PhilHealth: Universal Health Coverage For All Filipinos

April 17, 2017

Health Insurance

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Written by imoney

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.

Here are the membership categories of Philhealth along with their premiums, enrollment date, and minimum payment requirements to avail of
health benefits:

Group Premiums Enrollment Payment

Employer and worker each pay

Formal Economy Members: Employees, business owners, household workers, and family drivers. half, up to 2.5% (maximum of As of hire date 3 months
3%) of income up to ₱10,500

Indigent (NHTS): Poor families selected by the DSWD using the National Household Targeting System
₱2,400 annually National Government None
for Poverty Reduction (NHTS-PR or Listahanan).

Sponsored Members: Members whose contributions are paid by a sponsor like the local government,
government agency or private individual or agency. It includes low earning individuals that are not Local Government fully
considered as indigents like barangay health workers, nutrition scholars, etc. Orphans, abandoned kids, ₱2,400 annually subsidizes enrollment None
out-of-school-youth, street children, Person with Disabilities (PWDs), abused and pregnant women under annually.
the custody of the DSWD is also registered here.
 Group Premiums Enrollment Payment

Lifetime Members: Members age 60 and above and retired employees that contributed not less than
Free lifetime coverage Retirees and Pensioners None
120 months in Philhealth contributions.

Senior Citizen: Under the Expanded Senior Citizen Act (RA 10645), all Filipinos age 60 and above is Non Paying (RA 10645), Free
Age 60 years and up None
already covered by Philhealth. Lifetime coverage

₱2,400 annually for members

Informal Economy Members (or voluntary/individually paying): Includes Overseas Filipino Workers earning ₱25,000 and below
Enrollment date None
(OFWs), self-earning individuals, naturalized Filipinos and foreigners living in the Philippines. ₱3,600 annually for members
earning more than ₱25,000

No subsidy. Payment is on
OFW (Landbased) ₱2,400 annually Emigration date emigration date then
annually.

Employer and worker each pay

OFW (Seabased) half, up to 2.5% (maximum of As of hire date 3 months
3%) of income up to ₱10,500

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:

Enrollment of 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

For Newly Hired Employees With PIN

 Report your PIN to your employer for them to indicate the same in their ER2

Premium Requirements

 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.

Enrollment of 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.
 How do Lifetime Members enroll to PhilHealth?

 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) 1×1 latest ID picture,

 Two valid IDs; and

 Any of the following documents:

Photocopy of Death, Disability and Retirement (DDR) indicating the date of retirement and effective date of
pension
For SSS pensioners

Photocopy of the Retiree/Pensioner Certification indicating the effective date of retirement

Photocopy of Certification/Letter of Approval of Retirement indicating the effective date of retirement

Photocopy of Service Record issued by the employer showing rendered services of not less than 120
months
For GSIS pensioners

Photocopy of Certification/Retirement Gratuity from the employer indicating services of not less than 120
months

Photocopy of retirement voucher issued by GSIS

Photocopy of General/Special or Bureau Order indicating effective date of retirement

For Uniformed personnel of AFP, PNP, BJMP and BFP 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 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 effective date of
 pension

Photocopy of Disability Pensioner Certification issued by SSS/GSIS indicating effective date of pension or
the period of coverage for disabled pensioner.

Photocopy of Death, Disability and Retirement indicating the type of survivorship in nature and the effective
SSS Survivorship Pensioner before March 4, 1995 date of pension

Photocopy of Survivorship Pensioner Certification indicating the effective date of pension

Photocopy of official receipts of premium payments to PhilHealth

Other individuals who are not under the abovementioned categories

Any other documents indicating the months of premium payments to PhilHealth

 Await Member Data Record (MDR) and PhilHealth ID Card

How do Senior Members enroll to PhilHealth?

 There are two options to enroll as a Senior Citizen member of PhilHealth.

Via Office for the Senior Citizens Affairs (OSCA) Via PhilHealth Local Health Insurance Office (LHIO)

Fill out two (2) copies of the PhilHealth Member Registration Form (PMRF);

 Fill out two (2) copies of the PhilHealth Member Registration

Form (PMRF); Attach 1 x 1 photo taken within the last six months;

 Submit duly accomplished PMRF to the OSCA in the city or Present Senior Citizens’ Identification Card issued by the OSCA in the city or municipality where the
municipality where the elderly resides elderly resides or a valid government issued ID.

 Await Member Data Record and Identification card issued by

Submit duly accomplished PMRF

PhilHealth through OSCA

Await Member Data Record and PhilHealth Identification Card

 Premium Contributions
o 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

o 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.

o 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

 An acceptable proof of status as a senior citizen, including but not limited to the Senior Citizens’ Identification Card.

How do Informal Economy Members (Individually Paying Member) enroll to PhilHealth?

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

Premium Requirements

 Individually Paying Members (IPMs) earning an average monthly income of ₱25,000 and below pay ₱200 monthly or ₱2,400 per year, while those
earning above ₱25,000 pay ₱300 monthly or ₱3,600 per year. Premium contributions may be paid monthly, quarterly, semi-annually or annually.

Schedule of payment :
 Monthly Quarterly Semi-annual Annual

Pay until the last working day of the
month being paid for.
Example:Month: JanuaryDeadline:
January 31
Pay until the last working day of the quarter Pay until the last working day of the first quarter of
Pay until the last working day of the first quarter of the
being paid for. the year being paid for.
semester being paid for.
Example:Period: January to Example:Period: January to DecemberDeadline:
Example:Period: January to JuneDeadline: March 31
MarchDeadline: March 31 March 31

How do OFWs enroll to PhilHealth?

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,

o Visit any branch of PhilHealth’s accredited collecting partners iRemit and Ventaja Corporation

o Access the Electronic Registration facility and follow the step-by-step procedure

o Download the PhilHealth Member Registration Form, fill it out and email to ofp@philhealth.gov.ph

How much do you need to contribute to PhilHealth?

Accordingly, your contribution will be based on your income, please see the table below for the latest rates:

Premium Contribution Table

Salary Bracket Salary Range Salary Base Total Monthly Premium Employee Share Employer Share
1 8,999.99 and below 8,000.00 200.00 100.00 100.00

2 9,000.00 – 9,999.99 9,000.00 225.00 112.50 112.50

3 10,000.00 – 10,999.99 10,000.00 250.00 125.00 125.00

4 11,000.00 – 11,999.99 11,000.00 275.00 137.50 137.50

5 12,000.00 – 12,999.99 12,000.00 300.00 150.00 150.00

6 13,000.00 – 13,999.99 13,000.00 325.00 162.50 162.50

7 14,000.00 – 14,999.99 14,000.00 350.00 175.00 175.00

8 15,000.00 – 15,999.99 15,000.00 375.00 187.50 187.50

9 16,000.00 – 16,999.99 16,000.00 400.00 200.00 200.00

10 17,000.00 – 17,999.99 17,000.00 425.00 212.50 212.50

11 18,000.00 – 18,999.99 18,000.00 450.00 225.00 225.00

12 19,000.00 – 19,999.99 19,000.00 475.00 237.50 237.50

13 20,000.00 – 20,999.99 20,000.00 500.00 250.00 250.00

14 21,000.00 – 21,999.99 21,000.00 525.00 262.50 262.50

15 22,000.00 – 22,999.99 22,000.00 550.00 275.00 275.00

16 23,000.00 – 23,999.99 23,000.00 575.00 287.50 287.50

17 24,000.00 – 24,999.99 24,000.00 600.00 300.00 300.00

18 25,000.00 – 25,999.99 25,000.00 625.00 312.50 312.50

19 26,000.00 – 26,999.99 26,000.00 650.00 325.00 325.00

20 27,000.00 – 27,999.99 27,000.00 675.00 337.50 337.50

21 28,000.00 – 28,999.99 28,000.00 700.00 350.00 350.00

22 29,000.00 – 29,999.99 29,000.00 725.00 362.50 362.50

23 30,000.00 – 30,999.99 30,000.00 750.00 375.00 375.00

24 31,000.00 – 31,999.99 31,000.00 775.00 387.50 387.50

25 32,000.00 – 32,999.99 32,000.00 800.00 400.00 400.00

26 33,000.00 – 33,999.99 33,000.00 825.00 412.50 412.50

27 34,000.00 – 34,999.99 34,000.00 850.00 425.00 425.00

28 35,000.00 and up 35,000.00 875.00 437.50 437.50

 OFWs or those under the Overseas Workers’ Program (OWP) shall pay ₱2,400.00 as their annual premium contribution to PhilHealth. This is also applicable to
land-based OFWs, whether documented or undocumented. Payments may be made in two increments (₱1,200 every six months) or a one-time payment of the
full amount amounting to ₱2,400.

PhilHealth Contribution for Self-employed, Individually Paying Members:

 Members with monthly income of ₱25,000 and below shall pay ₱2,400 per year.
 Members with monthly income above ₱25,000 shall pay ₱3,600 per year.

 Sponsored Program Members: Whether fully or partially subsidized by the sponsor, members under this category shall pay an annual premium of
₱2,400.

What are the benefits to 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 thing 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 to 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?

Step 1: Conditions

To be eligible to 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.

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.

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.