avail of drugs and medicines for common conditions such as the following, EXCEPT:

a. Tuberculosis
The following are considered Accredited Health Care Institutions in providing inpatient benefits, EXCEPT:

a. Barangay Health Center

The following are TRUE regarding PhilHealth’s registration process in an accredited primary care facility:

a. All of the above are correct.

Protection provided by individual-based health benefit packages against conditions that are considered economically
catastrophic especially for the poor and marginalized sectors of society:

a. Financial risk protection

The following are the steps in availing PhilHealth’s Primary Care Benefits, EXCEPT:

a. The beneficiary accomplishes the needed forms (eKAS and/or ePresS) and submits to PhilHealth Local Health
Insurance Office or PhilHealth Regional Office.
The following outpatient benefits are in response to the country’s efforts to meet the sustainable development goals,
EXCEPT:

a. Hemodialysis
Claims are denied in the following instances in the evaluation of Z claims:

a. All of the above are correct

The medical detoxification package ensures provision of minimum standards of medical interventions to safely manage
acute physical symptoms of withdrawal associated with stopping drug use. The following statements are correct about this
benefit package:

a. Only B and C are correct.

The following statement is TRUE regarding PhilHealth’s outpatient chemotherapy package:

a. One cycle is equivalent to two-day deduction from the 45-day annual benefit limit.
The following are the third-party agencies or organizations that can assist in registering to a PhilHealth accredited primary
care facility, EXCEPT:

a. Barangay health workers

Based on the guidelines for the PhilHealth Konsultasyong Sulit at Tama (KONSULTA package), how does Primary Care
Benefit work?

a. Though registration to a primary care provider of choice, and availing of consultations, health risk screening,
laboratory tests, and drugs and medicines
Based on the guidelines for the PhilHealth Konsultasyong Sulit at Tama (KONSULTA package), what does ePresS stand
for?

a. Electronic Prescription Slip

Based on the guidelines on outpatient and other special benefits, the following are not covered by PhilHealth as outpatient
benefits:

a. All of the above are not covered.

According to the guidelines on PhilHealth’s outpatient and other special benefits, the following individual-based health
services may be availed of as outpatient services:
a. Only A and B are correct.
The reason why the case rate amounts for Maternity Care Package (MCP) and Normal Spontaneous Delivery Package
(NSD) are higher when availed in a non-hospital setting (such as lying-in facilities and birthing homes) than when availed in
a hospital setting:

a. Only A and B are correct.

The following statements are TRUE regarding the 45-day benefit limit on outpatient and other special benefits:

a. All of the above are correct.

In availing of the Z benefits, how many days shall be deducted from the 45-day annual benefit limit of the member?

a. 5 days
True of the Z benefit package:

a. covers primary disease conditions that are perceived as economically and medically "catastrophic”
The following is TRUE in the computation of PhilHealth benefits:.

a. Only A and B are correct.

The following is TRUE about PhilHealth’s individual-based health services:

a. PhilHealth primary members have 45 days annual benefit allowance.

The following refers to ‘individual-based health services’ as defined under the Universal Health Care Act and its
implementing rules and regulations:

a. All of the above are correct.

The following are services covered under the PhilHealth inpatient benefits:

a. Only A and C are correct.

While all admissible confinements are eligible for inpatient benefit package, the rule on Single Period of Confinement (SPC)
must be followed. What does the SPC rule mean?

a. No same illness shall be availed of within 90 days.