Benefit Package and
Amount of Benefit |
Selections criteria |
Acute Lymphocytic / Lymphoblastic Leukemia (standard risk)
P500,000 |
a. Signed Member Empowerment (ME) Form;
b. Age 1 to less than 10 years old and 364 days;
c. White blood cell count ‹50,000/µL;
d. No CNS leukemia at diagnosis;
e. There should be no testicular involvement of male patient at diagnosis; and
f. WHO Classification: B or T lymphoblastic leukemia immunophenotype (mature B-cell ALL or Burkitt leukemia are excluded).
|
Breast Cancer
(cStage 0 to IV)
P1.4 million
|
a. Signed ME Form
b. Laterality and Clinical Staging:
-cStage 0
-cStage IA
-cStage IB
-cStage IIA
-cStage IIB
-cStage IIIA
-cStage IIIB
-cStage IIIC
-cStage IV
|
Prostate Cancer
(low to intermediate risk)
P100,000 |
a. Signed ME Form;
b. Male patients age up to 70 years old;
c. Clinical stage (T1a-T2c), PSA level 10 to 20 ng/ml,
Tumor Grade (Gleason’s score of 2-7)
- Low risk: T1-T2a and Gleason score 2-6, and
PSA ‹10 ng/ml
- Intermediate risk: T2b to T2c, Gleason score of 7,
and PSA 10-20 ng/ml
d. Localized prostate cancer; and
e. No uncontrolled co-morbid conditions
|
End-stage renal disease eligible for requiring kidney transplantation (low risk)
P600,000 |
a. Signed ME Form;
b. Age ›10 and ‹70 years;
c. Single organ transplant;
d. Patient on chronic dialysis because of end stage renal disease or patient for pre-emptive kidney transplantation with the following:
i. The potential recipient should have an irreversible renal disease that has been progressive over the previous 6 – 12 months
ii. The recipient’s measured (nuclear scan) glomerular filtration rate, 24-hour urine creatinine clearance or calculated glomerular filtration rate should be less than 20 ml/min/1.73m2 in diabetics or less than 15 ml/min / 1.73m2 in patients with non-diabetic renal disease
e. Low immunologic risk defined as:
i. Past Panel Reactive Antibody (PRA) less than or equal to 20%
ii. Primary kidney transplant (no previous solid organ transplant)
iii. No donor specific antibody (DSA) in the potential recipient
iv. At least 1 HLA-DR match
f. Potential recipient has no previous history of cancer (except basal cell skin cancer), should be HIV negative, Hepatitis B surface antigen negative, and Hepatitis C antibody negative
g. Transplant candidate who is CMV-negative cannot receive an organ from a CMV-positive donor.
h. Absence of current severe illness (Congestive heart failure Class 3-4, liver cirrhosis (findings of small liver with coarse granular/heterogenous echo pattern with signs of portal hypertension), chronic lung disease requiring oxygen, etc)
i. Absence of the following: hemi-paralysis because of stroke, leg amputation because of peripheral vascular disease or diabetes, mental retardation such that informed consent cannot be made, and substance abuse for at least 6 months prior to start of transplant work-up.
j. Eligible patient for kidney transplant must have a certification from the social service of the hospital that they can maintain anti-rejection medicines for the next three (3) years.
|
Coronary Artery Bypass Graft Surgery (standard risk)
P550,000 |
a. Signed ME Form
b. Age 19-70 years
c. Stable Coronary Artery Disease requiring ELECTIVE ISOLATED Coronary Artery Bypass Graft Surgery (CABG) with indication based on coronary anatomy, symptom severity, LV function, and/or viability tests; non-invasive testing completed and discussed with patient
d. Current Medical Status
i. Not in severe decompensated heart failure (NYFC IV)
ii. Not with severe angina (CCS Class III)
iii. No other cardiac/vascular procedures /interventions planned to be done with CABG during the admission
e. Past History:
i. No previous cardiac surgery such as CABG, valve surgery, etc.
ii. No previous transcutancous cardiac intervention such as coronary angioplasty or stenting
f. ONLINE EUROSCORE II and/or STS scoring predictive of low mortality risk (‹5%)
|
Surgery for Tetralogy of Fallot in Children
P320,000 |
a. Signed ME Form
b. Age: 1 to 10 years and 364 days
c. 2D-echocardiogram:
i. Pulmonary artery size
- McGoon’s index (Aorta/Pa ratio) ≥ 1.5
- Z score Pulmonary Valve Annulus : Acceptable if z score / BSA : ≥ 3 or better
- Z score peripheral PA’s : Acceptable if ≥ 2 or better
ii. Absence of major aortopulmonary collateral arteries (MAPCAs)
d. If cardiac catheterization / hemodynamic study available: PA size: adequate by Z score standards / BSA
e. No previous cardiac surgery (Blalock Taussig Shunt)
f. Functional Class I-II
g. No co-morbid factors, such as any of the ff:
i. Preoperative seizures
ii. Brain abscess
iii. Stroke events
iv. Bleeding disorders
v. Infective endocarditis
vi. Other congenital anomalies
|
Surgery for Ventricular Septal Defect in Children
P250,000 |
a. Signed ME Form
b. Age: 1 to 10 years and 364 days
c. 2D-echocardiography
i. Isolated VSD perimembranous, subaortic or subpulmonic
ii. No combined shunts such as atrial septal defect or patent ductus arteriosus or atrioventricular septal defect
iii. No other associated CHD’s : such as coarctation of the aorta, or moderate to severe aortic insufficiency, or moderate to severe pulmonic stenosis
iv. Pulmonary artery pressure: ‹50 mmHg or at least 2/3 systolic blood pressure
v. QP QS: > 1.5:1
d. No previous cardiac surgery (PA Banding)
e. Functional Class I-II
f. No co-morbid factors, such as any of the ff:
i. Preoperative seizures
ii. Brain abscess
iii. Stroke events
iv. Bleeding disorders
v. Infective endocarditis
g. No chromosomal abnormalities and other associated congenital defects
|
Cervical Cancer:
Chemoradiation with Cobalt and Brachytherapy (low dose) or Primary surgery for Stage IA1, IA2 – IIA1
P120,000
Chemoradiation with Linear Accelerator and Brachytherapy (high dose)
P175,000 |
a. Signed ME Form;
b. No previous chemotherapy
c. No previous radiotherapy
d. No uncontrolled co-morbid conditions
e. Treatment plan from gynecologic oncologist
|
ZMORPH (Mobility,
Orthosis, Rehabilitation, Prosthesis Help)
- first right or left below the knee
P15,000
- both limbs
P30,000 |
a. Signed ME Form;
b. No associated disabilities or co-morbidities, such as contractures, deformities, mental or behavioral incapacity, quadriparesis, cardiopulmonary disease;
c. Community ambulation with or without cane, crutches or walker;
d. At least three (3) months post-amputation, if acquired; and
e. At least 15 years and 364 days of age, if congenital.
|
Expanded ZMORPH
Prostheses/ Orthoses
I. Prostheses
A. Above knee/ knee disarticulation (AKKD)
P75,000
B. Hip disarticulation (HD)
P135,000
C. Below elbow (BE)
P50,000
D. Above elbow (AE)
P70,000
E. Van Ness Rotationplasty
P85,000
II. Ortho / prostheses
Ankle Foot
P17,500
III Orthoses
A. Knee Ankle Foot
P35,000
B. Hip Knee Ankle Foot
P80,000
|
IV. Spinal Orthoses
A. Thoracolumbo-sacral P40,000
B. Lumbosacral P30,000
C. Cervicothoracic P45,00
|
|
|
1. Signed ME Form;
2. Upper and Lower Limb Prostheses
a. Age ≥ 18 years old
b. At least three (3) months post-amputation, if acquired
c. Wheelchair-independent, community-ambulator with or without crutches, cane or walker
d. On physical examination: no fresh or non-healing wound, neuroma or painful residual limb, no motor strength of < 3 +I- sensory loss, +/ - instability, with hip /knee flexion contracture
3. Lower limb orthosis
The following are the general criteria:
a. At least three (3) months post-onset
b. Upper limbs ≥ 4 with fair trunk control and full range of motion, if bilateral
c. Unaffected limbs ≥ 3 with fair trunk control and a full range of motion, if unilateral
d. Ambulatory with an assistive device
e. No fresh or non-healing wound
The following are the additional criteria for the specified subpackages:
3.1. Ankle foot orthoses
3.1.1. Weakness or absence of dorsiflexors and/or plantarflexors, +/ - grade 1-2 spasticity with full range of motion achieved passively
3.1.2. Equinovarus +/- foot rotation and +/- grade 1-2 spasticity with full range of motion achieved passively
3.1.3. Pain & Instability secondary to a sensory or structural deficit in a Charcot Arthropathy
3.2. Knee ankle foot orthoses
Quadriceps MMT of < 3 +/- sensory loss, +/- instability (genu recurvatum) with
hip /knee flexion contracture
3.3 Hip knee ankle foot orthoses
Hip, knee, ankle & foot muscles MMT < 3 +/- sensory loss, +/ - instability, with hip /knee flexion contracture <20 degrees
1. Signed ME Form;
2. Spinal orthosis
The following are the general criteria:
a. Age ≥ 18 years old
b. Upon diagnosis and/or post-operative clearance
c. No sensory deficit over body segment of application
d. Upper and lower limb manual muscle strength of ≥ 3
The following are the additional cnteria for the specified sub-package:
2.1. Thoracolumbosacral custom molded spinal orthosis
2.1.1. Thoracolumbar (T12-L2) spinal fractures involving posterior elements
2.1.2. Primary or metastatic lesions to the thoracolumbosacral spine
2.2 Lumbosacral custom molded spinal orthosis
The following are the additional criteria for the specified sub-package:
2.2.1. Lumbosacral fractures (L1-L3)
2.2.2. Primary or metastatic lesions to the lumbosacral spine
2.3 Cervicothoracic custom molded spinal orthosis
The following are the additional criteria for the specified sub-package:
2.3.1. Cervical spine fractures (C3-C7) without neurologic deficit
2.3.2. Torticollis
2.3.3. Metastatic lesions without neurologic deficit
|
Selected Orthopedic Implants
1. Implants for Hip Arthroplasty
- Implants Hip Prosthesis, cemented*
P103,400
- Total Hip Prosthesis, cementless**
P169,400
- Partial Hip Prosthesis, bipolar
P73,180
*cemented: 66 years old and above
** cementless: 65 years and 364 days old and below
|
|
2. Implants for Hip Fixation
- Multiple screw fixation (MSF)*** 6.5mm cannulated cancellous screws with washer
P61,500
***59 years and 364 days old and below (both displaced and undisplaced fracture); 60 years old and above (undisplaced fracture) |
|
3. Implants for Pertrochanteric Fracture
- Compression Hip Screw Set (CHS)
P69,000
- Proximal Femoral Locked Plate (PFLP)
P71,000
- Proximal Femoral Nail amounting to
P55,640
|
|
4. Implants for Femoral Shaft Fracture/tibial fracture
- Intramedullary Nail with Interlocking Screws
P48,740
- Locked Compression Plate (LCP) – Broad / Metaphyseal / Distal Femoral LC
P50,740 |
|
a. Signed ME Form
b. Clinical Features
|
i. hip fracture |
|
|
1. with avascular necrosis of the femoral head; OR
2. neglected fracture of the hip; OR
3. hip fracture with pre-existing cox-arthritis; OR
4. displaced hip fracture
|
|
ii. with avascular necrosis of the femoral head (FICAT Stage III and IV); OR
iii. hip dysplasia (CROWE I-IV); OR
iv. severe osteoarthritis; OR
v. severe inflammatory joint disease (rheumatoid, gout, psoriatic, ankylosing spondylitis) |
c. Pre-injury status: ambulatory patients
d. With no more than two co-morbid illnesses based on: Physical status classification based on ASA (low to moderate risk)
ASA I – normal healthy patient
ASA II – Patient with mild systematic disease; no functional limitation |
|
a. Signed ME Form
b. Any hip fracture not covered under the total hip package for femoral neck fracture
|
i. with no avascular necrosis of the femoral head; OR
ii. acute fracture of the hip; OR
iii. hip fracture with no pre-existing cox-arthritis; OR
iv. displaced hip fracture |
c. Pre-injury status: ambulatory patients
d. With no more than two co-morbid illnesses based on: Physical status classification based on ASA (low to moderate risk)
ASA I – normal healthy patient
ASA II – Patient with mild systematic disease; no functional limitation |
|
a. Signed ME Form
b. CHS: stable fracture of the intertrochanteric area (AO Classification Type A1 fracture)
c. PFLP: unstable/comminuted pertrochanteric fracture (AO Classification Type A2 and A3 fracture)
d. Pre-injury status: ambulatory patients
e. With no more than two co-morbid illnesses based on: Physical status classification based on ASA (low to moderate risk)
ASA I- normal healthy patient
ASA II – Patient with mild systemic disease; no functional limitation
|
|
a. Signed ME Form
b. Femoral shaft fracture
|
i. without malignant/metastatic pathologic fracture: AND
ii. with any complete fracture of the femur
Pre-injury status: ambulatory patients |
c. Physical status classification based on ASA (low to moderate risk)
ASA I – normal healthy patient
ASA II – Patient with mild systemic disease: no functional limitation
|
|
“PD First” - for End-Stage Renal Disease Requiring Peritoneal Dialysis
P270,000 per year |
a. Signed ME Form (to be submitted annually together with the pre-authorization)
b. Patients must have a permanent Tenckhoff peritoneal dialysis catheter properly placed in the abdominal cavity;
c. Patients must have completed PD initiation in an accredited healthcare institution so that the patient is no longer uremic, with stable vital signs and adequately trained (patient himself/herself or a caregiver) to perform PD at home using manual exchanges;
Clinical Criteria
i. Must be at least 10 years of age;
ii. Diagnosed to have end-stage renal disease requiring renal replacement therapy;
iii. No previous history of cancer other than a successfully and completely treated cutaneous squamous cell or basal cell carcinoma or carcinoma in-situ of the cervix , within the past 5 years;
iv. HIV-negative;
v. No mental incapacity such that informed consent cannot be made or that would interfere with the patient’s ability to comply with the PD prescription;
vi. For pediatric patients, aged 10 to 18 years and 364 days, informed consent from the parents or when appropriate, from the guardian, must be secured;
vii. Absence of current severe illness, including congestive heart failure Class IV, liver cirrhosis (findings of small liver with coarse granular/heterogeneous echo pattern with signs of portal hypertension) and chronic lung disease requiring oxygen;
viii. Absence of hemiparalysis and leg amputation because of peripheral vascular disease;
ix. No history of substance abuse for at least 3 months prior to start of chronic dialysis treatment;
x. Absence of any disease of the abdominal wall, such as injury or surgery, burns, hernia, extensive dermatitis involving the abdomen;
xi. Absence of any inflammatory bowel diseases (ex. Crohn’s disease, ulcerative colitis or diverticulitis)
xii. Absence of any intra-abdominal tumors or intestinal obstruction;
xiii. Absence of active serositis;
xiv. Absence of known or suspected allergy to PD solutions |
Colon and Rectum Cancer
Colon Cancer
Stage I-II (low risk) – P150,000
Stage II (high risk) – III – P300,00
Rectum Cancer
Stage I (clinical and pathologic) – P150,000
Pre-operative clinical stage I but with post-operative pathologic stage II-III
- using linear accelerator as mode of radiotherapy) - P400,000
- using cobalt as mode of radiotherapy - P320,000
Clinical Stage II-III
- using linear accelerator as mode of radiotherapy) - P400,000
- using cobalt as mode of radiotherapy -P320,000 |
1. Signed Member Empowerment (ME) Form
For Colon Cancer
a. Clinical and TNM Staging from stage I to III (Clinically T1-T4, N0-2, M0)
b. Pre-operative physical risk classification
ASA I – normal health patient OR
ASA II – patient with mild systemic disease
c. ECOG Performance Status
d. Mandatory and other services (procedures, diagnostics, medicines & others)
e. See Table 1 of Circular No. 028-2015
For Rectum Cancer
a. Biopsy proven rectum cancer stages I to III (clinically T1-4, N0-2, M0)
b. No previous pelvic radiation
c. Pre-operative physical risk protection
ASA I – normal health patient OR
ASA II – patient with mild systemic disease
d. ECOG Performance Status
e. Mandatory and other services ( procedures, diagnostics, medicines & others)
See Tables 6, 7, 8 of Circular No. 028-2015 |
PREMATURE and SMALL NEWBORN
Prevention of Preterm Delivery
1.Prevention of preterm delivery with severe pre-eclampsia/eclampsia - 3,000.00
2.Prevention of preterm delivery, with preterm pre-labor rupture of membrane (pPROM) - 1,500.00
3. Prevention of preterm delivery without pre-eclampsia/eclampsia or rupture of membranes but with labor or vaginal bleeding or multifetal pregnancy - 600.00
4. With coordinated referral and transfer from a lower level of facility - 4,000.00 |
The following benefits shall be available for pregnant women who are in their 24 to 36 and 6/7 weeks of gestation, at risk of preterm delivery. The packages for the prevention of preterm delivery are availed exclusive of each other, with or without the coordinated referral and transfer package. |
Preterm and Small Newborns (24 to < 32 weeks)
1. Essential interventions for 24 to < 32 weeks - 35,000.00
2. Essential intervention with minor ventilator support and Kangaroo Care for 24 weeks to < 32 weeks - 85,000.00
3. Essential interventions with major ventilatory support and Kangaroo Care for 24 weeks to < 32 weeks - 135,000.00
|
The following benefits shall be available for pregnant women who are in their 24 to 36 and 6/7 weeks of gestation, at risk of preterm delivery. The packages for the prevention of preterm delivery are availed exclusive of each other, with or without the coordinated referral and transfer package. |
Preterm and Small Newborns (32 to < 37 weeks)
1. Essential interventions for 32weeks to < 37 weeks - 24,000.00
2. Essential interventions with mechanical ventilation and Kangaroo Care for 32 weeks to < 37 weeks - 71,000.00 |
The following benefits shall be available for premature newborns who are visually small or very small, 24 weeks to < 37 weeks by fetal aging or 500g to ≤ 2,499g fetal weight |
|
Children with Developmental Disabilities
Assessment and discharge assessment ranges from P3,626.00 – P5,276.00
Rehabilitation Therapy Sessions P5,000.00 per set*
*Eligible children with developmental disability can only avail of a maximum of nine sets of therapies. Each set of therapies has a maximum of 10 sessions
|
a. Chronological age must be zero to 17 years and 364 days old; and
b. A child presents with functional problems secondary to delays, regressions, or deviations in any of the following developmental domains: cognitive-adaptive, sensorimotor, communication, social, emotional, or behavioral |
Children with Mobility Impairment
Requiring assistive devices ranges from P13,110.00 – P163,540.00
Requiring seating device, basic and intermediate wheelchair ranges from P12,730.00 – P29,450.00
Yearly services and replacement of devices ranges from P1,590.00 – P13,690.00
|
a. General Criteria |
|
i. Age must be 0 to 17 years and 364 days old;
ii. Absence of conditions that will compromise safety and functionality with the use of prosthesis, orthosis,
iii. On physical examination: no fresh or non-healing wound on body part of interest
iv. At least three months-post-surgery, if acquired amputation
|
b. With mobility impairment, presenting with any of the following:
i. Disorders resulting to mobility impairment:
|
|
a.) Musculoskeletal conditions characterized with any of the following: limb loss (amputation), limb deficiency, limb deformity and spine deformity (Cobb’s angle ≥ 20 degrees and Risser ˂ 4) classified into:
i.) Gross motor function classification system (GMFCS) 1 and 2 for prosthesis and orthoses
ii.) GMFCS 3, 4, and 5 for seating device, wheelchair, prosthesis and orthosis (note: For seating device, a child must be six months to six years & 364 days),
iii.) Talipes equinovarus (clubfoot)
|
|
b.) Neuromuscular conditions characterized with any of the following: weakness or paralysis, imbalance, incoordination, sensory deficits classified into:
i.) GMFCS 1 and 2 for prosthesis and orthosis, OR
ii.) GMFCS-3, 4, and 5 for seating device, wheelchair and orthosis
ii. Presence of cardiopulmonary, behavioral or cognitive conditions that impairs a child’s mobility
|
|
Children With Visual Disabilities
Package code and rates for initial assessment and intervention
Initial assessment and intervention (i.e. rehabilitation and training) for Category 1 Visual impairment - 25,920.00
Initial assessment and intervention (i.e. electronic assistive device, rehabilitation and training) for Categories 2, 3, and 4 Visual impairment - 31,920.00
Initial assessment and intervention (i.e. electronic assistive device, rehabilitation and training) for Category 5 Visual impairment - 9,070.00
Optical Aid 1: Low Power Distance, Categories 1, 2, 3 and 4 visual impairment eyeglasses + low power optical device - 7,350.00
Optical Aid 2: High power Distance, Categories 1, 2, 3 and 4 visual impairment progressive eyeglasses + high optical device - 13,820.00
Optical Aid 3: Colored Filter, Categories 1, 2, 3 and 4 visual impairment - 2,940.00
White cane, Category 5 visual impairment - 1,000.00
Description for add-on* devices
*These add-on assistive devices are availed of on top of the benefits for initial assessment and intervention for the Z Benefits for visual disabilities.
Description for yearly diagnostics, after the first year of enrolment
Yearly Diagnostics for Categories 1, 2, 3 and 4 - 3,220.00
Yearly follow up consultation for Category 5 - 780.00
Description for other benefits
Electronic Aid Replacement done every 5 years - 6,000.00
Ocular Prosthesis, per eye - 20,250.00
** Ocular prosthesis may be availed of exclusively or with any of the benefits for visual disabilities if the child fulfills the inclusion criteria stated in Item VII.1. c of PhilHealth Circular 2018-0010
|
a. General Criteria |
|
1. Chronological age must be equal to 0 to 17 years and 364 days old;
2. AND any of the following:
i. The child must have undergone a visual disabilities assessment from an ophthalmologist where the child was categorized into Category 1, 2, 3, 4, or 5 visual disability and determined to need assistive devices with prescribed appropriate rehabilitation plan
ii. Children needing an ocular prosthesis should fulfill the following criteria:
a. The child has enucleated eye
b. Other clinical indications determined by ophthalmologists
3. Must be eligible at the time of pre-authorization
|
|
Children With Hearing Impairment
Description for assessment and hearing aid provision of children 0 to less than 3 years old at the time of approval of pre-authorization
Assessment and hearing aid provision, with moderate hearing loss
Assessment: Otoacoustic Emission Screening and Auditory Brainstem Response (ABR)
Habilitation: Hearing Aid fitting, hearing aid device, batteries good for 5 years, ear mold, hearing aid verification
Ear mold refitting every six months for five years
53,460.00
Assessment and hearing aid provision, with severe to profound hearing loss
Assessment: Otoacoustic Emission Screening and Auditory Brainstem Response (ABR)
Habilitation: Hearing Aid fitting, hearing aid device, batteries good for 5 years, ear mold, hearing aid verification
67,100.00
Description for assessment and habilitation of children 3 to less than 6 years old at the time of pre-authorization
Assessment and hearing aid provision, with moderate hearing loss
Assessment: Age Appropriate Behavioral Audiometry
Habilitation: Hearing Aid fitting, hearing aid device, batteries good for 5 years, ear mold, hearing aid verification
Ear mold refitting once a year for five year
45,400.00
Assessment and hearing aid provision, with severe to profound hearing loss
Assessment: Age Appropriate Behavioral Audiometry
Habilitation: Hearing Aid fitting, hearing aid device, batteries good for 5 years, ear mold, hearing aid verification
Ear mold refitting once a year for five years
54,100.00
Description for assessment and habilitation of children 6 to less than 18 years old at the time of approval of pre-authorization
Assessment and habilitation, with moderate hearing loss
Assessment: Diagnostic Pure Tone Audiometry
Habilitation: Hearing Aid fitting, hearing aid device, batteries good for 5 years, ear mold, hearing aid verification
Ear mold refitting once a year for three years
43,880.00
Description for speech therapy assessment and sessions
Speech therapy assessment and sessions for moderate hearing loss
Include speech evaluation, speech therapy sessions and counselling
22,100.00
Speech therapy assessment and sessions for severe to profound hearing loss
Include speech evaluation, speech therapy sessions and counselling
63,420.00
Description for hearing aid replacement (The rates mentioned cover the hearing aid, its prescription, fitting, and fitting evaluation for one ear only)
Replacement of hearing aid for moderate hearing loss, 5 to less than 18 years old
Includes hearing aid fitting, hearing aid, batteries good for five years , ear mold and hearing aid fitting verification
43,670.00
Replacement of hearing aid for severe to profound hearing loss, 5 to less than 18 years old
This is only available to those who have been enrolled prior to the age of six years old and availed of hearing aid. This require a new application for pre-authorization.
Includes hearing aid fitting, hearing aid batteries good for five years, ear mold and hearing aid fitting verification
48,670.00
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Children presenting with the following are entitled to avail themselves of the benefit package:
1. Age must be equal to 0 to 17 years and 364 days old
2. A child must have undergone professional assessment and is deemed to have ALL of the following:
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|
i. Presence of delay on auditory milestones and/or communication issues at home/school
ii. Sensorineural hearing loss presenting with either moderate or severe to profound hearing loss described as:
a. Moderate hearing loss – three frequency (500 Hz, 1000Hz, 2000Hz) average threshold between 41 dBHL to 60 dBHL or
b. Severe to profound hearing loss –three frequency (500Hz, 1000Hz, 2000Hz) average threshold greater than or equal to 61 dBHL
iii. Absence of signs and symptoms of
an active ear infection (e.g. otalgia,
otorrhea, fever and tenderness) |
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Follow this link to view the Z Benefits Contracted Health Care Institutions » |