TMC Clark Now Offers PhilHealth Z Benefit Package for CABG

The Medical City Clark (TMC Clark) is now an accredited facility for the delivery of PhilHealth Z Benefit Package for coronary artery bypass graft (CABG). Phil health will cover as much as P550,000 for member patients needing a coronary bypass.

In order to help achieve Universal Health Care for all Filipinos and true to its aspiration of ensuring that “Bawat Pilipino, Miyembro; Bawat Miyembro, Protektado; Kalusugan Natin, Segurado,” PhilHealth issued a call for private health care institutions such as The Medical City Clark to apply for contracting services for the delivery of any of its existing Z Benefit Packages.

The Z Benefit Packages, designed to address catastrophic illnesses, were initially available in selected government hospitals nationwide. It was designed for the treatment of breast and prostate cancer, acute lymphocytic leukemia, ventricular septal defect, tetralogy of fallot, coronary artery bypass graft, selected orthopaedic implants, among others. PhilHealth’s move to invite private hospitals hopes to increase accessibility and provide more options for its members.

Who are eligible for the Z benefit packages? Only standard-risk outpatients are eligible for this package as determined by the screening committee from the TMC Clark Department of Cardiology together with the Thoracic Cardiovascular Surgeons (TCVS) who shall then refer the patient to the PhilHealth Officer for completion of requirements.

What are the requirements for eligibility for the Z-benefit packages? Prior to completing the requirements, the patient must qualify under the inclusion criteria for elective CABG as assessed by the screening committee. An approved pre-admission assessment checklist, pre-authorization form and other PhilHealth forms are necessary for approval of application for Z-benefit package.

The preauthorization from PhilHealth, based on the agreed selection criteria, is required for approval, for the Z-benefit package. What are required for approval of application for Z-benefit package for CABG Surgery? The patient must submit the following documents to the PhilHealth Officer.
 MDR Form
 Member Empowerment Form
 Approved Pre-Admission Assessment Checklist (Signed by Attending Cardiologist & Surgeon)
 Pre-Authorization Form (approved by Hospital Director)
 PhilHealth ID
 Signed Patient Educational Brochure
 CF1/CF2

All these forms should be in order and checked by the PHC Nurse Case Manager. These forms shall then be submitted to the City of San Fernando PhilHealth Benefits Office (Region III). The approved pre-authorization form from PhilHealth will then be given back to the PhilHealth Officer who will process the request, inform the attending physicians who will then schedule the date of admission and surgery.

Eligible patients can avail of fixed co-pay with a minimum of P100,000 that covers for the specialized services for the holistic care management of the case. For indigent patients, TMC Clark’s Medical Social Worker can assist the patient and his family identify other sources of funding which may include the hospital’s partner medical assistance providers.

With this latest development, TMC Clark makes its world-class Cardiovascular services more accessible to patients in Central Luzon and nearby provinces. Patients in need of a coronary bypass need not go to Metro Manila hospitals to undergo this life-saving procedure.
For futher inquiries, feel free to reach our customer service number at 0916-448-8046 /045-300-8888.