Philhealth, Calamba Medical Center expand Z benefit coverage for critical care

CALAMBA CITY, Laguna — More patients in CALABARZON will have access to specialized medical treatment as the Philippine Health Insurance Corporation (PhilHealth) Region IV-A and Calamba Medical Center (CMC) signed an agreement expanding the hospital’s coverage under selected PhilHealth Z Benefit packages.

The agreement, signed on September 16, authorizes CMC to provide Z Benefit packages for Coronary Artery Bypass Graft (CABG) surgery, peritoneal dialysis, and hearing impairment services for children aged 0 to 17.

The expanded coverage is expected to help qualified patients obtain specialized treatment while reducing the financial burden associated with serious and potentially life-changing medical conditions.

Under the enhanced CABG Z Benefit, qualified patients may receive coverage of up to ₱660,000 for standard-risk cases and ₱960,000 for expanded or high-risk cases involving co-morbidities.

The package also includes post-operative services such as up to six cardiac rehabilitation sessions, medicines, and specified laboratory and diagnostic procedures.

For patients with kidney failure, the Peritoneal Dialysis (PD) Z Benefit covers treatment that may be performed at home. The procedure uses the peritoneum, the lining of the abdomen, as a natural filter to remove waste and excess fluid from the blood.

The enhanced PD Z Benefit provides annual coverage of up to ₱510,140 for adult continuous ambulatory peritoneal dialysis (CAPD), depending on the patient’s prescribed treatment.

It also covers catheter insertion and initiation, infection prevention, treatment of peritonitis, and laboratory diagnostics.

Qualified children with hearing impairment will likewise have access to applicable assessment, hearing-aid and habilitation services under PhilHealth’s Z Benefit package.

The Memorandum of Agreement was signed by Dr. Edwin Oriña, PhilHealth Region IV-A regional vice president, and Atty. Pilar Nenuca P. Almira, president and chief executive officer of CMC.

Almira described the agreement as a milestone for the hospital and said CMC is committed to strengthening preventive healthcare and improving access to medical services.

“We value the quality of care that we provide to our patients and consider ourselves an instrument of the hospital in preventing illness through preventive healthcare,” Almira said.

She said CMC has also pursued international accreditation as part of its efforts to meet higher standards in healthcare delivery.

“Our hospital is now accredited by an international accreditation body in Canada. This is an international accreditation, and we are committed to meeting high standards and becoming more globalized,” she said.

Almira also highlighted the hospital’s medical professionals, saying many of its doctors are committed to patient care beyond financial considerations.

“We are fortunate to have many physicians whose goal is to help patients get well—not only to earn or receive a large professional fee. Our physicians have heart for their patients,” she said.

She said CMC intends to keep its services accessible and reasonably priced while reaching more patients who require specialized treatment.

“Calamba Medical Center is accessible and remains reasonable in terms of cost. We want to give, share and invite more people whom we can help,” Almira said.

Almira also offered CMC as a potential partner for future PhilHealth pilot programs and research initiatives.

“We would like PhilHealth to know that we are here to offer our hospital as a partner. CMC can be your pilot hospital. If you want to start something, test it or incubate it, CMC is here to partner with you,” she said.

She added that the hospital is also open to participating in research, including studies involving outpatient care.

Almira said the signing of the agreement represents CMC’s commitment to implementing the Z Benefit packages in accordance with PhilHealth’s guidelines, standards and procedures.

“Today, we are blessed to formalize this partnership that will provide three important benefits—CABG, peritoneal dialysis and hearing impairment services,” she said.

“These are very important because they address three basic functions of an individual—the heart, hearing capability and kidney function,” Almira added.

“Please be assured that our signatures are a firm commitment that we will implement these benefits in good faith and in accordance with the guidelines, standards and procedures set by PhilHealth,” she said.

Oriña, meanwhile, said the partnership is consistent with the government’s goal of providing universal healthcare coverage.

“Under universal healthcare, 100 percent of the population in the Philippines is covered by PhilHealth,” Oriña said.

He clarified that PhilHealth coverage and registration in the agency’s database are separate matters.

“We have what we call registration, which refers to those who are already in the PhilHealth database. Around 96 to 98 percent are registered,” he said.

Oriña said patients who are not yet registered may still be able to access PhilHealth benefits, subject to existing rules and procedures.

“Benefits can also be given to non-registered individuals. Once you are in a hospital, you will automatically be registered by the hospital. So you can really use PhilHealth, and no one is excluded,” he said.

“Everyone, every Filipino, can use PhilHealth,” Oriña added.

Dr. Rhodora D. Ocampo, CMC chief operating officer, said the partnership is also intended to improve access to healthcare for patients who may otherwise find private hospital services difficult to afford.

“One of our goals is to improve access. Just because CMC is a private hospital does not mean you cannot come here,” Ocampo said.

She said PhilHealth coverage can help qualified patients access treatment in private healthcare facilities.

“Through PhilHealth, patients have a means to afford private healthcare. That is where we come in. With these PhilHealth packages, we can help make private healthcare more affordable,” Ocampo said.

CMC is a 160-bed Level 2 hospital located in Crossing, Barangay Real, Calamba City, Laguna.

It provides primary care, specialized treatment and diagnostic services.

The hospital operates several specialized centers, including the Calamba Eye Center, Calamba Cancer Center, Calamba Kidney Care Center and Diabetes Care Center.

The Calamba Kidney Care Center has 80 dialysis chairs and is among the larger dialysis centers in Laguna, while the Diabetes Care Center provides comprehensive diabetes services in Southern Luzon.

The new PhilHealth accreditation adds CABG surgery, peritoneal dialysis and pediatric hearing impairment services to the specialized care available to qualified patients at CMC