What is PhilHealth
What is PhilHealth
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Also called as the National Health Insurance Program, PhilHealth was created in 1995 to make sure that Filipinos have an end-to-end access to quality health insurance coverage that is not only affordable but also efficient.
This serves as the primary means of helping Filipino citizens to pay for the cure and care of their illnesses, particularly those who do not have immediate access to quality healthcare.
Its universal health insurance program includes a sustainable system of funds constitution, collection, management, and disbursement for funding the purchase of basic minimum package.
It also includes supplementary packages of health insurance benefits by the growing population.
Philhealth Forms
Philhealth Forms
Philhealth Member Registration - Update form.pdfPhilhealth Member Registration / Update From
ClaimSignatureForm_2018.pdfClaim Signature Form
Why Do You Need PhilHealth?
Why Do You Need PhilHealth?
The benefits of enrolling in PhilHealth encompasses inpatients and outpatients, senior citizens, dual citizens and foreigners, premature and small newborns, and pregnant women.
But it’s more than that—being a PhilHealth contributor allows you to enjoy special benefits paid to the accredited Health Care Institution through all case rates.
These rates are inclusive of hospital charges and professional fees for the attending physician, as well as day procedures, radiotherapy, hemodialysis, and outpatient blood transfusion.
Among the primary care benefits that PhilHealth covers include consultations, diagnostic examinations, and medicines for the cure of certain infections like Urinary Tract Infection (UTI).
How To Maximize Your PhilHealth Benefits?
How To Maximize Your PhilHealth Benefits?
To maximize your PhilHealth contributions, you need to be more aware of its coverage and its limitations.
Taking for example, an expectant mother. Moms who are excited about giving birth to their little bundle of joy should start thinking about the costs that come with childbirth.
Women giving birth need to shell out anywhere between P5,000 and P100,000, depending on where they want to deliver the baby. Caesarian delivery adds more to the total costs, which means that a lot of preparation in terms of budget is needed.
This does not include prenatal needs such as supplements, vaccinations, regular ob-gyne check-ups, and ultrasound scans.
PhilHealth members with a monthly regular contribution can enjoy maternity benefits encompassing all that’s stated above. However, there are certain limitations to the coverage:
Pregnancy below age 19
First pregnancy at age 35 and older
Multiple births such as twins and triplets
Abnormalities of the ovaries, uterus, or placenta
History of three miscarriages or abortions
History of one stillbirth
History of serious medical conditions such as diabetes, heart disease, hypertension, moderate to severe asthma, etc.
Types Of PhilHealth Members?
Types Of PhilHealth Members?
Employed/ members of the formal economy
All employees with offices in the Philippines. This includes seafarers and household helpers, since their agencies are based in the country.
Premium range: Php 200-875/month
Individually paying or self-employed, voluntary, or members of the informal economy
All unemployed or self-employed employees. This includes professionals or business owners, as well as retirees and farmers.
Premium range: Php 600/ quarter and Php 900/quarter for those earning more than Php 25,000 a month
Overseas workers (OFWs)
All OFWs who passed through POEA and pay their OEC fees
Premium: Php 2,400/year
Sponsored
All members working for a non-profit organization
Premium: Sponsor pays Php 2,400/year
Indigent
All members with no source of income, or those without a stable household income
Membership is pre-determined by the DSWD
Lifetime
Members who were able to pay at least 120 monthly premiums. Membership becomes free as soon as they reach 60 years old.
Senior Citizens
Filipino citizens who are already 60 or above but have never been a PhilHealth member. This also includes senior citizens who were not able to pay 120 premiums for the duration of their membership.
How To Become A PhilHealth Member?
How To Become A PhilHealth Member?
For Newly Hired without PhilHealth number yet
Fill out two (2) copies of the PhilHealth Member Registration Form (PMRF).
Submit PMRF to the People Operations
Await Member Data Record and PhilHealth ID card from the People Operations Team
For Newly Hired Employees with Philhealth number
Fill out two (2) copies of the PhilHealth Member Registration Form (PMRF).
Submit PMRF to the People Operations with your Philhealth Identification Number (PIN).
Await Member Data Record from the People Operations Team
Who are qualified as PhilHealth dependents?
Who are qualified as PhilHealth dependents?
The following also enjoy PhilHealth coverage without additional premiums:
A legitimate spouse who is not a member;
Child or children - legitimate, legitimated, acknowledged and illegitimate (as appearing in birth certificate) adopted or stepchild or stepchildren below 21 years of age, unmarried and unemployed.
Children who are twenty-one (21) years old or above but suffering from congenital disability, either physical or mental, or any disability acquired that renders them totally dependent on the member for support, as determined by the Corporation;
Foster child as defined in Republic Act 10165 otherwise known as the Foster Care Act of 2012;
Parents with a permanent disability regardless of age as determined by PhilHealth, that renders them totally dependent on the member for subsistence.
Qualified dependents shall be entitled to a separate coverage of up to 45 days per the calendar year. However, the 45 days allowance shall be shared among them.
PhilHealth Contribution Table
PhilHealth Contribution Table
Per PhilHealth Circular No. 2017-0024, the new rate for computing the contribution amount is 2.75%.
How to Monitor your Philhealth Contributions?
How to Monitor your Philhealth Contributions?
There are two ways to check your PhilHealth contributions:
1. Via website
Visit the PhilHealth website
Log in to the Member Inquiry facility by entering your PIN and password (check activation sent to your email)
Answer the security question briefly
The Member Static Information page will appear. Click on Premium Contributions below the table that shows your personal details.
2. Via phone call
PhilHealth has an Interactive Voice Response System, a 24/7 landline-based service that accommodates all member inquiries regarding contribution status, membership, benefits and other related concerns. Just dial (02) 441-7442 and follow the instructions from the voice prompt.
How do I claim PhilHealth benefits?
How do I claim PhilHealth benefits?
Before you can begin claiming your PhilHealth benefits, you have to meet the following conditions.
Per the Sufficient Regularity of Payment (SRP) rule mentioned in PhilHealth Circular No. 2017-0021:
You should have been able to make 6 months worth of contributions preceding the 3 months qualifying contributions within the 12-month period prior to the first day of confinement.
This means that to be eligible to claim PhilHealth benefits, you should have paid at least 9 months worth of premiums within the 12 months preceding the confinement (including the period of confinement).
Claims should be made within 45 days of obtaining room and board.
Here are the steps for claiming your PhilHealth benefits:
Here are the steps for claiming your PhilHealth benefits:
Prepare and complete all the necessary documents for filing a claim. You can get copies from the hospital or download the appropriate forms from the Philhealth website.
Member Data Record Form (MDR) - To be provided by the People Operations Team
PhilHealth claim form 1 (original copy)
Certificate of payments (with OR numbers) - To be provided by the People Operations Team
PhilHealth ID and another valid ID
How to Amend / Update your information in Philhealth?
How to Amend / Update your information in Philhealth?
Tick FOR UPDATING on the upper right-hand corner of the PMRF
Submit properly filled out PMRF to People Operations to coordinate with Philhealth
Fully accomplished PMRF with employer report (ER2)l form will be submitted by the People Operations team to Philhealth together with ER2.People Operations will email you as soon as the updated Member Data Record from PhilHealth is available
BENEFITS
BENEFITS
PhilHealth Maternity Benefits You Should Know About
PhilHealth Maternity Benefits You Should Know About
If you’re expecting a baby, you get PhilHealth maternity benefits that can partially pay for your delivery and prenatal care.
PhilHealth has a Maternity Care Package that covers births in birthing homes, midwife clinics, and lying-in clinics. If you are going to give birth in an accredited hospital, you may avail of PhilHealth’s Normal Spontaneous Delivery Package or its Caesarean Section benefit.
The cost benefit depends on the type of delivery and the type of healthcare facility where the delivery takes place, but it typically covers medical facility fees, professional fees, and prenatal care.
Even your baby is entitled to the Newborn Care Package, which includes a physical examination, eye prophylaxis, Vitamin K administration, BCG vaccination, the first dose of Hepatitis B vaccine, and newborn screening tests. Breastfeeding advice is also given to mothers.
Maternal Care Package
Maternal Care Package
PhilHealth’s Maternity Care Package (MCP) covers prenatal care, delivery, and postnatal care for both you and your baby.
Members and eligible dependents are qualified to avail of this package. You can only use it up to your fourth delivery, provided you don’t have any history of three or more miscarriages.
PhilHealth provides P6,500 facility fee for deliveries within a hospital. The coverage increases to P8,000 for if you give birth in infirmaries, dispensaries, birthing homes, and maternity clinics.
The MCP is further divided into subtypes, which are as follows:
Antenatal Care Package
As part of the MCP, the Antenatal Care Package (ANC01) covers essential health services during pregnancy and before delivery.
To qualify, you should have at least four prenatal checkups, with the last one done during the third trimester of pregnancy. The facility and healthcare provider should also be PhilHealth-accredited.
PhilHealth provides P1,500 for prenatal care.
Normal Spontaneous Delivery Package
If you give birth to your baby via normal delivery, you can avail of the Normal Spontaneous Delivery Package (NSD01). It also covers the immediate post-partum period within the first 72 hours, as well as seven days after delivery.
PhilHealth covers P5,000 for birth in hospitals and P6,500 for deliveries in birthing homes or maternity clinics.
Other Methods of Delivery
But if you give birth through other methods, your PhilHealth coverage depends on your total bill.
PhilHealth typically covers P19,000 for Cesarean deliveries, P9,700 for complicated vaginal deliveries, P12,120 for breech extraction, and P12,120 for vaginal delivery after previous Cesarean section.
Newborn Care Package
Newborn Care Package
PhilHealth’s benefits extend to your baby, too.
The Newborn Care Package includes newborn care, screening and hearing tests, hepatitis B and BCG vaccination, eye prophylaxis, weighing, and essential intrapartum and newborn care protocol. It’s worth P1,750, all covered by PhilHealth.
Unlike the MCP, this package has no limit to the number of births. However, it should be filed within 60 days after the delivery.
Z BENEFITS
Z BENEFITS
The Z Benefits Package includes illnesses classified as case type Z – diseases perceived to be economically and medically catastrophic. It seeks to help out members who are going to have long and expensive treatments because of their illnesses.
Illnesses and operations eligible for Z Benefits include:
Acute lymphocytic or lymphoblastic leukemia (standard risk)
Breast cancer (early stage)
Prostate cancer (low to intermediate risk)
Kidney transplant (low risk)
Coronary artery bypass graft surgery (standard risk)
Tetralogy of Fallot surgery for children
Ventricular septal defect surgery for children
Cervical cancer (early stage)
Selected orthopedic implants
Colon and rectum cancer
Prevention of preterm delivery
Sponsored members can get as much as 100% coverage for case type Z diseases, as long as they meet the eligibility and risk requirements posted by PhilHealth.
MDG BENEFITS
MDG BENEFITS
You are also eligible for PhilHealth benefits if you are suffering from any illness that is part of PhilHealth’s Millennium Development Goals (MDG).
These diseases include malaria, HIV-AIDS, tuberculosis, and animal bites. You may also get voluntary surgical contraception procedures (vasectomy for men and transection of fallopian tube for women) through PhilHealth’s MDG benefits.
Other PhilHealth Frequently Asked Questions [FAQs]:
Other PhilHealth Frequently Asked Questions [FAQs]:
If the employee will leave formal employment to venture into self-employment, how are they going to continue PHIC membership?
If the employee will leave formal employment to venture into self-employment, how are they going to continue PHIC membership?
Employee will need to register under the Informal Economy and pay the premium at any PhilHealth Office or accredited payment center. Payment can be made quarterly, semi-annually or annually
What if the employee has multiple jobs? Can the employee deducted with PhilHealth contribution only once?
What if the employee has multiple jobs? Can the employee deducted with PhilHealth contribution only once?
Section 18-20 of the Implementing Rules and Regulations of RA 7875, as amended, mandates employers to enroll their employees, deduct from their salaries the required premium contribution, and remit the same, together with the corresponding employer share, to PhilHealth. As each employer has to adhere to this law, those who are engaged in multiple employment should consequently be deducted of their corresponding employee share by each and every employer with which they are currently employed.
If the employee is on leave without pay, how they will continue paying their PHIC contribution.
If the employee is on leave without pay, how they will continue paying their PHIC contribution.
Employee may continue paying their premiums for months if they are on leave without pay as an Individually Paying Member (IPM). To pay premiums as an IPM, visit any PhilHealth office and present a copy of the RF-1 from the employer indicating that the EE is on leave without pay or a Certification from the employer indicating the same.
Can parents be dependents for PhilHealth?
Can parents be dependents for PhilHealth?
Yes, but only if the parent(s) is deemed as permanently disabled and completely dependent on the PhilHealth member.
The National Health Insurance Act of 2013 states that “Parents with a permanent disability, regardless of age as determined by the Corporation that renders them totally dependent on the member for subsistence.” can be legally declared as a dependent.”
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