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.
asthma
b.
mild pneumonia
c.
diabetes
d.
tuberculosis
e.
urinary tract infection
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The correct answer is:
tuberculosis
Question 2
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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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Only A and B are correct.
Question 3
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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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All of the above are correct.
Question 4
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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 5
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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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P10,000.00
Question 6
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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 90 days.
b.
All illness shall be availed of within 90 days.
c.
Only one illness may be availed of for every confinement.
d.
No same illness shall be availed of within 45 days.
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The correct answer is: No same illness shall be availed of within 90 days.
Question 7
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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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All of the above are correct.
Question 8
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The following are considered Accredited Health Care Institutions in providing inpatient benefits, EXCEPT:
a.
Barangay Health Center
b.
Hospitals
c.
Infirmaries
d.
Dispensaries
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The correct answer is:
Barangay Health Center
Question 9
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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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All of the above are correct.
Question 10
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The following are the steps in availing PhilHealth’s Primary Care Benefits, EXCEPT:
a.
The beneficiary accomplishes the needed forms (eKAS and/or ePresS) and submits to PhilHealth Local Health Insurance
Office or PhilHealth Regional Office.
b.
The facility physician conducts primary care consultation, health screening and assessment, and dispenses medicine, if
necessary.
c.
The beneficiary secures a unique system-generated Authorization Transaction Code or ATC.
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.
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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 12
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Based on the guidelines for the PhilHealth Konsultasyong Sulit at Tama (KONSULTA package), what does ePresS stand
for?
a.
Electronic Prescription Slip
b.
Electronic Patient Slip
c.
Electronic Primary Slip
d.
Electronic Payment Sheet
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The correct answer is:
Electronic Prescription Slip
Question 13
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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.
Outpatient Malaria Package
c.
Hemodialysis
d.
Voluntary Surgical Contraception Procedures
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Hemodialysis
Question 14
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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 15
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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.
PhilHealth Local Health Insurance Office
b.
Barangay health workers
c.
Social Worker of the PhilHealth accredited primary care provider
d.
Employer
e.
Local Government Unit or Office for Senior Citizens Affairs
f.
PhilHealth employees assigned in PhilHealth accredited facility called P-CARES
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Barangay health workers
Question 16
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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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Only B and C are correct.
Question 17
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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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5 days
Question 18
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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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None of the above
Question 19
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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 20
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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 21
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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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All of the above are not covered.
Question 22
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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 23
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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 24
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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 25
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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 26
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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 27
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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 28
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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 29
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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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Though registration to a primary care provider of choice, and availing of consultations, health risk screening, laboratory
tests, and drugs and medicines
Question 30
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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.
Pap smear
b.
CBC with platelet count
c.
Fasting blood sugar
d.
Lipid profile
e.
HbA 1c test
f.
RT PCR test
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The correct answer is:
RT PCR test
