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Primary Care
Benefit
Strengthening Gatekeeping in the Philippines
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Expansion of Primary Care
Benefit 1 (PCB1) Package to
Personnel of the
Department of Education
(DepEd)
Circ. 10 s. 2013
Published: May 22, 2013
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Coverage
Teachers Non-teaching Dependents
personnel
Coverage
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1. PhilHealth shall provide DepEd a list of currently-accredited PCB1 providers for distribution to their local offices. 2. DepEd shall select their preferred PCB1 providers for their employees from the list provided by PhilHealth.
DepEd-Preferred PCB1 Providers
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Where to avail services?
DepEd will identify the PCB providers nearest to the workplace: • OPD of hospitals • RHU/Health Center •PhilHealth Accredited/Engaged DepEd Clinics
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Masterlist, Assignment & Enlistment
• DepEd shall submit the official masterlist of its personnel reflecting the preferred PCB1 provider to PhilHealth.
• The list shall be submitted in soft and hard copies (Format to be provided by PhilHealth).
• For employees without PIN, please indicate the gender (M-Male or F-Female) in the PIN Column of the masterlist.
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Masterlist, Assignment & Enlistment
• PhilHealth shall forward the verified masterlist to PCB1 providers.
• DepEd personnel shall be deemed assigned and enlisted once the masterlist is received by the preferred PCB1 provider.
• PhilHealth shall issue a certification to the concerned DepEd office confirming the enlistment of DepEd personnel with their preferred PCB1 provider
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Additional Assignment or Re-assignment
• DepEd shall inform PhilHealth by submitting a list of additional / transferred personnel eligible for PCB1.
• Also, retired personnel shall be reported .
• The list shall be submitted not later than 15 days before the succeeding quarter.
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What to bring?
• DepEd shall guarantee that all its personnel has PhilHealth Identification Number or PIN.
• PhilHealth Identification Card (PIC) or Member Data Record (MDR)
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How to avail?
DepEd personnel and their dependents shall be profiled by the PCB1 providers to avail the Primary Care Benefit package.
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Service Provision
• Annex 1 or similar document
Demographic data
Past medical history
Personal/social history
Immunization
Reproductive health history
Pertinent medical exam findings
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Primary Preventive Services
•Consultation
•Visual inspection with acetic acid
•Regular BP measurements
•Breastfeeding program education
•Periodic clinical breast examinations
•Counselling for lifestyle modification
•Counselling for smoking cessation
•Body measurements
•Digital Rectal Examination
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Recommended Diagnostic Exams
•Complete Blood Count
(CBC)
•Urinalysis
•Fecalysis
•Sputum microscopy
•Fasting Blood Sugar
•Lipid profile
•Chest x-ray
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Obligated Services
SERVICES TARGET CLIENTS FREQUENCY
BP measurement Hypertensive (with
BP >/= 140/90 mmHg Once a month
Non-hypertensive
(>/=18 y/o)
Once a year
Periodic clinical
breast
examination
Female, 25 years old
and above
Visual inspection
with acetic acid
Female, 25 – 55 y/o
with intact uterus
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Drugs and Medicines
• Asthma including nebulization services
• Acute Gastroenteritis (AGE) with no or
mild dehydration
• Upper Respiratory Tract Infection
(URTI)/Pneumonia (minimal and low
risk)
• Urinary Tract Infection (UTI)
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Payment for the Services of PCB1 Provider
• Per Family Payment Rate of P500.00 annually for each family (DepEd employee and his/her dependents) enrolled, enlisted and profiled, in accordance with the set guidelines.
• Paid directly to the service provider
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FYIs
Non-transferrable, non-portable
DepEd employees are encouraged to choose their PCB1 provider according to their family and personal needs and living arrangement.
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Accreditation of DepEd Division Clinics
• Completely filled-out Provider Data Record (http://www.philhealth.gov.ph/downloads/accreditation/pdr010713.pdf) • Performance Commitment signed by Head of
DepEd Division Office • Copy of MOA with a referral facility for diagnostic
services that are beyond the PCB1 provider’s service capacity
• Proof of Payment of Accreditation Fee
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CHALLENGE
“Do not follow where the path may lead,
Go instead where there is no path and leave a
trail…”