The PhilHealth Konsulta is an expanded and comprehensive outpatient benefit package that aims to provide primary and preventive care services for all Filipinos.
"To avail of the PhilHealh Konsulta, members must be registered to a PhilHealth-accredited Konsulta facility of their choice," the statement said.
It stated that registration to the facility may be done online, through self-registration or through the nearest Local Health Insurance Office (LHIO) or any authorized third-party agencies or organizations with assisted-registration services.
"Once registered in a Konsulta facility, members may avail of services including initial and follow-up primary care consultations, health screening and assessment and selected diagnostic services and medicines," the statement said.
It said that access to these services is based on the health needs of the patients.
" To avail of such services, a member must generate an Authorization Transaction Code or ATC prior to his or her visit to the facility. The ATC is similar to a One Time Pin (OTP) that a member must present to the Konsulta facility for each visit or availment," the PhilHealth said.
It is generated through the Member Inquiry option in the PhilHealth website or through assistance from PhilHealth or the Konsulta providers, themselves.
PhilHealth Konsulta providers shall also perform health screening assessment as part of the preventive services of the program. They shall serve as the initial point of contact for members accessing health services and they shall ensure continuity of car through referral to higher or specialized facilities, depending on patients’ health needs. Further, they shall keep electronic records on results of consultations, laboratory and other drugs and medicines provided to the patients through an interim system called eKonsulta.
PhilHealth pays the Konsulta benefit as an annual capitation to facilities, to be released in two tranches. The maximum per capita rate amount for Konsulta are Php750.00 per beneficiary and Php 500 per beneficiary, for private and public facilities, respectively.
The state health insurance firm is calling on to members to start registering themselves in the Konsulta provider of their choice, in order to commence availment of the services under the Konsulta. Healthcare facilities, whether public or private are also encouraged to accredit themselves as Konsulta providers through self-assessment and submission and compliance to the documentary requirements in accreditation.
The agency also emphasizes the need for member and stakeholder participation in order to facilitate the effective roll out and implementation of the Konsulta. Presence of more accredited facilities are vital to give members access points to the program.