ALAGA KA

PARA SA MAAYOS NA BUHAY

 ALAGA KA
stands for
ALAMIN AT GAWIN
 The advocacy campaign dubbed “Alaga Ka para
sa Maayos na Buhay” targets to provide the
country’s 14.7 million indigent families with greater
access to primary health care services.
 Launched on March 24, 2014.
 Held in all 17 regions.
 Alaga Ka Program offers Philhealth services that
prioritize the indigent members who were chosen
by the Department of Social Welfare and
Development (DSWD) through National Household
Targeting System for Poverty Reduction (NHTS-PR).
 Philhealth officers and health workers provided an
information on the services encompassed in Alaga
Ka program
 AllCase Rates wherein Philhealth will pay the bills
depending on the rate and the condition of the patient;
benefits that caters to patients that need long-term
medications;
 TSeKaP service that gives preventive health
examinations; and the out-patient benefits.
TSeKaP (Tamang Serbisyo
para sa Kalusugan ng
Pamilya Program)
TSeKaP
 provides consultations with a primary care doctor
and package of preventive services to keep the
members healthy and to detect illnesses early on.
 through TSeKaP, poor families will be more
empowered to see a doctor and demand medical
attention even without an illness.
Who can provide TSeKaP Package?

 Any government health facility such as health

centers/rural health centers (HCs/RHUs) and the
Out Patient Department (OPD) of Municipal / City /
Provincial Health Offices and government hospitals,
that meets the Standards as provided in Annex C.1
of PhilHealth Circular No. 10, series 2012.
 Any private health facility accredited as a training
institution of the Philippine Academy of Family
Physicians (PAFP), recommended by PAFP in
underserved areas and approved by PhilHealth.
 Entitled Members
 Indigent and Sponsored Program (SP) members
and their qualified dependents - include those
members identified under the NHTS-PR and those
enrolled by the LGUs (municipal, city and
provincial governments), Senators, House
Representatives, private institutions and other
national agencies.
 Organized Groups/ iGroups (OG/IG) members
and their qualified dependent
 Entitled Members
 Overseas Workers Program (OWP) members
and their qualified dependents - Coverage of
OWP members pertain only to land based
overseas Filipino Workers since sea-based OFW
are included in the employed sector
 Department of Education (DepEd) personnel
and their qualified dependents
Qualified Dependents
 Legitimate spouse who is not a member
 Unmarried and unemployed legitimate,
legitimated, acknowledged and illegitimate
children as appearing in the birth certificate,
and legally adopted or stepchildren below
twenty-one (21) years of age
Qualified Dependents
 Children who are twenty-one (21) years old or
above but suffering from congenital disability,
either physical or mental, or any disability acquired
that renders them totally dependent on the member
for support
 Parents who are sixty (60) years old or above, not
otherwise an enrolled member, whose monthly
income is below an amount to be determined by the
Corporation in accordance with the guiding
principles set forth in the Act
Services
Diagnostic Tests
 Complete blood count
 Urinalysis

 Fecalysis

 Sputum microscopy
 Fasting blood sugar

 Lipid profile

 Chest X-ray
Medicines
If not listed by DSWD

POINT-OF-CARE
ENROLMENT PROGRAM
Point-of-Care Enrolment Program
 Membership:
 Identification of hospital-sponsored members by
medical social workers
 Hospital to mandatorily enroll those classified as Class
D and Class C3
 Validity: first day of the month of confinement up to
December 31 of the same year
Point-of-Care Enrolment Program
 Benefits:
 Immediate availment of members and hospital is
entitled to reimbursement
 No balance billing

 Faster turn around time of claims reimbursements

No Balance Billing
 No Balance Billing or NBB is a privilege given to
qualified PhilHealth members. If you are covered
by the NBB policy, you no longer need to pay for
your hospitalization at any government hospital and
selected private medical centers nationwide.
 It is the government that pays for the member’s
hospital expenses without prejudice to the quality of
service and attention given to the patient.
No Balance Billing
 Indigent members
 Sponsored members
 Kasambahay members
 Lifetime members
 Senior Citizens
No Balance Billing
 All services and benefits afforded to other
PhilHealth members are likewise extended to those
under the NBB policy, such as:
 Allcase rates
 Case Type Z benefits
 TB-DOTS package
 Outpatient Malaria Package
 Animal Bite Treatment Package
 Voluntary Surgical Contraception Package
 Outpatient HIV/AIDS Treatment (OHAT) Package
THANK YOU!