UHC MODULE 6
Question 1
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The following are covered under PhilHealth’s inpatient benefit package:
a.
Medical cases
b.
Check-up
c.
Surgical (or procedural) cases
d.
All of the above are correct.
e.
Only A and C are correct.
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The correct answer is:
Only A and C are correct.
Question 2
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While all admissible confinements are eligible for inpatient benefit package, the rule on
Single Period of Confinement (SPC) must be followed. What does the SPC rule mean?
a.
No same illness shall be availed of within 45 days.
b.
Only one illness may be availed of for every confinement.
c.
All illness shall be availed of within 90 days.
d.
No same illness shall be availed of within 90 days.
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Your answer is correct.
The correct answer is: No same illness shall be availed of within 90 days.
Question 3
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The following refers to ‘individual-based health services’ as defined under the Universal
Health Care Act and its implementing rules and regulations:
a.
The health service can be accessed within a health facility or remotely through digital
health services.
b.
The health service can definitively be traced back to one recipient.
c.
The health service has limited effect at a population level.
d.
The health service does not directly alter the underlying cause of illness.
e.
All of the above are correct.
f.
Only A, B and C are correct.
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The correct answer is:
All of the above are correct.
Question 4
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Based on the guidelines for the PhilHealth Konsultasyong Sulit at Tama (KONSULTA
package), what does ePresS stand for?
a.
Electronic Payment Sheet
b.
Electronic Patient Slip
c.
Electronic Prescription Slip
d.
Electronic Primary Slip
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The correct answer is:
Electronic Prescription Slip
Question 5
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True of the Z benefit package:
a.
covers primary disease conditions that are perceived as economically and medically
"catastrophic”
b.
covers only inpatient and not outpatient services.
c.
may be availed of at all contracted PhilHealth accredited level 3 government hospitals
only and some private hospitals
d.
All of the above are correct.
e.
Only A and B are correct.
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The correct answer is:
covers primary disease conditions that are perceived as economically and medically
"catastrophic”
Question 6
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The following are services covered under the PhilHealth inpatient benefits:
a.
Facility fee
b.
Consultation fee
c.
Professional fee
d.
All of the above are correct.
e.
Only A and B are correct.
f.
Only A and C are correct.
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The correct answer is:
Only A and C are correct.
Question 7
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Factors to be considered in the reimbursement of Z claims:
a.
All vouchers shall be paid to the hospital
b.
No direct filing of the members
c.
The amount is fixed per illness and per tranche payments
d.
All of the above are correct.
e.
Only A and B are correct.
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The correct answer is:
All of the above are correct.
Question 8
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The following is TRUE about PhilHealth’s individual-based health services:
a.
Only PhilHealth primary members may avail of inpatient benefits.
b.
Outpatient benefits are for qualified dependents only.
c.
PhilHealth primary members have 45 days annual benefit allowance.
d.
Each qualified dependents have 45 days annual benefit allowance.
e.
Only C and D are correct.
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The correct answer is:
PhilHealth primary members have 45 days annual benefit allowance.
Question 9
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Claims are denied in the following instances in the evaluation of Z claims:
a.
If any mandatory service was not given
b.
If required signatures are missing in the forms
c.
Late filing
d.
All of the above are correct
e.
Only A and C are correct
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The correct answer is:
All of the above are correct
Question 10
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The primary care benefit package (KONSULTA package) for qualified beneficiaries
includes the following laboratory tests deemed necessary per physician’s
recommendation, EXCEPT:
a.
CBC with platelet count
b.
HbA 1c test
c.
RT PCR test
d.
Pap smear
e.
Fasting blood sugar
f.
Lipid profile
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The correct answer is:
RT PCR test
Question 11
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Under the implementation guidelines of PhilHealth, “Z” in Z-benefits stands for:
a.
Zero
b.
Zika
c.
Zenith
d.
None of the above
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The correct answer is:
None of the above
Question 12
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The following are the third-party agencies or organizations that can assist in registering
to a PhilHealth accredited primary care facility, EXCEPT:
a.
Social Worker of the PhilHealth accredited primary care provider
b.
PhilHealth Local Health Insurance Office
c.
Barangay health workers
d.
Local Government Unit or Office for Senior Citizens Affairs
e.
PhilHealth employees assigned in PhilHealth accredited facility called P-CARES
f.
Employer
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The correct answer is:
Barangay health workers
Question 13
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The medical detoxification package ensures provision of minimum standards of medical
interventions to safely manage acute physical symptoms of withdrawal associated with
stopping drug use. The following statements are correct about this benefit package:
a.
The current medical detoxification package rate is P12,000.
b.
The medical detoxification service is on a one-time availment basis.
c.
Management of co-morbidities is an addition to the package.
d.
Only A and B are correct.
e.
Only B and C are correct.
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The correct answer is:
Only B and C are correct.
Question 14
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Under the UHC Act, every PhilHealth member and dependent are granted immediate
eligibility for health benefit package. However, the following conditions must be met:
a.
The health services are provided by PhilHealth-accredited health care institution.
b.
The doctor providing the health services is PhilHealth-accredited.
c.
Documents needed include the Member Data Record or PhilHealth Benefit Eligibility
Form (PBEF) and duly accomplished PhilHealth Claim Form 1.
d.
All of the above are correct.
e.
Only A and B are correct.
f.
Only A and C are correct.
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The correct answer is:
All of the above are correct.
Question 15
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Based on the guidelines for the PhilHealth Konsultasyong Sulit at Tama (KONSULTA
package), how does Primary Care Benefit work?
a.
Though registration to a primary care provider of choice, and availing of consultations,
health risk screening, laboratory tests, and drugs and medicines
b.
Though visits at the health facility of choice for consultations and assessment at least
once a year as advised by the attending primary care physician
c.
Through consultations and health risk screening and assessment of existing health and
medical conditions at a primary care facility
d.
Though regular updates of membership data record to facilitate primary care benefit
eligibility and access to health services at a primary care facility
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The correct answer is:
Though registration to a primary care provider of choice, and availing of consultations,
health risk screening, laboratory tests, and drugs and medicines
Question 16
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In availing of the Z benefits, how many days shall be deducted from the 45-day annual
benefit limit of the member?
a.
Depends on the number of confinement days
b.
3 days
c.
5 days
d.
None of the above
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The correct answer is:
5 days
Question 17
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The following are considered in monitoring and evaluation of Z claims:
a.
All contracted hospitals shall be subject to monitoring rules as stipulated in the
Performance Commitment.
b.
All contracted hospitals shall be subject to monitoring rules as stipulated in the Z-
Benefit Contracts.
c.
Any violation noted and validated from monitoring activities shall be a ground for
sanctions and penalties as provided in the Performance Commitment and Z-Benefit
Contract.
d.
All of the above are correct.
e.
Only A and B are correct.
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The correct answer is:
All of the above are correct.
Question 18
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The following statement is TRUE regarding PhilHealth’s outpatient chemotherapy
package:
a.
One cycle is equivalent to two-day deduction from the 45-day annual benefit limit.
b.
One session is equivalent to a one-day deduction from the 45-day annual benefit limit.
c.
One cycle is equivalent to one session.
d.
Only A and B are correct.
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The correct answer is:
One cycle is equivalent to two-day deduction from the 45-day annual benefit limit.
Question 19
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The following are the steps in availing PhilHealth’s Primary Care Benefits, EXCEPT:
a.
The beneficiary secures a unique system-generated Authorization Transaction Code or
ATC.
b.
The facility physician conducts primary care consultation, health screening and
assessment, and dispenses medicine, if necessary.
c.
The beneficiary accomplishes the needed forms (eKAS and/or ePresS) and submits to
PhilHealth Local Health Insurance Office or PhilHealth Regional Office.
d.
The beneficiary gives the ATC to the PhilHealth accredited primary care facility.
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The beneficiary accomplishes the needed forms (eKAS and/or ePresS) and submits to
PhilHealth Local Health Insurance Office or PhilHealth Regional Office.
Question 20
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The following outpatient benefits are in response to the country’s efforts to meet the
sustainable development goals, EXCEPT:
a.
Outpatient HIV/AIDS Treatment
b.
Voluntary Surgical Contraception Procedures
c.
Hemodialysis
d.
Outpatient Malaria Package
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The correct answer is:
Hemodialysis
Question 21
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The following is TRUE in the computation of PhilHealth benefits:
a.
For Medical Case, 70% of the case rate goes to facility fees while 30% goes to
professional fees.
b.
For Surgical Case, 60% of the case rate goes to facility fees while 40% goes to
professional fees.
c.
For both medical and surgical cases, 50% of the case rate goes to facility fees and the
remaining 50% goes to professional fees.
d.
Only A and B are correct.
e.
None of the above
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The correct answer is:
Only A and B are correct.
Question 22
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The case rate for dengue fever based on the current medical case rate of PhilHealth:
a.
P5,000.00
b.
P11,000.00
c.
P15,000.00
d.
P10,000.00
e.
P20,000.00
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The correct answer is:
P10,000.00
Question 23
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The reason why the case rate amounts for Maternity Care Package (MCP) and Normal
Spontaneous Delivery Package (NSD) are higher when availed in a non-hospital setting
(such as lying-in facilities and birthing homes) than when availed in a hospital setting:
a.
Lying-in facilities and birthing homes are equipped and capable of delivering MCP and
NSD services.
b.
This will leave hospitals to take care of the more serious illnesses and conditions.
c.
Hospitals charge higher costs for these services.
d.
Only A and B are correct.
e.
Only A and C are correct.
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The correct answer is:
Only A and B are correct.
Question 24
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Aside from consultations and laboratory tests, qualified beneficiaries of primary care
benefit package (KONSULTA package) may also avail of drugs and medicines for
common conditions such as the following, EXCEPT:
a.
tuberculosis
b.
diabetes
c.
asthma
d.
mild pneumonia
e.
urinary tract infection
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The correct answer is:
tuberculosis
Question 25
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The following statements are TRUE regarding the 45-day benefit limit on outpatient and
other special benefits:
a.
Each PhilHealth member is entitled to a 45-day benefit limit in a calendar year.
b.
All qualified dependents shall also have a 45-day benefit limit to be shared among
them.
c.
Each outpatient session shall have a corresponding number of days to be deducted
from the 45-day benefit allowance.
d.
All of the above are correct.
e.
Only A and B are correct.
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The correct answer is:
All of the above are correct.
Question 26
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The following are TRUE regarding PhilHealth’s registration process in an accredited
primary care facility:
a.
Registration to a PhilHealth accredited primary care facility can be done online.
b.
PhilHealth Identification Number or PIN is needed for registration.
c.
Registration to a PhilHealth accredited primary care facility can be done through a third
party agency or institution.
d.
All of the above are correct.
e.
Only A and C are correct.
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The correct answer is:
All of the above are correct.
Question 27
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Protection provided by individual-based health benefit packages against conditions that
are considered economically catastrophic especially for the poor and marginalized
sectors of society:
a.
Managerial risk protection
b.
Financial risk protection
c.
Health risk protection
d.
All of the above are correct.
e.
Only B and C are correct.
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The correct answer is:
Financial risk protection
Question 28
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Based on the guidelines on outpatient and other special benefits, the following are not
covered by PhilHealth as outpatient benefits:
a.
non-prescription drugs and devices
b.
cosmetic surgeries
c.
optometric services
d.
All of the above are not covered.
e.
Only A and B are not covered.
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The correct answer is:
All of the above are not covered.
Question 29
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According to the guidelines on PhilHealth’s outpatient and other special benefits, the
following individual-based health services may be availed of as outpatient services:
a.
cataract surgery
b.
hemodialysis
c.
appendectomy
d.
All of the above are correct.
e.
Only A and B are correct.
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The correct answer is:
Only A and B are correct.
Question 30
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The following are considered Accredited Health Care Institutions in providing inpatient
benefits, EXCEPT:
a.
Infirmaries
b.
Dispensaries
c.
Hospitals
d.
Barangay Health Center
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The correct answer is:
Barangay Health Center
