Download - PhilHealth Benefits

PhilHealth BenefitsNational Health Insurance Program

29 October 2016

Concept“The National Health Insurance Program (NHIP), formerly known as Medicare, is a health insurance program for SSS members and their dependents whereby the healthy subsidize the sick who may find themselves in need of financial assistance when they get hospitalized.”

“The Philippine Health Insurance Corporation or PhilHealth is the mandated administrator of the Medicare program (now known as NHIP) under the National Health Insurance Act of 1995 (Republic Act 7875).”

Citation: 2016 Handbook on Statutory Monetary Benefits by DOLE-BWC

Coverage1. Members In The Formal Economy - “includes those with formal contracts and fixed terms of employment including workers in the government and private sector, whose premium contribution payments are equally shared by the employee and the employer.”2. Sponsored Members – “includes members whose contributions are being paid for by another individual, government agencies, or private entities.”3. Members In The Informal Economy – “includes a wide range of individuals and sectors ranging from the self-earning to migrant workers.”


Coverage4. Lifetime Members – “members who have reached the age of retirement under the law and have paid at least 120 monthly premium contributions.”5. Indigent Members – “persons who have no visible means of income, or whose income is insufficient for family subsistence, as identified by the Department of Social Welfare and Development (DSWD), based on specific criteria.”6. Senior Citizens – “those who are 60 years old and above and are not currently covered by any of the existing membership categories of PhilHealth.”


Benefits1. Inpatient hospital care:• Room and board;• Services of health care professionals;• Diagnostic, laboratory, and other medical examination

services;• Use of surgical or medical equipment and facilities;• Prescription drugs and biologicals, subject to the limitations

stated in Section 37 of RA 7875; and• Inpatient education packages.


Benefits2. Outpatient care:• Services of health care professionals;• Diagnostic, laboratory, and other medical examination

services;• Personal preventive services;• Prescription drugs and biologicals, subject to the limitations

described in Section 37 of RA 7875; and• Emergency and transfer services.


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