Every one is entitled to be a member of Philhealth. It is mandated by law under National Health Insurance Act of 1995. The PhilHealth is primarily designed to lessen out of pocket expenses when hospitalized by providing financial assistance to its Members.
Learning more about Philhealth is a great idea! Let’s dig in the important things we must do according to Philhealth.
1. Register To Philhealth
Every Filipino, ages 21 years old and above must register in Philhealth and to have their own Philhealth ID Number and Philhealth PIN.
To be able to register in Philhealth, the applicant is required to submit the following document in any Philhealth Branch or Office. Philhealth registration is also accepted in different Philhealth Registration Partners such as SM Branches and Bayad Centers. The following documents required for the registration in Philhealth are the following:
- Philhealth Member Registration Form or PMRF – Fill up the registration form correctly and accurately. (Procedure and downloadable Forms)
- Copy of the Birth Certificate of Philhealth Applicant.
- The following documents are required if and only if thePhilhealth Applicant is declaring his/her Legal Dependent:
- Marriage Certificate if the spouse is not yet a member of Philhealth.
- Birth Certificates of the children under twenty one (21) years old .
- Birth Certificate of the parent above Sixty (60) years old.
The Philhealth Pin or Philhealth Number will be issued once the Applicant’s documents is successfully processed. The Member Data Record and the Philhealth ID card can also be obtained in any Philhealth Branch or Office after paying the very first premium.
2. Update Your Philhealth Record
A Philhealth Member is required to update his/her Philhealth record whenever the following events occurred:
- Changed Marital Status
- Added additional Legal Dependents
- New Employer
- or Any details that needs to be change or to correct the old Philhealth record (i.e. Wrong spellings, birth date and gender).
Fill up and Submit a copy of Philhealth Member Registration Form (PMRF) to the nearest Philhealth Branch together with the appropriate supporting documents such as Birth Certificates of the Legal Dependents or Marriage Certificate to complete the Philheath Record update process. The Philhealth Member will be issued a new Member’s Data Record or MDR once the update is completed.
3. Pay Your Philhealth Premium Regularly
A Member of Philhealth is required to pay the adequate amount of Philhealth Premium Contribution to avail all the benefits offered by Philhealth. Make sure to pay regularly your monthly Philhealth Premium Contribution to avoid hassles and delays in availing your benefits. Keep in mind that if you missed one month of contribution, the results is one month unpaid Philhealth Premium Contribution which makes your total PHIC Contribution lower than the expected amount.
|MEMBERSHIP TYPE||PREMIUM CONTRIBUTION|
|Individual Paying with a monthly income of not more than P25,000.||Starting July 2012, the amount of Philhealth Contribution Premium is P2,400 per year.||Discount is given if the Member paid the whole amount of Philhealth Contribution Premium for one (1) year or two (2) years from January to July 2012.|
|Overseas Worker||Starting July 2012, the amount of Philhealth Contribution Premium is P2,400 per year.|
|Sponsored||Starting 2012, the amount of Philhealth Contribution Premium is P2,400 per year. The entire amount can be paid by the sponsor or both sponsor and member by dividing the total premium contribution.|
|Individually Paying with montly income more than P25,000||Starting January 2012, the amount of Philhealth Contribution premium is P3,600.|
|*Employed||The amount of Philhealth Contribution Premium is according to his/her monthly salary. The Philhealth Contribution Premium is automatically deducted.|
|Lifetime||Not Applicable – No need to pay the Philhealth Contribution Premium.|
*Employed Members can refer to the Philhealth Contribution Table for the respective Philhealth deductions.
4. Use Your Philhealth Benefits When Hospitalized
Whenever a Philhealth Member is hospitalized, a Member is entitled to use the benefits available for him/her. The Philhealth benefits is automatically deducted to the total hospital bill of the Philhealth Member/Patient provided that he/she will submit the necessary requirements.
To avail the Philhealth Benefits, submit the following documents in the Billing Section/Department of the accredited Hospital to deduct a portion of the total amount of the Hospital Bill.
- Accomplish a copy of Philhealth Claim Form 1 (filled up correctly and accurately).
- Copy of Philhealth Id and Member Data Record (MDR).
- Official Receipt of prescribed medicines the patient bought outside of the hospital which was used for confinement. These are also the medicines which are not included in the hospital bills.
- Proof of payment of any of the following:
|MEMBERSHIP TYPE||PROOF OF PAYMENT|
|Individually Paying||A copy of Official Receipt of Philhealth Contribution Premium payments for the last six (6) months or the last nine (9) months.|
|Overseas Worker||A copy of Member Data Record (MDR) or Official Receipt for the last month’s Philhealth Contribution Premium payment|
|Lifetime & Sponsored||Copy of Philhealth ID Card and Member Data Record (MDR)|
|Employed||Philhealth Claim Form 1 signed by the Authorized Personnel of the Patient/Member’s Employer.|
5. Know Your Philhealth Benefits
Philhealth is giving its Members Hospital Subsidy when confined in a hospital at least within twenty-four (24) hours in every Philhealth Accredited Hospital. The Hospital Subsidy of Philhealth includes the following:
- Room and board
- Drugs and Medicines
- Xray, laboratory and others
- Operating room fees
- Professional fees.
From the list above is an equal amount to be availed if confined. The amount of allowance is fixed depending on the seriousness of the illness of the patient. If the illness is more complicated, the higher the amount of benefits to be received.
Philhealth can also provide subsidies to an “outpatient” Philhealth Member. Some surgeries such as Cyst Excisions, Dialysis, chemotherapy, radiotherapy, cataract extraction, malaria treatment, TB-DOTS, HIV treatment and other minor surgeries. For more details about the day surgeries covered by Philhealth, kindly visit the nearest PHIC office or inquire in the Billing Section of any Accredited Hospital.
In addition to Philhealth Hospital Subsidy, a Philhealth Sponsored Member can be granted a Primary Care Package from its Rural Health Unit (RHU), Health Center or Hospital.
Did you find anything important? I hope everyone can use this guide to be more well informed as a Philhealth Member.
And if you have any suggestions, reactions, or anything you want to add to this list, please do share!