Is CT Scan Covered by PhilHealth?

PhilHealth implements the case rate system with its coverage. The amount that PhilHealth will reimburse the patient depends on the specific illness/case. This coverage includes healthcare professional fees and facility charges. 

Are you wondering if imaging procedures like CT scans are covered by PhilHealth? Let’s find out the answer in this quick guide. 

Disclaimer: This article has been published for educational purposes only. Neither the author nor FilipiKnow is affiliated with PhilHealth, so specific queries about your membership and insurance benefits must be forwarded to the proper authority.

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Are Imaging Procedures Like CT Scan Covered by PhilHealth?

It depends. Any laboratory tests or imaging deemed necessary will be covered within the limit of the case rate, if inpatient hospitalization. If it is an expensive imaging procedure like a CT scan, and outpatient, it might not be covered by PhilHealth. 

PhilHealth does have the Z Benefits Package1 which might cover laboratory and imaging costs of catastrophic diseases as long as deemed necessary and covered by the package.

What Is the Z Benefits Package?

The Z Benefits Package covers conditions that are considered to be economically and medically devastating and are categorized as Case Type Z. It aims to assist members whose illnesses will require lengthy and expensive therapies.

Illnesses and operations eligible for Z Benefits include:

  • Acute lymphocytic or lymphoblastic leukemia (standard risk)
  • Breast cancer (early stage)
  • Prostate cancer (low to intermediate risk)
  • Kidney transplant (low risk)
  • Coronary artery bypass graft surgery (standard risk)
  • Tetralogy of Fallot surgery for children
  • Ventricular septal defect surgery for children
  • Cervical cancer (early stage)
  • Selected orthopedic implants
  • Colon and rectum cancer
  • Prevention of preterm delivery

If sponsored members match the eligibility and risk criteria listed by PhilHealth, they may get up to 100% coverage for diseases of case type Z.

Return to the main article: How To Register in PhilHealth Online: A Complete Guide for New Members

Reference

  1. Philippine Health Insurance Corporation (PhilHealth). (2021, December 2). PhilHealth Circular No. 2021-0022: The Guiding Principles of the Z Benefits (Revision 1) [Press release]. Retrieved September 20, 2022, from https://www.philhealth.gov.ph/circulars/2021/circ2021-0022.pdf

Camille Lamera, MD

Camille Lamera is a medical doctor with clinical and government work experience. She has always been passionate about health education and public service, having worked in two government offices and as a part-time educator in Preventive and Community Medicine. She is currently working as a doctor in public health while also doing freelance academic and scientific writing.

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