The reality is that illnesses can strike any time and hospitalization cost is always a concern particularly when paying out of pocket is your only option. Fortunately for Filipinos, PhilHealth is around to provide healthcare benefits to all members. As a member, you and your dependents are entitled to health and hospitalization subsidies.
The Philippine Health Insurance Corporation or Philhealth is a government-owned and controlled corporation (GOCC) founded on February 5, 1995. Its main goal is to ensure the health of every Filipino through social health insurance regardless of social status: poor, rich, young, old, sick, healthy, working or jobless. To achieve this, all premiums paid by members are pooled nationally and in effect, there is a cross-subsidization across districts.
How much do you need to contribute to PhilHealth?
According to Philhealth’s December 2019 contribution table, members of the formal economy (kasambahay, family drivers, sea-based OFWs) and employees of both public and private sectors will have the following monthly premium. The contribution will be shared by both the employer and employee for those formally employed, meanwhile direct contributory members (freelancers, professional practitioners, self-employed, and OFWs) will pay it in full.
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Updated December 2019
Premiums for self-paying members like the OFWs (land-based and sea-farers) and professional practitioners will now be based directly on their monthly salary. Their payment will be annual and in the full amount.
Here are the membership categories of Philhealth along with their premiums, enrollment date, and minimum payment requirements to avail of health benefits:
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How Do You Register With PhilHealth?
Registration is easy under any membership categories. You just need to go to any PhilHealth office near you and follow the following procedures:
1. Formal economy members
- Fill out two (2) copies of the PhilHealth Member Registration Form (PMRF)
- Submit PMRF to the HR Department of employer
- Await Member Data Record and PhilHealth ID card from employer
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- Report your PIN to your employer for them to indicate the same in their ER2 [/block]
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- Premium contributions are shared by the employee and the employer, the amount of which is determined using the table of contributions. After deducting half of the premium requirement from your monthly salary, total premiums are remitted by your employer to PhilHealth. [/block]
2. Indigent / sponsored members
Philhealth Members Sponsored by LGUs, National Government, congress and Indigents belonging to the lowest 25% of the Philippine population can become Sponsored Members by submitting the usual requirements to their sponsors or at any PhilHealth office.
3. Lifetime members
- Fill-out two (2) copies of the PhilHealth Member Registration Form (PMRF)
- Submit PMRF to the nearest PhilHealth Local Health Insurance Office (LHIO) together with the following documents:
- Two (2) 1x1 latest ID picture,
- Two valid IDs; and
- Any of the following documents:
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- Await Member Data Record (MDR) and PhilHealth ID Card
4. Senior members
There are two options to enroll as a Senior Citizen member of PhilHealth.
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- Premium Contributions
- The premium contributions of those who will be enrolled under the Senior Citizen category shall be sourced from the proceeds of Republic Act No. 10351, commonly known as the Sin Tax Law.
- Benefits
- In hospitals with installed HCI Portal, Senior Citizens only need to present their senior citizen card, MDR or any accepted proof of identity and age. The hospital shall print a PhilHealth Benefit Eligibility Form (PBEF). A PBEF that says “YES” means that the patient is entitled to the benefits and shall serve as a basis for automatic deduction.
- In case the hospital has no HCI portal installed, or the PBEF says “NO”, or the senior citizen was not able to enroll before discharge, the following should be attached to the usual claim documents:
- Duly accomplished PhilHealth Member Registration Form (PMRF); and
- Acceptable proof of status as a senior citizen, including but not limited to the Senior Citizens' Identification Card. [/block]
5. Informal economy members (individually paying members)
If you are currently unemployed or is self-employed, you can register as an Individually Paying Member. This is also being referred as “voluntary member” by some. To become one, you must submit the following requirements at the Philhealth office near you.
- Visit any of the Local Health Insurance Offices or PhilHealth Express outlets nationwide.
- Fill out (2) copies of the PhilHealth Member Registration Form (PMRF)
- Submit PMRF to the LHIO or PhilHealth Express
- Await Member Data Record (MDR) and PhilHealth ID Card
- Pay the necessary premium contribution using your PhilHealth ID number
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Individually Paying Members (IPMs) earning an average monthly income of ₱10,000 and up will pay a corresponding percentage of their salary as determined by the new contribution schedule rolled out by Philhealth. From 3% for the year 2020, the premium will continue to increase yearly up to 5% until 2025. The corresponding premium percentage is capped at a salary ceiling of ₱60,000 in 2020, increasing up to ₱100,000 by 2024 and onwards. [/block]
Schedule of payment
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6. OFWs
For OFWs (Overseas Filipino Workers), you can register and pay your contributions once you register at the POEA as an OFW:
- If currently in the Philippines, visit the nearest PhilHealth Regional Office, Local Health Insurance Office, PhilHealth Business Center or PhilHealth Express outlet in your locality.
- If currently overseas,
- Visit any branch of PhilHealth’s accredited collecting partners iRemit and Ventaja Corporation
- Access the Electronic Registration facility and follow the step-by-step procedure
- Download the PhilHealth Member Registration Form, fill it out and email to ofp@philhealth.gov.ph
What are the benefits provided by PhilHealth?
To maximize your PhilHealth membership, it is important for you to know the benefits that you are entitled to, as well as the requirements you need to procure to allow you and your beneficiaries to fully enjoy your entitlements.
First things to know are these basic items:
- You as a member and your qualified dependents are entitled to benefits for medical expenses for every sickness or operation.
- Both, you as a member and your legal dependents, can get equal benefits.
- Every year, there is an allocated 45 days hospitalization allowance for the member and 45 days to be divided to all qualified dependents. Hospitalization days in excess of 45 days will not be covered by PhilHealth.
Secondly, these benefits can be used by you as a member and your qualified dependents, provided that:
- You, as a member, have updated contributions (except Lifetime and Senior Citizen Members) or valid PhilHealth coverage (for Sponsored, Indigent, and OFWs).
- That the hospital or clinic that you went to is PhilHealth-accredited.
- And that the allocated 45 days in a year has not yet been consumed (except for other PhilHealth benefits such as hemodialysis)
How much can you claim on PhilHealth?
The benefits will be paid by PhilHealth in terms of Case Rates whereas every illness or operation has price allotment to be divided into the hospital and the doctor. This way, the member can already determine how much will be covered by PhilHealth before hospitalization.
Check the PhilHealth website to find out what the equivalent value of benefits for covered illnesses and operations under the All Case Rates (ACR) program of PhilHealth.
How can you claim your PhilHealth benefits?
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Step 1: Conditions
To be eligible for the PhilHealth benefits when hospitalized, the following conditions must be met:
- Payment of at least 3 months’ worth of premiums within the immediate 6 months of confinement. For pregnancies, the new born care package, dialysis, chemotherapy, radiotherapy and selected surgical procedures, 9 months’ worth of contributions in the last 12 months is needed.
- Confinement in an accredited hospital for 24 hours due to illness or disease requiring hospitalization. Attending physician(s) must also be PhilHealth accredited.
- Claim is within the 45 days allowance for room and board.
Step 2: Required documents
You’ll also need to submit the following documents before being discharged from the hospital for automatic deduction:
- A clear, updated copy of your Member Data Record (MDR). If you are dependent, make sure that you are listed in the MDR.
- An original copy of PhilHealth Claim Form 1, which you can get at PhilHealth, the hospital or your employer. Submit the original copy signed by your employer.
- Receipt of premium payments. Employees only need to submit the Certificate of Premium Payments with OR numbers.
- Your PhilHealth ID and a valid ID.
Ask the hospital regarding their PhilHealth submission rules. If you can’t submit the claim form personally, have an authorization letter and a valid ID ready for your representative.
Step 3: Claiming and post-claims
- As direct filing is no longer needed, submission of the documents to the hospital before the end of your stay means automatic deduction of your benefits from your total bill.
- Once your benefits have been automatically deducted, PhilHealth will send a benefit payment notice to the address declared in your MDR. This details the actual payments made by PhilHealth relative to your claim or confinement.
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Keeping your PhilHealth up-to-date is important, remember that updated premiums is key to enjoy your entitlements. It is also essential for you to keep your updated premium payment receipts safe and within easy reach for emergencies. You will definitely need them in asking the hospital billing section to deduct your benefits from your total charges.
In addition, as soon as you have anything to update in the membership profile, i.e. additional dependents or change in civil status, promptly inform the nearest PhilHealth office (by just filling out the PhilHealth Membership Registration Form or PMRF) to effect the needed changes.
How to get a Philhealth ID
In order to have the convenience of using Philhealth’s benefits whenever and wherever (in the Philippines) you may need it, getting a Philheath ID card is a must. Registration for a Philhealth membership may be enough to get you covered by their health insurance, but their facilities and benefits may not be easily accessible if you don’t have an ID.
Being a member and paying your monthly premium does not automatically grant you a Philhealth ID card. The process of acquiring it is separate from acquiring a membership for their health insurance.
Two types of Philhealth ID Card
There are two types of Philhealth ID cards that members can get. While each card can serve the same purpose (show proof of membership for the enrolled members), the extent of their usability is different.
Regular Philhealth ID
This is a paper ID that you can acquire from any Philhealth Local Health Insurance Office (LHIO). It is given to Philhealth members without any fees and can be used at any hospitals to subsidize their hospital expenses.
Despite being acknowledged as an official ID card of Philhealth, this ID card cannot be used as a valid ID for other government or banking transactions. Having this card will only provide access to Philhealth’s basic services and in filing insurance claims at any public and some private hospitals.
PhilHealth Insurance ID Card
The second ID is the PhilHealth Insurance ID Card. It’s a digitized ID issued to all registered members of Philhealth. Getting this card is optional and can cost some fees, but it has more use than the regular ID card. The downside to this is that it’s not yet available for distribution in all regions. You may want to check with your LHIO to see if it’s already available in your area.
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1. Apart from hospital discounts, members with a PhilHealth Insurance ID Card can get access to the following money saving deals exclusive to Philhealth members:
- 15% discount on generic drugs on Watson’s, Rose Pharmacy, South Star Drug, and The Generics Pharmacy
- 20% to 80% discount on flu vaccines on PQ Health Shield and GSK
- Free eye exam from Vivian Sarabia Optical
- 20% discount on regular items in Vivian Sarabia Optical
- 10% discount on drug testing services at JNW Drug Testing sites
2. This PhilHealth ID can be used as a valid government ID, making it acceptable for any official banking and government transactions.
3. Dependents can use this card to take advantage of the discounts when buying medicines in affiliated pharmacies. [/block]
Regular Philhealth ID vs Philhealth insurance card
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How do I get a Philhealth ID?
The process of getting a Philhealth ID is separate from membership application. Being enrolled in Philhealth only grants you a Philhealth number which you can provide to healthcare providers for insurance assessment. If you are not registered yet, check out our guide for Philhealth’s registration process.
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If you are a regular employee of a company, your human resource department is required to accomplish your PhilHealth membership for you. However, unemployed, self-employed, and probationary employees or individuals need to register as a “Voluntary Member” to receive a PhilHealth ID and avail of the organization’s benefits. [/block]
If you’re already a registered Philhealth member, here’s what you can do next:
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1. Download Philhealth’s registration form from their website (PMRF).
2. Submit PMRF to the nearest LHIO together with the following documents:
- Two (2) 1×1 latest ID picture,
- Two valid IDs; and
- Any of the following documents:
- For SSS pensioners
- Photocopy of Death, Disability and Retirement (DDR) indicating the date of retirement and effectivity date of pension
- Photocopy of the Retiree/Pensioner Certification indicating the effectivity date of retirement
- For GSIS pensioners
- Photocopy of Certification/Letter of Approval of Retirement indicating the effectivity date of retirement
- Photocopy of Service Record issued by the employer showing rendered services of not less than 120 months
- Photocopy of Certification/Retirement Gratuity from the employer indicating services of not less than 120 months
- Photocopy of retirement voucher issued by GSIS
- For Uniformed personnel of AFP, PNP, BJMP and BFP
- Photocopy of General/Special or Bureau Order indicating effectivity date of retirement
- Photocopy of Certification/Letter of Approval of Retirement from the GSIS indicating services of not less than 120 months
- Photocopy of Statement of Services issued by a previous employer showing service of not less than 120 months
- GSIS Disability Pensioner / SSS Permanent Total Disability Pensioner before March 4, 1995
- Photocopy of Death, Disability and Retirement (DDR) indicating the date of retirement and effectivity date of pension
- Photocopy of Disability Pensioner Certification issued by SSS/GSIS indicating effectivity date of pension or the period of coverage for disabled pensioner.
- SSS Survivorship Pensioner before March 4, 1995
- Photocopy of Death, Disability and Retirement indicating the type of survivorship in nature and the effectivity date of pension
- Photocopy of Survivorship Pensioner Certification indicating the effectivity date of pension
- Other individuals who are not under the abovementioned categories
- Photocopy of official receipts of premium payments to PhilHealth
- Any other documents indicating the months of premium payments to PhilHealth
- For SSS pensioners
3. Await Member Data Record (MDR) and PhilHealth ID Card [/block]
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After you’ve accomplished the process above, you just need to do a few things to get the Philhealth insurance card.
1.) Download Philhealth’s registration form from their website (PMRF).
2.) Submit PMRF to the nearest LHIO or any of their SM Mall branches together with the following documents:
- Two (2) 1×1 latest ID picture,
- Two valid IDs; and Photocopy of official receipts of premium payments to PhilHealth or any other documents indicating the months of premium payments to PhilHealth.
- Twp (2) valid IDs of your dependent (if you wish to include them).
3.) Declare your dependents to apply for maximum benefits. (if applicable)
4.) Pay ₱90 for the ID; ₱358 additional payment if you wish to include your dependents. [/block]
While having a Philhealth ID card isn’t required to gain access to Philhealth’s services, owning one will make it easier for healthcare establishments to accomplish your insurance claims request. Meanwhile, spending a little more for the digital Philhealth insurance card and exerting a little more effort to comply with the application process will allow you to have full access to Philhealth’s perks and other benefits that regular cardholders don’t have access to. The perks may come in handy for people who have maintenance medication as it will cut down the cost of their medicine if they buy it from any of Philhealth’s accredited pharmacies.
Just by owning any of the two Philhealth ID cards, you can easily take comfort in the fact that your security is literally at the palm of your hands whenever a medical emergency may arise. So, if you don’t have one yet, you might as well get one!
There you have it, here are all the essential things you need to know regarding PhilHealth. However, if you are considering to get additional coverage, you can visit our selection of health insurance providers in the Philippines as we assist you in choosing which provider offers the best match based on your requirements. You can also read our article about which jobs need health insurance the most.
This article was originally published in January 2018 and is updated to keep information relevant and up to date.
The post PhilHealth: Universal Health Coverage For All Filipinos [Updated] appeared first on iMoney.ph.