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GUIDING PRINCIPLES OF THE Z BENEFITS FOR CHILDREN WITH DISABILITIES

THE Philippine Health Insurance Corp announced that benefit packages designed to support children with hearing, visual, mobility impairment and development disability will soon be available.

The Philhealth ZMorph package for children with disabilities is awaiting the signature of Malacanang. In the meantime, here’s the planned benefits and guidelines as stated on their website
(Source:https://www.philhealth.gov.ph/circulars/2016/TS_circ2016-032.pdf)

1. What is the current situation of children with disabilities in the Philippines?
 Disability deprives affected individuals of opportunities, access to education, social and
health services
 Being a child with disability further predisposes the affected person into continued nonparticipation
in day-to-day societal activities.
 Among persons with disabilities, it is estimated that 18.9% are within 0 to 14 years old (PSA,
2010)
 Prevalence is highest among urban slum and rural communities (ADB, 2005)
 Evidence supports that early recognition of these impairments and timely intervention with
appropriate assistive technology and rehabilitation can improve functioning and
participation, that allows children with disabilities to lead productive lives.
 Among children, the impairments that have a profound impact on function are those that
affect hearing, vision, mobility and delay or regression in the child’s cognitive, adaptive,
motor, language and social development.

2. What is the Rationale in the development of the benefit package?
The development for the Z Benefits for children with disabilities benefit package envision
persons with disabilities to be active participants and contributors in their respective economies
through education, inclusion and participation in their communities based on the
multidisciplinary assessment of individual needs.

3. What are the Guiding Principles for the Z Benefits for Children with Disabilities?
a. The value of this benefit package is to improve societal participation of children with
disabilities that have the highest impact on their functionality;
b. The interventions must be locally available, with good quality and will result to improved
functionality;
c. The spectrum of health care services is designed within the perspective of preventive,
curative to habilitative/rehabilitative care because children present in different
developmental stages that would require benefit packages corresponding with the child’s
growth phase;
d. It shall capitalize on service delivery networks (SDN) that shall ensure viability of service
provision at all levels of care and contracting arrangement between PhilHealth and the HCI.
e. It shall facilitate the expansion of the current provision and supply of assistive technologies;
promote the improvement of maintenance and repair mechanisms; sustainability in service
delivery via production and training of the appropriate local complement of human
resources;
f. The benefit package shall drive conformity to existing global standards on assistive products;
g. The benefit package is distinct for the type of impairment that it addresses. Actively engage
users’ and caregivers’ participation in ensuring acceptability, appropriateness and safety of
the use of prescribed assistive devices;
h. All members of the National Health Insurance Program shall be afforded financial risk
protection.
4. What are the objectives and coverage of the benefit packages?

5. Who are entitled to avail of the Z benefits for children with disabilities and how can these be availed of?

The details on the criteria for benefit availment, the minimum standards of care, the corresponding package rates and the rules for claims filing and reimbursement of these benefit packages for children with disabilities shall be published in separate issuance.

6. How will PhilHealth monitor the implementation of these benefit packages?

PhilHealth shall monitor the utilization of the benefit packages as well as the performance of contracted providers and the satisfaction of patients who availed themselves of the Z benefits. Providers shall be monitored subject to the current rules of the Health Care Provider Assessment System (HCP PAS) (PhilHealth Circular 2016-026) and other monitoring policies that shall also be disseminated in a separate issuance. Patients, on the other hand, shall be required to fill up the Z Satisfaction Questionnaire and randomized for the field monitoring to be conducted by PhilHealth personnel. Results of the monitoring activities shall be used for policy research and benefits enhancement.

7. Will the policies on the Z Benefits for children with disabilities be updated/ reviewed?

The policies of the Z Benefits for children with disabilities shall be reviewed regularly in collaboration with stakeholders, staff of PhilHealth Regional Offices, experts, patients and technical staff representatives from the Corporation.

8. Where can patients avail themselves of the Z benefits for children with disabilities?

PhilHealth shall contract with capable health care institutions (HCIs) for the provision of the specialized services for the Z Benefits for children with disabilities. The list shall be posted in the PhilHealth website once available.

9. How can health care institutions be contracted to provide the Z benefits for children with disabilities?

Health care institutions interested to become contracted by PhilHealth to provide the services for the Z benefits for children with disabilities may write a letter of intent to the Regional Vice Presidents of the respective PhilHealth Regional Office covering their institutions. The specific policies and guidelines for contracting HCIs and the minimum requirements for renewal of contracts are stipulated in PhilHealth Circular No. 14, s. 2015 (Guidelines for Contracting Health Care Institutions as Z Benefit Package Providers).

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