Utilizing your PhilHealth benefits is the last thing you want to do, mainly because no one wants to visit or stay at the hospital for injury or illness.
But if you do get hospitalized, PhilHealth is a great thing to have because it will save you money on hospital expenses and doctor’s fees.
This is why it’s important to know what you can get out of your Philhealth membership in case you need this kind of financial assistance in the future. Here are some of the important things to take note of.
What is PhilHealth?
PhilHealth is a government corporation attached to the DOH (Department of Health) that is tasked to administer the National Health Insurance Program.
It was formed in 1995 to provide financial aid to Filipinos in paying for their medical needs.
In short, PhilHealth ensures affordable and accessible health care services for all Filipinos.
Who are members of PhilHealth?
Under the Universal Health Care Law, all Filipinos are now automatically members of PhilHealth.
Members are classified into Direct and Indirect Contributors.
Direct Contributors are members who have the capacity to pay their PhilHealth premiums, are gainfully employed, and bound by an employer-employee relationship.
They can also be self-earning or are professional practitioners or overseas Filipino workers.
Indirect contributors are all those who don’t fall under the Direct Contributor category, as well as their qualified dependents, whose premiums are subsidized by the national government.
Active and inactive PhilHealth members will remain PhilHealth members, and those who have not yet registered are considered automatic members.
|Employees with formal employment
|Indigents identified by DSWD
|Persons with Disability
|Overseas Filipino Workers
|Pantawid Pamilyang Pilipino Program (4Ps) beneficiaries
|Filipinos with dual citizenship or are residing abroad
|Sangguniang Kabataan officials
|Previously identified at point of service or sponsored by Local Government Units
|All Filipinos aged 21 and above with capacity to pay
|All Filipinos aged 21 and above without capacity to pay
How do you become a member of PhilHealth?
You will need to fill out two copies of the PhilHealth Member Registration form. Submit the duly accomplished forms to your nearest Local Health Insurance Office (LHIO) together with the following:
- Latest 1 x 1 ID photo (2 pcs)
- 2 valid IDs or NSO copy of your birth certificate
- Any of the following, if applicable:
After submission of the required documents, wait for your Member Data Record and PhilHealth ID card.
Employed individuals can have their human resources department process the PhilHealth application on their behalf.
Unemployed, self-employed, and others that don’t fall under this category can sign up on their own online or at their nearest PhilHealth office or Local Health Insurance Office.
How much do you need to pay for PhilHealth premium contributions?
Recently, President Duterte ordered the suspension of the premium hike for OFWs in light of the Covid-19 pandemic.
This came after OFWs were required to remit 3% of their yearly salaries to PhilHealth from last year’s 2.75%.
As of this writing, all OFW PhilHealth contributions have been put on hold until 30 May 2020 and on a voluntary basis.
To know how much you should pay for your PhilHealth contributions, you can refer to this graphic below.
What are the PhilHealth benefits?
Members and their qualified dependents can get medical expense benefits for every surgery or sickness.
There’s an allocation of 45 days hospitalization for the member and another 45 days divided to all his or her qualified dependents. Any excess of these 45 days will no longer be covered by PhilHealth.
As long as you keep your contributions updated, have a valid coverage, and go to a PhilHealth-accredited hospital, clinic, or facility, you can get benefits from PhilHealth. That is if you have not used up your hospital allocation benefits, of course.
This benefit will be paid to the accredited hospital (Health Care Institution) through All Case Rates (the fixed rate or amount that PhilHealth will reimburse for a specific illness or case).
The Case Rate amount will be deducted from the total bill before the patient is discharged.
To avail of the inpatient benefits, you should have at least 9 monthly contributions within 1 year immediately before the first day of confinement or availment.
The following procedures are covered by Philhealth under its outpatient benefits:
- Day Surgeries (non-emergency minor and major surgical procedures where patients can go home on the same day)
- Radiotherapy (2,000 PHP per session for cobalt and 3,000 PHP per session for linear accelerator)
- Hemodialysis (2,600 PHP per session)
- Outpatient Blood Transfusion (3,640 PHP for one or more units)
- Primary Care Benefit (for indigents, sponsored members, land-based Overseas Workers Program, organized groups or iGroups)
- Expanded Primary Care Benefit
This is a benefit package for catastrophic illnesses that will require prolonged hospitalizations and very costly medical treatments.
It includes leukemia, breast cancer, prostate cancer, colon cancer, end-stage renal disease, and coronary artery bypass, just to name a few.
You can find the complete list of benefit packages, including their selection criteria and where you can avail them here.
|Amount of Benefit
|Outpatient Malaria Package
|Outpatient HIV-AIDS Package
|30,000 PHP per year
|Voluntary Surgical Contraception Procedures
|Animal Bite Treatment Package
PhilHealth Covid-19 Package
Covid-19 patients can also avail of the Covid-19 package, with different benefit amounts depending on the severity.
How do you file a PhilHealth claim?
Before you get discharged from the hospital, submit a copy of your MDR (Member Data Record) and the PhilHealth Claim Form 1. This form is available at the PhilHealth counter in the hospital or from your employer.
You will also need to provide a copy of your PhilHealth ID, a valid ID, and receipts of premium payments/Certificate of Premium Payments.
When in doubt, check with the PhilHealth representative regarding submission of claim and other claim procedures. Make sure that you have complete requirements before you proceed to the billing department and they deduct all the PhilHealth discounts.