The Universal Health Care (UHC) Law provides that the State shall ensure that all Filipinos are guaranteed equitable access to quality and affordable health care goods and services and against financial risk. It also provides that every Filipino shall be granted immediate eligibility and access to preventive, promotive, curative, rehabilitative, and palliative care for medical, dental, mental, and emergency health services, delivered either as population based or individual based health services.
As PhilHealth commits to expand the primary care benefit to cover all Filipinos, it introduced the PhilHealth Konsulta (Konsultasyong Sulit at Tama) Package as a transitory benefit towards the achievement of a comprehensive outpatient benefit. It is PhilHealth’s concrete response to ensure that every Filipino family is afforded with primary care services ranging from initial and follow-up consultations, health screening and assessment, diagnostic services, to maintenance medicines.
The PhilHealth Konsulta integrates the previous Primary Care Benefit and Expanded Primary Care Benefit. The benefit package is provided in all accredited government and private health care providers.
The following providers are qualified to be accredited for Konsulta: Outpatient department/section of accredited levels 1, 2, 3 private and hospitals; non-hospital facilities such as Rural Units (RHUs)/centers, Ambulatory Surgical Clinics, Infirmary/Primary Care Facilities, private medical outpatient clinics.
What is PhilHealth Konsulta Package?
This is an endeavor of PhilHealth to provide all Filipinos financial access to a primary care provider that will deliver basic essential services at every life stage that aims to promote health, identify risks, and ensure early diagnosis, treatment and care.
This is a transitory benefit towards the achievement of a comprehensive outpatient benefit. If we stay true to this path, we can possibly help in lowering medical care costs in the country. Just imagine if all Filipinos are taken care of by Konsulta. Early detection of diseases will lead to early and immediate attention and treatment — if not total avoidance of such
The primary care provider will also serve as navigator, coordinator, and initial and continuing point of contact in the health care delivery system. (Section 6.d of the UHC Law).
What services are covered under the Konsulta Package?
The Philhealth Konsulta package covers:
- Primary care services – first-contact, comprehensive, continuing and coordinative care
- Select Laboratory/Diagnostic Examinations as needed as part of case management:
- CBC w/ platelet count
- Urinalysis
- Fecalysis
- Sputum Microscopy
- Fecal Occult Blood
- Pap smear
- Lipid profile ( Total Cholesterol, HDL and LDL Cholesterol, Triglycerides)
- FBS
- OGTT
- ECG
- Chest X-Ray
- Creatinine
- HbA1c
- Select Drug and Medicines as needed as part of case management:
| Medicine | Category |
| Amoxicillin | Anti-microbial |
| Co-Amoxiclav | |
| Cotrimoxazole | |
| Nitrofurantoin | |
| Ciprofloxacin | |
| Clarithromycin | |
| Oral Rehydration Salts | Fluid and Electrolytes |
| Prednisone | Anti-asthma |
| Salbutamol | |
| Fluticasone + Salmeterol | |
| Paracetamol | Anti-pyretics |
| Gliclazide | Anti-diabetic |
| Metformin | |
| Simvastatin | Anti-dyslipidemia |
| Enalapril | Anti-hypertensives |
| Metoprolol | |
| Amlodipine | |
| Hydrochlorothiazide | |
| Losartan | |
| Aspirin | Anti-thrombotics |
| Chlorpheniramine Maleate | Anti-histamine |
Are the dependents qualified to avail of the Konsulta Package?
Yes. All Filipinos and their qualified dependents are entitled to the Konsulta Package.
Members and dependents must have their PIN before they can register to a Konsulta
facility. Member’s Konsulta facility does not need to be the same with the dependent.
How can a member or dependent register to a Konsulta facility?
Members can start registering to a provider of their choice.
Registration can be done through the following:
Self-registration – can be done by the member through the PhilHealth Member Portal
Assisted registration — visiting PhilHealth Office, or through the social workers of the
Konsulta facility, LGU/OSCA, Employer, PCARES; PhilHealth Action Center.
Are senior citizens and PWDs automatically registered in a Konsulta facility?
No. All members need to register to a Konsulta facility of their choice in order to avail of the services.
There are assisted registrations that can help members register to a Konsulta facility.
Can a member choose a Konsulta facility?
Yes. Members and dependents can choose from the accredited Konsulta facility in their
place.
To know the available providers, members may visit the PhilHealth website or contact the nearest PhilHealth Regional Office (PRO) or Local Health Insurance Office (LHIO).
How can a member know that a facility is PhilHealth accredited for Konsulta?
A PhilHealth signage will be posted in the facility as proof that it is an accredited Konsulta
provider.
A Konsulta provider is either an OPD of the hospital, Rural Health Units, Ambulatory Surgical Clinics, Infirmary/Primary Care Facilities, Private Medical Outpatient Clinics.
Can a dependent register to a Konsulta facility different from the facility where the principal member is registered?
Yes. If the principal member and his/her dependents live separately, they can register in
different Konsulta providers.
Members and dependents must have their PIN before they can register to a Konsulta facility. However, the member or dependents can transfer to a different Konsulta facility the following year. Registration to a Konsulta facility is good for one year.
Can a member avail of a Konsulta service where he/she is not registered?
No. The principal member and his/her dependents need to register in a Konsulta facility of their choice in order to avail of the benefits.
Members should stay tune for the announcements of PhilHealth for the updated list of accredited Konsulta facilities.
When can a member start availing the Konsulta Package?
Once registered to a Konsulta facility, member and dependents can start availing of the Konsulta services.
An ATC (Authorization Transaction Code) is needed before one can avail of the benefits.
An ATC is a like a One Time PIN (OTP) given to Konsulta facility to avail of the services. ATC can be secured through the PhilHealth website, by calling the Action Center, through the PCARES, by visiting PhilHealth office. Or if no access, can visit the facility instead and have a photo taken to avail the benefits.
Can a member without PIN register and avail of the Konsulta package?
No. PIN is needed in order for the member and dependents register in a Konsulta facility.
Members are advised to update their PhilHealth record.
To secure PIN/update record, submit properly accomplished PMRF to:
– Any PhilHealth office
– Employer (for employed members)
– OSCA (for senior citizens)
For the dependents with no PIN yet, member has to accomplish a PMRF reflecting the details of his/her dependents together with the required supporting documents in order for PhilHealth to assign a PIN to each of the dependents.
At present, how many providers have been accredited to provide the
Konsulta package?
As of April 30, 2023, a total of 1,967 health care facilities have been accredited as Konsulta Providers nationwide.
or Region IV-B, 87 facilities were accredited wherein 30 of which is from the province of Batangas.
