PhilHealth: Universal Health Coverage For All Filipinos
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:
|Formal Economy Members: Employees, business owners, household workers, and family drivers.||Employer and worker each pay half, up to 2.5% (maximum of 3%) of income up to ₱10,500||As of hire date||3 months|
|Indigent (NHTS): Poor families selected by the DSWD using the National Household Targeting System for Poverty Reduction (NHTS-PR or Listahanan).||₱2,400 annually||National Government||None|
|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 considered as indigents like barangay health workers, nutrition scholars, etc. Orphans, abandoned kids, out-of-school-youth, street children, Person with Disabilities (PWDs), abused and pregnant women under the custody of the DSWD is also registered here.||₱2,400 annually||Local Government fully subsidizes enrollment annually.||None|
|Lifetime Members: Members age 60 and above and retired employees that contributed not less than 120 months in Philhealth contributions.||Free lifetime coverage||Retirees and Pensioners||None|
|Senior Citizen: Under the Expanded Senior Citizen Act (RA 10645), all Filipinos age 60 and above is already covered by Philhealth.||Non Paying (RA 10645), Free Lifetime coverage||Age 60 years and up||None|
|Informal Economy Members (or voluntary/individually paying): Includes Overseas Filipino Workers (OFWs), self-earning individuals, naturalized Filipinos and foreigners living in the Philippines.||₱2,400 annually for members earning ₱25,000 and below|
₱3,600 annually for members earning more than ₱25,000
|OFW (Landbased)||₱2,400 annually||Emigration date||No subsidy. Payment is on emigration date then annually.|
|OFW (Seabased)||Employer and worker each pay half, up to 2.5% (maximum of 3%) of income up to ₱10,500||As of hire date||3 months|
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 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:
|For SSS pensioners||
|For GSIS pensioners||
|For Uniformed personnel of AFP, PNP, BJMP and BFP||
|GSIS Disability Pensioner / SSS Permanent Total Disability Pensioner before March 4, 1995||
|SSS Survivorship Pensioner before March 4, 1995||
|Other individuals who are not under the abovementioned categories||
- 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)|
- 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.
- 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
- 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
- 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:
|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 being paid for.
Example:Period: January to MarchDeadline: March 31
|Pay until the last working day of the first quarter of the semester being paid for.
Example:Period: January to JuneDeadline: March 31
|Pay until the last working day of the first quarter of the year being paid for.
Example:Period: January to DecemberDeadline: 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,
- 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 firstname.lastname@example.org
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.