Updates on Philhealth

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Transcript of Updates on Philhealth

Updates on Membership & BenefitsTechnical Session VI 34th GACPA Convention

Mr. DELIO A. ASERON IIChief Social Insurance Officer Deputy Spokesperson & Head of Corporate Call Center Corporate Affairs Group

REPUBLIC ACT 7875As amended by R.A. 9241

The National Health Insurance Act of 1995 was signed into Law on February 14, 1995


MANDATEto provide health insurance coverage and ensure affordable, acceptable, available & accessible health care services for

ALL FILIPINOSFinancial Risk Protection



The Aquino Health Agenda (AHA): Achieving Universal Health Care for all Filipinos

. Universal

coverage can only become a reality if everyone pulls together in the same direction

Universal Health Care GoalBawat Pilipino, Miyembro Bawat Miyembro, Protektado Kalusugan Natin, Segurado

Compulsory coverage of all those formally employed in the government and private sector (All SSS & GSIS Members)


PhilHealth contribution is deducted every month from their salary. Amount varies based on their respective salary bracket. Employer shares 50% of premium

Er1 + Er2 + PMRF =PhilHealth Identification Card

Employed Sector: Premium ContributionSalary Monthly Bracket Monthly Salary Range Salary Base Total Monthly (BS) Contribution Personal Employer Share (PS) Share (ES) (PS=SB x 1.25%) (ES=PS)

12 3 4 5 23 24 25 26

P 4,999.99 and below P 4,000.00P 5,000.00 P 5,999.99 P 6,000.00 P 6,999.99 P 7,000.00 P 7,999.99 P 8,000.00 P 8,999.99 P 26,000.00 - P 26,999.99 P 27,000.00 - P 27,999.99 P 28,000.00 - P 28,999.99 P 29,000.00 - P 29,999.99 P 5,000.00 P 6,000.00 P 7,000.00 P 8,000.00 P 26,000.00 P 27,000.00 P 28,000.00 P 29,000.00

P 100.00P 125.00 P 150.00 P 175.00 P 200.00 P 650.00 P 675.00 P 700.00 P 725.00

P50.00P62.50 P75.00 P87.50 P100.00 P 325.00 P 337.50 P 350.00 P 362.50

P50.00P62.50 P75.00 P87.50 P100.00 P 325.00 P 337.50 P 350.00 P 362.50


P 30,000.00 - UP

P 30,000.00

P 750.00

P 375.00

P 375.00

Those who earn more, must contribute more to the common fund!

PhilHealth Circular No. 11, s. 2012 New Premium Schedule for the Formal Sector Effective JANUARY 1, 2013Mpnthly Salary Range Monthly Premium Rate Employer Share Employee Share

P7,000 & Below P7,000 to P50,000 P50,000 & Above

P 210. 00 3% P1,500. 00

P105 1.5 % P750

P105 1.5 % P750

All ERs are hereby reminded that monthly premium contributions should be remitted on or before the 10th day of the month following the applicable month at any PhilHealth Offices or through PhiiHealth Accredited Collecting Agents nationwide. It must be supported by a monthly Employer Remittance List (RF-1) which shall be submitted to nearest PhilHealth Local Health Insurance Offices not later than the 15th day of the month following the applicable month.

Overseas Workers Program

Apart from existing benefits being provided by OWWA, Overseas worker-members are assured of a more expanded benefit package which they can avail of in times of medical contingencies.

Premium Contribution is pegged at Php 1,200.00 a year.Overseas workers may likewise pay their premiums in their place of employment using the currency where their payments will be made. * A PhilHealth Certification Eligibility shall be issued for this purpose.

A joint partnership between Philhealth and the LGU/ Fund Sponsors in subsidizing the one (1) year

FREE PhilHealth coverage of the poorest of the poor constituentsBasis:

DSWDs NHTS-PR Masterlist

Sponsored ProgramLGU Legislative Private Govt Agencies

Aside from the regular Philhealth Medicare Benefits, the indigent members can also avail the

PRIMARY CARE BENEFIT PACKAGE from theaccredited RHUs/Health Centers (Ex. Sputum Microscopy, Fecalysis, CBC, Chest X-ray etc.)

*All existing (active/inactive) SSS Self-employed/Voluntary Members *No Employer-Employee Relationship *Categorized under the Informal Sector *Disqualified as a legal dependent or from other program component of NHIP

Premium contribution can be paid Quarterly (P600), Semi-annually (P1,200), or Annually (P 2,400) . Hence, only P200 a month or P 6.70 a day! * (below P25K)

Individually Paying Program

3 STEPS ENROLMENT PROCEDURE 1. Go to the nearest Service Office or directly to the Central Office 2. Fill-up one (1) PhilHealth Member Registration Form (PMRF) & attach documentary requirements for declared qualified dependents 3. Pay at least one (1) quarter (P600.00). Then present the validated receipt to secure the PhilHealth Identification Card (PIC) & MDR. *You can pay your succeeding contribution to any Accredited Banks/ Bayad-Centers

Market Segmentation of Potential MembersIndividually Paying MembersAll existing (active / inactive) members of the SSS Self-employed / Voluntary Program Individuals who dont have an established/existing Employer-Employee Relationship Those who are categorized under the Informal Sector (based on the definition of ILO) Those individuals who failed to qualify from the other program components of the NHIP but wishes to join the program by paying for their own premium contributions

Self-Practicing Professionals-Lawyers-Doctors -Consultants -Freelance Journalist -Etc.

Transport Sector-Jeepney Drivers-Tricycle Drivers -Transport Operators -FX/Taxi Drivers -Etc.


Barangay Sector


-Sari-sari Store Owners -Brgy. Tanods

-Market vendors -Single proprietors and other Volunteer -Entertainment Industry workers -Sidewalk vendors -Etc -Etc.

-Organized Groups -Brgy. Health Workers -Contractors-House Helpers -Religious Sector -Disqualified as Indigent /Non-Paying Members -Etc.

Be an advocate of PhilHealth!

The National Health Insurance Program (NHIP)Average of 3-5 dependents per household



SPONSOREDLGU Legislative Private Govt Agencies

C B I.P.P. D

LIFETIME MEMBERSHIP PROGRAM (PhilHealths Long Term Benefit) Must have reached the age of 60 years old and above

AND Must have contributed at least 120 monthly contributions (10 years)


REGISTRATION PROCEDURE:NOT QUALIFIED? A. Declare as Dependent of one of the Member-ChildRequirements:

1. Properly accomplished PMRF (to be accomplished by the Member-Child) 2 Supporting documents: Members Birth Certificate & Parents Proof of age B. Enroll under IPP



1. Properly accomplished PMRF 2. Quarterly Payment of Php 600.00C. Enroll under Sponsored Program - Depending on the existing program implementation in the city/municipality. - Inquire at LGU-Local Social Welfare Ofc

Coverage that extends to your immediate family

45 DAYS / Calendar Year(exclusive for the member)


45 DAYS / Calendar Year(to be shared by qualified dependents) Legitimate spouse not yet a PhilHealth member Children 20 years old below, single & unemployed (legitimate, illegitimate, stepchildren, adopted, etc). Parents-60 years old and above and not a GSIS or SSS Retiree / Pensioner


(biological parent, step parent & adoptive parent)


PhilHealth Identification Cards EMPLOYED




Register now in all SM Malls & Bayad CentersP50.00 per card ; must be an ACTIVE member!

Health Insurance Card Has a space for members photograph and biometric capture Will serve as a key card for hospitals and merchant-partners to access member records


Updating of Members Data RecordSubmit a properly accomplished PMRF Form and attach the necessary supporting requirementsLegal Spouse Xerox of Marriage Contract All Children 20 yrs.old below Xerox of Birth Certificate Parents above 60 yrs. old Senior Citizens ID & Members Birth Certificate


What are my Benefits?A. In-Patient Care ( FEE FOR SERVICE SCHME) Allowance for:

Room and Board Drugs and Medicines X-Ray and Laboratories Operating Room Fees Professional FeesConfinement of less than 24 hours will not be paid except the ff:1. Case is Emergency 2. Patient is Transferred to another Hospital 3. Patient Expired


New Inpatient PhilHealth Benefits ScheduleFor all PHIC Members and their DependentsAdmissions starting April 05, 2009 (Circular 09, s. 2009)

Levels 3 & 4 Hospitals (Tertiary)

Benefit ItemA B

Case TypeC D

Room & Board(maximum of 45 days/year)

P500 P4,200 P3,200

P500 P14,000 P10,500

P800 P28,000 P21,000

P1,100 P40,000 P30,000

Drugs and Medicines(per single period of confinement)

X-ray, Lab & Others(per single period of confinement)

For procedures with RVU 30 and below = 1,200

Operating Room

For procedures with RVU 31 to 80 = 1,500 For procedures with RVU 80 to 600: RVU x PCF 20 (minimum = 3,500)


New Inpatient PhilHealth Benefits ScheduleAdmissions starting April 05, 2009 (Circular 09, s. 2009)

Levels 3 & 4 Hospitals (Tertiary)

Professional FeesA A. Daily Visits Gen. Practitioner (Groups 1, 5 and 6) B

Case TypeC D

Per dayMaximum per confinement Specialist (Groups 2, 3 & 4)





Per dayMaximum per confinement B. Surgery