PhilHealth Guide in the Philippines

What is PhilHealth?

The Philippine Health Insurance Corporation (PhilHealth) was created in the year 1995 to implement universal health coverage for its citizens, including those working outside the country.

The Philippine Health Insurance Corporation (1) or PhilHealth is a government-owned and controlled corporation (GOCC) that works under the Health Department to establish a National Health Insurance Program.

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The primary goal of PhilHealth is to make quality healthcare accessible and affordable for every Filipino.

Anyone with Filipino citizenship can become a member of the PhilHealth scheme and keep it active with a monthly contribution. The different set of membership schemes allows everyone, irrespective of their financial, social, gender, or age status, to be part of the system.

One can choose his membership scheme according to his capabilities. For the less privileged, the government takes care of their contributions.

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Some of the significant features of PhilHealth

Suppose you are employed and about to be enrolled in Philhealth. What is the first thing you need to know about?

1. A PhilHealth Member and his legal dependents have equal benefits for all their medical expenses.
2. The scheme offers subsidies for your total health care expenses such as outpatient care, inpatient services, surgeries, professional fees, medicines, room and board, diagnostic processes, deliveries, etc.
3. In traditional health insurance schemes, the ceiling is for the amount. In PhilHealth, a member and his dependents can get PhilHealth bonuses for up to 45 days of hospitalization care in a year.
4. PhilHealth benefits work based on case rates. Here every illness or its procedure costs are predetermined, including the doctor’s fees and hospital expenses. So a patient will have a clear picture of the PhilHealth benefits much prior to his hospitalization.
5. Patients have the freedom to choose the health care provider. You can seek service from public or PhilHealth accredited private hospitals. In such cases, the applicant needs to pay the additional hospital expenses, if it exceeds the PhilHealth benefits.
6. It covers day procedures such as radiotherapy, hemodialysis, and outpatient blood transfusion as well.
7. The Primary Care Benefit package Philhealth scheme provides better management of existing illness and early detection of diseases through regular monitoring and medications.

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The eligibility to claim a PhilHealth allowance:

• The applicant should be an active PhilHealth member with at least three months’ worth of premiums within the immediate six months of confinement.
• For some healthcare expenses such as pregnancies, newborn care packages, dialysis, chemotherapy, radiotherapy, and selected surgical procedures, nine months of contributions in the last 12 month is essential.
• The attending physician must be PhilHealth accredited.
• The applicant should submit the claim within 45 days of obtaining room and board.

The essential documents for a successful claim processing are:

• Member Data Record Form (MDR) – that includes your name either as the member or dependent.
• PhilHealth claim form 1 (original copy) – the employer’s signature is a must for employees.
• Certificate of payments (with OR numbers) – if you are an employee, the Certificate of Premium payments with OR number will be sufficient.
• PhilHealth ID and another valid ID. How to get an ID, you can find on the PhilHealth official website.

If you can’t make a personal representation during the process, there is an option to authorize someone for the same.
Usually, submission of the required documents at the hospital before your discharge would be sufficient for the automatic deduction  from your total bill.

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Why do You Need New PhilHealth ID?

The primary reason for enrolling in PhilHealth is the treatment costs. A medical emergency has no other options than getting the treatment, whatever be the costs. In the absence, you need to pay the entire amount. It can create irrevocable damage to your financial stability.

With its Primary Care Benefit scheme, PhilHealth effectively takes care of both emergencies and routine treatment of chronic conditions. This avoids lost work days and prevents the manifestation of disease.

PhilHealth Maternity also services take care of a significant portion of your financial obligations and allow you to enjoy the bliss of parenthood without any distractions.

Types of PhilHealth members

So, the following categories of Filipinos can be members of PhilHealth:

1. Employees. All employed people in the Philippines, including sailors and domestic helpers.
2. Self-employed or those with unofficial income. This includes business owners.
3. Foreign Workers (OFWs).
4. Sponsored. These are employees working for a non-profit organization.
5. Indigent. These are people who have no source of income.
6. Elderly people. Filipino citizens who are 60 years old and have never been PhilHealth members automatically become PhilHealth members at the age of 60.

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How Can I Check my PhilHealth Contribution?

You can do this on the official My PhilHealth website. This is the easiest way to check your PhilHealth contribution. To do this you must know your PIN code. You need it to sign up for an account if you don’t already have one. To find out your PhilHealth PIN, call the PhilHealth hotline (02) 441-744 or visit your nearest PhilHealth branch or local health insurance office.

How can I get PhilHealth member registration form?

A completed member registration form (PMRF) is all you need to enroll as a voluntary member. This is the form where you must enter your information. You can download it from the official PhilHealth website or visit the nearest philhealth PhilHealth branch.

How to Apply for PhilHealth ID Online?

PhilHealth ID requirements are restricted only for the members. Perhaps you are interested in the question, what is the formal economy in PhilHealth? For the formal economy employees, the employer takes care of their PhilHealth membership and its monthly contributions. Other categories of PhilHealth memberships such as Self-Employed, Informal Sector Workers, Overseas Filipino Workers (OFWs), Sponsored Members, Indigent Members, Lifetime, and Senior Citizens need voluntary membership registration.(2)

One can register for a suitable membership either through a local health insurance office or using PhilHealth online services as given below:

Step 1: Access the online registration in PhilHealth site and select “Register” under the “Philhealth Membership” category.
Step 2: Read and accept the PhilHealth Electronic Registration Terms and Conditions.
Step 3: Fill the online PhilHealth application with the relevant data.
Step 4: Upload supportive documents to the portal.
Step 6: Review and confirm the details.
Step 7: Wait for the confirmation mail with your PhilHealth ID Number.

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PhilHealth Contribution Table 2023

Here’s the latest Philhealth dues table update for 2023 based on your eligibility and steps to sign up as a PhilHealth member.

Starting in January 2021, PhilHealth’s monthly contribution rate for active participants increased from 3% of monthly base salary in 2020 to 4.50% in 2023. The monthly contribution will continue to be split equally between employee and employer. The monthly contribution for employees earning 10,000 pesos and below will be 450 pesos. Those earning 70,000 pesos and above will pay a contribution from 450 to 4,050 pesos. Note that the salary ceiling of 90,000 pesos in 2023 will continue to increase by 10,000 pesos per year until it reaches 100,000 pesos in 2024.

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PhilHealth Terms

Below are some of the common terminologies you may encounter with every reference to PhilHealth.

What is my PhilHealth number?

The PhilHealth Identification Number (PIN) is a 12-digit number that is issued to each PhilHealth member. It is unique for each participant. The PhilHealth number is required in all PhilHealth operations. So when you get it, be sure to copy and write it down in case of emergency.

What is PEN in PhilHealth?

The law stipulates that all private and public employers have to register with PhilHealth to ensure their PhilHealth coverage. Every such employer will have a unique PhilHealth Employer Number (PEN). So, what is the role of PEN in PhilHealth application? The PEN will be the organization’s identification number for all PhilHealth activities. The employer has to display the PhilHealth Certificate Registration in the workplace. Similarly, any changes in the employees, business details, or organization structure needs to update in the PhilHealth register.

What is Member Data Record (MDR) in PhilHealth?

PhilHealth MDR online, or Philhealth member data record, carries vital information about the member such as PhilHealth Identification Number (PIN), membership details, address, and the list of dependents.
The cardholder has to ensure that MDR contains all his dependent details to avoid the chances of denial of Phil-Health benefits.

What is ePCB PhilHealth?

Earlier, the Primary Care Benefit (PCB), a package covering preventive care and diagnostic services, was accessible only to a specific category of members.
The new Expanded PCB enables all members and their dependents to have free health screening and assessment, free diagnostic services, and discounts on specific medicines.

What is ER2 PhilHealth?

The employer has to file the ER2 form for each recruit to ensure

PhilHealth Coverage to them. For employees with an existing PhilHealth Membership, essential details such as PhilHealth Number need to be mentioned in the ER2 form.

Suppose the employee is unsure about his PhilHealth number. In that case, he can get it from his previous employer, PhilHealth branches, or by texting or sending emails to the department.

What is CSF PhilHealth?

A scanned image of the Claim Signature Form (CSF) is mandatory to settle a PhilHealth benefit claim. All providers have to use a uniform standard PhilHealth form CSF for claim settlement processes.

What is CF1 PhilHealth?

Claim Form 1 (CF1) is used to ascertain the member’s eligibility for the PhilHealth benefits. The first part of the form covers member/patient’s details. The second part covers the employer’s details and contribution details.

Ways to pay for PhilHealth contributions

• Any branch of PagIBIG, SSS, or PhilHealth
• SM Bill payment counters
• CIS Bayad Center
• Bank of the Philippines Islands, Citibank,Land Bank, Security Bank, Union Bank
• Post offices in Metro Manila

How Can I Get a PhilHealth ID?

Active membership with regular contributions will make one eligible for PhilHealth benefits. But availing of the services would be quite complicated unless you have an ID card. This portable ID card ensures every provider in the Philippines that you are eligible for PhilHealth benefits.
The PhilHealth ID cards are not issued automatically for all members. You have to apply separately for this card. Both formal and informal sector members are eligible for the PhilHealth Cards. Any PhilHealth member can obtain a PhilHealth ID card by approaching the nearby PhilHealth office and completing the formalities. You can find detailed ID requirements on the PhilHealth official website.

PhilHealth ID benefits

Having your own PhilHealth Insurance ID card gives you the following benefits:

• 15% discount at Watson’s, South Star Drug, Rose Pharmacy, The Generics Pharmacy on select items;
• Up to 80% off flu vaccines at PQ Health Shield and GSK;
• Free eye exams and 20% off items at Vivian Sarabia Optical;
• 10% off drug testing services at JNW locations.

What is Philhealth loan?

PhilHealth also offers loans for qualified members to help them with medical expense coverage, as well as other financial aid for health-related needs. These loans are interest-free and are offered with flexible payment terms. To qualify for a loan through PhilHealth, members must meet certain income requirements, be up to date on their premium payments, and have no outstanding claims or debts to the company.

What are Philhealth loan Requirements

Here is a list of requirements to qualify for a PhilHealth loan in the Philippines:

• Be a registered member of PhilHealth
• Meet income requirements
• Have no outstanding claims or debts with PhilHealth
• Be up to date on premium payments
• Provide proof of employment and/or other source of regular income
• Submit necessary documents such as government-issued ID, proof of address, proof of income, medical certificate (if applicable)

Is PhilHealth a Valid ID?

There are two types of PhilHealth ID cards:

• Regular PhilHealth ID;
• PhilHealth Insurance ID Card.

The regular PhilHealth ID card is just a paper printed ID document that will help you get your Phil-health claims. The PhilHealth Insurance ID Card is a digitized ID issued to employed members and active members. It means the card is available only to the members of the formal economy definition of PhilHeath, and it adds some legitimacy for it. Hence these cards are accepted as a valid ID form for some category of operations and organizations.

loan App that Accepts Philhealth ID

Still, PhilHealth ID cards are not yet fully established as a valid ID card for all purposes. For example, only some state-licensed and legitimate lenders accept this ID as a valid ID for loans.

Here is a list of loan apps that accept PhilHealth ID in the Philippines:

• Cashalo
• Cimbbank
• LoanOnline
• Asteria Personal Loans
• Maanimo.ph

It is also possible to apply for an emergency loan in the Philippines using only a PhilHealth ID. For example:

• SSS Emergency Loan
• GSIS emergency loan

The Bottom Line

Being a member of PhilHealth is important for many reasons. Firstly, it ensures that individuals are covered in the case of any medical emergencies or illnesses, providing financial protection and access to healthcare services. Secondly, PhilHealth members have access to discounted medicines, hospital care, health insurance coverage, and more. Finally, members receive emergency loan options with lower interest rates and easier eligibility requirements.

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