Top Ten PhilHealth 101 Posts for 2011

This blog was created last March as our own small way of helping PhilHealth members deal with some of their concerns regarding their PhilHealth membership, benefits, etc. Well, nine months and 48,000+ hits later, we come to the end of 2011. We have 100+ posts under our belt from the time we started, and some posts are just more popular than others.

And with that, we are pleased to present to you our top ten most popular posts for the year 2011:

10. New PhilHealth Card

9. Sample PhilHealth Request Letter

8. Tips in Availing PhilHealth Benefits

7. How to Check Your Premium Payment Contributions

6. NCR: Directory of PhilHealth Offices

5. What is a PhilHealth MDR (Member Data Record)?

4. How to Update Your Membership Record with PhilHealth

3. Download the PhilHealth Premium Payment Slip (PPPS)

2. Getting the Fully Loaded PhilHealth Card with Privileges

And lastly, the most read PhilHealth 101 post for 2011 is:

1. How to Request for a New PhilHealth ID Card

We hope you have found our posts even just a little helpful, and our sincere thanks to all those who have visited us in the past nine months. We aim to continue writing more PhilHealth-related posts in the coming year, and we hope you'll still visit us in 2012.

Seasons greetings, and a happy, healthy, and prosperous new year to all!

Increase in Premium Contributions Starting CY 2012

The newly released PhilHealth Circular No. 22 s-2011 "New Premium Contributions to the National Health Insurance Program (NHIP) in Support to the Attainment of Universal Health Care and Millenium Development Goals (MDG)", has announced the implementation of new premium rates for CY 2012.

Affected programs are the Sponsored Program (SP), Individually Paying Program (IPP), Overseas Workers Program (OWP) and the employed program. Below summarizes the new rates per program classification.


Sponsored Program

• Members included in the DSWD NHTS-PR list will be covered for 2 years. Annual premium shall be Php2,400.00 effective January 1, 2012;
• Annual premiums for the partial subsidy will be increased from Php1,200 to Php2,400 effective JULY 2012. 
• For sponsors who enroll and pay their contributions within the first semester, the annual premium shall be Php1,200.00;
• For sponsors who enroll and commits to pay for its members a period of two (2) consecutive years, the annual premium shall be Php1,200.00.

Individually Paying Members

• Starting JULY 2012, the annual premium contribution will be Php2,400.00, quarterly payment shall be Php600.00 and monthly premiums will be Php200.00;
• Self-employed professionals earning an average monthly income of more than Php25,000 will pay an annual rate of Php3,600. For self-employed professionals earning Php25,000 or less, they will be required to present an ITR as proof of income;
• Members paying their annual contributions within the first semester 2012 will still be able to pay the Php1,200 annual premium;
• Members paying for two (2) consecutive years within the first semester of 2012 will be paying for the annual premium rate of Php1,200.00.

Overseas Filipino Workers (OFW)

• Starting January 2012, the annual premium contribution for OFWs will be increased from Php900.00 to Php1,200.00;
• Starting July 2012, the annual premium to be implemented will be Php2,400.00;
• For payment of two (2) consecutive years within the first semester of 2012, the annual rate to be applied will still be Php1,200.00.

Employed Sector

• Effective January 2013, the premium contributions for the employed sector shall be three percent (3%) of the basic monthly salary of the employee shared equally by the employer;
• Monthly Salary Base = Php7,000.00 and Monthly Salary Ceiling = Php50,000.00.

The need of increasing the members' premium contribution have been cited by PhilHealth President Dr. Eduardo P. Banzon as reported by SunStar (see article here) last November 2011 as necessary in sustaining the enhanced PhilHealth benefits.

Please help the victims of Sendong

Who are qualified to enroll under the Lifetime Member Program (LMP)?

New registrants that have reached retirement age may be eligible to enroll under the Lifetime Member Program being implemented by PhilHealth. Lifetime members are no longer required to pay monthly premium contributions but may still avail of the same PhilHealth benefits offered in other programs such as those provided for  employed or individually paying members.

Registrants that are not able to meet the qualifications may still opt to enroll in PhilHealth under the Individually Paying Program (IPP).

Who are qualified to enroll under the Lifetime Program

• Old-age retirees and pensioners of the GSIS, including uniformed and non-uniformed personnel of the Armed Forces of the Philippines (AFP), Philippine National Policy (PNP), Bureau of Fire Protection (BFP), and the Bureau of Jail Management and Penology (BJMP) who have reached the compulsory age of retirement before June 24, 1997, and retirees under Presidential Degree 408;
• GSIS disability pensioners prior to March 4, 1995;
• SSS pensioners prior to March 4, 1995;
• SSS permanent total disability pensioners;
• SSS death/survivorship pensioners.
• SSS old age retirees/pensioners;
• Uniformed members of the AFP, PNP, BFP and BJMP who have reached the compulsory age of retirement on or after June 24, 1997, being the effectivity date of RA 8291 which excluded said individuals in the compulsory membership of the GSIS;
• Retirees and pensioners who are members of the judiciary;
• Retirees who are members of Constitutional Commission and other constitutional offices;
• Former employees of the government and/or private sectors who have accumulated/paid at least 120 monthly premium contributions as provided for by law but separated from employment before reaching sixty (60) years old and thereafter has reached age sixty (60);
• Former employees of the government and/or private sector who were separated from employment without completing 120 monthly premium contributions but continued to pay their premium payment as individually paying members (IPM) until completion of the required 120 monthly premium contributions and have reached age sixty (60) as provided for by law;
• Individually paying members (IPM), including SSS self-employed and voluntary members who continued paying premium contributions to PhilHealth, have reached age sixty (60) and have met the 120 monthly premium contributions as provided for by law; and,
• Retired underground mine workers who have reached the age of retirement as provided for by law and have met the minimum required premium contributions.

Are PhilHealth premiums taxable? No, they are not.

Please note that the above Revenue Memorandum Circular and its subsequent amendment, specifically the portions referring to the taxability of PhilHealth premiums only apply to contributions over and above the mandatory/compulsory contributions. In the case of PhilHealth, it presently does not have any mechanism allowing payment of premiums over that prescribed by law or by PhilHealth itself. As such, no taxes are imposable on PhilHealth premiums.

Stated another way, PhilHealth premiums may only be taxable if the payments are over and above the premiums prescribed by law or by PhilHealth. Since PhilHealth only collects compulsory/mandatory premiums, these compulsory/mandatory premiums are not covered by the BIR circular and thus are not taxable.

Other references:

PhilHealth contributions not taxable -PHIC
No tax on PhilHealth premium
NO taxes on PhilHealth contributions

Kurang A Papeles Dagiti Miyembro, Problema Iti Philhealth Office

PhilHealth Service Office and Palliative Care Unit set up in Bulacan

Health organizations vowed to continue their fight against inadequate health budget

Philhealth and NSO Public service in Caloocan

"I don't know anyone to blame except me" says Former Health Secretary Romualdez on health gap

Price hike facing PhilHealth premiums

PhilHealth implements e-Claims Project

PhilHealth has announced the Phase I implementation of the e-Claims Project in its recently released PhilHealth Circular No. 014 s-2011. The project promotes and enables online connection of hospitals and healthcare facilities to PhilHealth which will eventually lead to online submission of claims. Through the Claims Eligibility Web Service (CEWS), hospitals and health care facilities may now directly verify eligibility status of PhilHealth members and dependents using their own system.

The CEWS aims to:

• Speed up the eligibility verification of the hospitals;
• Reduce Return-to-Sender (RTS) claims due to member eligibility issues/problems.

The web service shall facilitate the verification of the following areas:

• Existence of the PhilHealth member;
• Qualified dependents;
• Qualifying contributions;
• 45-days limit for room and board of members and/or dependents.

Requirements in Connecting to the CEWS:

• The hospital or facility must have an existing hospital information system;
• Internet connection;
• Capacity to modify existing hospital information system or develop a prototype to connect to PhilHealth through the CEWS.

For additional information, please refer to the circular.

All hospitals or facilities interested in participating in the e-Claims Project may submit a written expression of interest to PhilHealth.

PhilHealth Run

Watsons special discounts to PhilHealth members

PhilHealth TV Ads: Reasons To Enroll

Duties and Responsibilities of a PhilHealth Member

The duties and responsibilities of a PhilHealth member are:

Have in possession at all times your PhilHealth Number Card or Identification Card;

It pays to be prepared in emergency situations such as accidents or illness. Members should always have their PhilHealth ID card or PhilHealth number card ready for presentation at the accredited health care provider to prevent delay in the availment of benefits.

Update your Member Data Record (MDR) for any change in personal information such as change in civil status or addition of a new dependent;

The Member Data Record is a document required during availment of PhilHealth benefits or claiming reimbursement. Members should keep the MDR up-to-date to prevent any inconsistency from being reflected in the MDR. The address in the MDR will be used to send the check payment and any other correspondence that will be issued by PhilHealth. There are instances when health care providers will require that the name reflected in the MDR be the same with their records in order to automatically avail the benefits and others such cases.

Request for a replacement in case of loss of PhilHealth Number Card or Identification Card;

This is in reference to the first discussed responsibility of a PhilHealth member where the PhilHealth Number Card or Identification Card should always be made available as this will be presented to the health care provider when undergoing an emergency admission or surgery. Members should not wait for the need to arise to get a replacement of their lost PhilHealth number card or identification card.

Ensure that you promptly and regularly pay your contributions (for individually paying members and Overseas Workers Program members) to avoid suspension of benefits;

Individually paying members should have a qualifying contributions in order to avail PhilHealth benefits. Moreover, some benefits require nine monthly contributions within a twelve month period prior confinement to avail the benefit, hence, if the member should miss payment for a given quarter or period, this will affect the availment of the benefit. This is the same with OWP members. Although OWP members are covered within their validity period and do not require qualifying contributions, continuous coverage or validity period should be ensured for uninterrupted eligibility for benefits.

For newly hired employees, check if your name is reported by your employer to PhilHealth in the ER2 Form (Report of Employee-Members);

The ER2 form is being submitted by the employers to PhilHealth which is basically a list that certifies the employees of the company. It should also be noted that the date of employment is required information that should be reflected in the ER2. The ER2 will serve as the baseline of the employer in the preparation of their monthly remittance report. Employed members should ensure that their employers have included their names in the ER2 and have properly reported it to PhilHealth as this serves as protection of the employees from employers that are not remitting their premium contributions to PhilHealth.

Ensure that your monthly premium contributions are deducted from your salary and promptly remitted and reported by your employer to PhilHealth;

Every month the employers are submitting a monthly remittance report which includes all employees and corresponding premium contributions that have been deducted. This report is used by PhilHealth to post the contributions to the employees' member accounts. Hence, employees should keep their payslips reflecting premium contribution deductions as this will serve as proof of deduction which may be presented to PhilHealth if a discrepancy in the number of contributions was found.

Report to PhilHealth at once an employer who does not remit premium payments;

Employers are mandated by law to deduct PhilHealth premium contributions and it is also the responsibility of the employer to report the members that have been deducted and how much premium contribution each employee has paid. Hence, if an employee found out that their employer is not remitting their premium payments, PhilHealth should immediately be notified so that they may coordinate with the employer.

Ensure that you have sufficient qualifying contributions to avail of PhilHealth benefits anytime;

Members should not start paying or continue payment when they are expected to use or avail PhilHealth benefits, it should be done regularly.

Secure an updated list of accredited facilities from any PhilHealth office wherein you can avail of benefits;

This is similar to the health management organizations (HMO) where they are providing a list of accredited partners in which the members may be able to go to. It is the responsibility of the member to keep in mind the available health care facilities and hospitals that they may go to in case of illness to prevent denial of PhilHealth benefits.

Others are:

• Submit a properly and completely filled-up PhilHealth Claim Form 1 to the hospital and ensure that all the information you stated in the said form are true and factual;

• Ensure that you properly and completely submit all the necessary documents to the hospital including a copy of your Member Data Record (MDR) to avail of PhilHealth benefits;

• Clarify with providers (hospital/doctor), the appropriate and final benefits deducted upon settlement of bills and charges;

• Ask for a copy of your Statement of Account/Billing Statement from the hospital upon discharge;

• Ask for an Official Receipt (OR) and Waiver from the hospital and doctor for payments made in full;

• Ensure that your claim, if opt for direct filing, is filed at PhilHealth within sixty (60) days from the date of discharge for local confinements and within one hundred eighty (180) days for confinements abroad;

• Be aware of amendments and updates on PhilHealth policies and benefits schedule;

• Seek clarification from any PhilHealth office on any unclear policy or guideline;

• Report at once to PhilHealth any hospital that fails, without valid reason, to accommodate a PhilHealth member who wishes to avail of benefits;

• Report at once to PhilHealth any fraudulent transactions that you know about;

• Observe and comply with PhilHealth rules and regulations as there are offenses in its Implementing Rules and Regulations that a member may be held liable for.

We hope that members are guided accordingly in order to prevent any negative experiences from occurring when transacting with PhilHealth.

Source: http://www.philhealth.gov.ph/forms/others/member_duties.pdf

PHILHEALTH RUN: Run for Hope

Tripartite Manifest of the PMA, PHAP, PHA on PhilHealth Circular 011-2011

Letter of PMA, PHAP, PHA to PhilHealth re: No Balance Billing

Availing PhilHealth Benefits for Direct Filing of Claims

Eligibility for Direct Filing:

• You have paid the hospital and doctor's fee in full (without PhilHealth benefit);
• You have the required number of premium payment (for employed and individually paying members) or date of availment is within your membership coverage (for sponsored and ofw members). Lifetime members are eligible to avail PhilHealth benefits and need not pay premiums;
• The hospital/facility is accredited from the time of confinement/admission;
• The doctor is accredited from the time of confinement/admission.

Documents Required to Submit:

• Fully accomplished and original PhilHealth Claim Form 1;
• An updated Member Data Record (MDR) or required supporting documents;
• Waiver from the Hospital and Doctor/s specifying fees are paid in full;
• Official Receipts from drugs/medicines (purchased within confinement period), laboratory procedures, surgical procedures, hospital bills and doctor's fee;
• Fully accomplished and original PhilHealth Claim Form 2 (to be provided by the hospital/facility);
• Fully accomplished and original PhilHealth Claim Form 3 for confinement in primary hospitals or availment of maternity benefit;
• Operative record (if applicable);
• Hospital Statement of Accounts which contains breakdown of charges;
• Authorization or Special Power of Attorney (SPA) for transactions made through an authorized representative (immediate family member).

The Hospital may request for you to submit all receipts to prepare the PhilHealth Claim Form 2. Just provide them a photocopy of the documents they would need and do not give the original. Be sure to go back to the hospital to retrieve the Claim Forms and then submit the form and corresponding required attachments to the PhilHealth Office assigned to the area of the hospital. This should also be filed within 60 days from date of discharge. Ensure that the PhilHealth Claim Form 2 waiver portion for full payment is accomplished by the Hospital. You will need this to be reimbursed.

For inquiries on the status of your claim, you may call PhilHealth's call center or the PhilHealth Office - Claims Department.

Issuance of PhilHealth ID Cards and MDR to Employed Members

An official advisory has been released by PhilHealth informing the public that transactions for members belonging to the Private and Government Sectors should be facilitated by their respective Human Resource Departments (HRD).

Employees that are not yet registered with PhilHealth and those without PhilHealth Identification Numbers (PIN) should submit a fully accomplished PhilHealth Membership Registration Form (PMRF) with attached supporting documents:

• Clear copy of employee's birth certificate/baptismal certificate or one (1) valid ID;
• Clear copy of legal supporting documents of declared dependent/s such as birth certificate, marriage certificate and others as necessary.

Submit all the requirement to the HRD of the company you are in. They will in turn submit the documents together with the ER2 (Employer-Employee List) to PhilHealth. PhilHealth in turn will process your documents and forward your PhilHealth ID Card (PIC) and Member Data Record (MDR) to your office's HRD for distribution.

New employees whether newly employed or transferred who are existing PhilHealth members would just need to inform their current employer of their PhilHealth Identification Number (PIN) for the preparation of the Monthly Employer's Remittance Report (RF-1).

Source: PhilHealth Advisory No. 08-01-2011

One Dream. One Card.

Privileges Covered Under the I-PhilHealthy Card

In our previous post, we have not mentioned the details on the privileges that an I-PhilHealthy Card holder may get. This is because the privileges will expand as PhilHealth continues partnering with other private establishments to offer the members additional services through their tie-ups.

This post will enumerate the existing tie-up establishments and the corresponding privileges that they are offering to active PhilHealth members.

The I-PhilHealthy Card may be used in any of the following establishments:

• Watsons Personal Care Stores Phils. Inc.
• 15% discount for unbranded generic medicine products (both OTCs and prescription medicines);
• 10% discount on Watson's branded cosmetics;
• 10% discount on compliance packs;
• 5% discount on medical devices;
• 50-60% discount on Qualifirst products (*no minimum purchase required);
• Php380.00 flu vaccine (includes administration).
• Fresenius / FMC Renal Care Corp
• Reduced price of Php4,000.00 from Php6,700.00 for hemodialysis (in 18 outlets in Luzon and Visayas).
• PQ Healthshield
• 20% discount on vaccines.
• Rose Pharmacy Inc.
• 15% discount for unbranded generic medicines (both OTCs and prescription medicines);
• 5% discount for medical supplies and devices;
• 50-60% discount on Qualifirst branded generic drugs/medicines.
• South Star Drugstore
• 15% discount for unbranded generic medicine products;
• 5% discount for medical supplies and devices;
• 50-60% discount on Qualifirst branded generic drugs/medicines.
• Vivian Sarabia Optical Corp. (available at SM City North EDSA, Cubao, Megamall and Mall of Asia)
• Free eye exam;
• 20% discount for lenses and frames
• JNW Drug Testing Inc.
• 10% discount on drug testing services (at J & W sites)

Aside from the list of establishments where the I-PhilHealthy Cards may be used, below are the other partners that are helping in the implementation of the project.

• Qualifirst Health Inc.
• 50-60% discount on Qualifirst branded generic drugs/medicines through Watson's Personal Care, Rose Pharmacy and South Star Drugstores at no minimum purchase requirement.
• GlaxoSmith Kline (GSK)
• Provides Php380.00 flu vaccine (includes administration)
• Globe
• Provides text blasts;
• Use of LEDs in NCR;
• G-Cash premium payment.
• Smart Communications
• Provides text blasts;
• Inclusion in the SHINE project.
• United Laboratories, Inc.
• Shoulder the cost of Senior Citizen's Card.
• SM outlets
• Provides registration and collection services available in 307 sites nationwide.
• Bayad Centers
• Provides registration and collection services available in 1,067 sites nationwide.
• Prime IT Source
• Provides mobile and onsite registration services by schedule.
• e-Soluzione
• Provides e-premium cards;
• Mobile phone registration services;
• Dependent's ID Card;
• PhilHealth Sabado (remittance-by-air).
• All Cards Plastic Philippines
• I-PhilHealthy Cards for principal members.
• 1abx
• Provides point-of-sale (POS) machines for all merchants and phased-in implementation for providers.

Watch out for more partnering establishments to be included in this post.

PhilHealth Case Payment - The Hemodialysis Package

Another package offered under the Case Payment Scheme is the Hemodialysis Package for a total of Php4,000.00 with Php500.00 professional fee for every treatment inclusive in the package.

Coverage of Hemodialysis

• Covers all outpatient hemodialysis procedures with RVS code 90935;
• Includes payment per session for:
• Facility use and hemodialysis machine;
• Drugs and medicines (0.9% sodium chloride, heparin, bicarbonate or acetate hemodialysis solution, e-cart drugs and epoetin alfa or beta);
• Supplies and others (fistula kits, blood tubing set, dialyzet. syringe, and gauze).

Excluded in the package will be paid for through the fee-for-service scheme such as:

• Hemodialysis performed during hospital confinement;
• Other renal replacement therapy (e.g., CAPD, automated peritoneal dialysis);
• Emergency dialysis procedure for Acute Renal Failure (e.g., ARF secondary lo leptospirosis);
• Creadon of fistula for hemodialysis.

Source: PhilHealth Circular No. 011-B-2011

PhilHealth President Rey Aquino on Headstart

Getting the Fully Loaded PhilHealth Card with Privileges

It's all in the news. PhilHealth has recently launched its new PhilHealth card launched last September 5, 2011 at SM MOA. This card is packed with privileges in the form of discounts and other incentives offered by partner establishments. The new card known as the I-PhilHealthy Card is the first project under the Public Private Partnership Scheme that will be implemented by PhilHealth. Under this scheme, PhilHealth may engage in partnerships with private establishments or merchants which are interested in offering their services or providing product discounts and other incentives to PhilHealth members. Through this, PhilHealth members need not be confined, admitted or undergo surgery to avail PhilHealth benefits as they are able to avail the privileges offered by partner merchants.

Aside from the added value of the I-PhilHealthy Card, PhilHealth has also used this opportunity to facilitate and provide an easier means of enticing and getting new members into the program through the services of partner registration sites. With this, PhilHealth has enhanced public accessibility through the increase in the registration sites and collection windows towards the goal of universal coverage.

The PhilHealth ID Card and the I-PhilHealthy Card

The difference between the PhilHealth ID Card and the I-PhilHealthy Card is not only on the material used for the card. As shown in the illustrations of the card, the PhilHealth ID card can be considered a valid ID card due to the presence of the cardholder's picture not present in the I-PhilHealthy Card. The I-PhilHealthy Card is similar to the old card released by PhilHealth known as the PhilHealth Number Card (PNC) which only contains the PhilHealth Identification Number (PIN) and the name of the member. The I-PhilHealthy card is made up of PVC material, has a magnetic stripe and displays additional information such as the date of birth and sex of the cardholder.

Will the I-PhilHealthy Card replace the PhilHealth ID Card? The answer is no, PhilHealth will still be issuing the PhilHealth ID Card to its members who will request for it and both cards can be used in availing PhilHealth benefits. The I-PhilHealthy card is optional, meaning it is the choice of the member to obtain the card to avail the added value of being a PhilHealth member. Moreover, obtaining a PhilHealth ID Card is issued free of charge and applying for an I-PhilHealthy Card will have entail a minimal cost that will be borne by the member.

Who can avail of the I-PhilHealthy Card?

• Non-PhilHealth members. Individuals interested in becoming a PhilHealth member may obtain an I-PhilHealthy Card upon registration and a one (1) quarter payment of premium contribution. Employed individuals who have not yet been issued their PhilHealth number may also obtain the card through registration with PhilHealth;

• Existing members. Existing members (those who already have their PhilHealth numbers) in any category (private and government employees, OFWs, individually paying members, sponsored members and lifetime members) may obtain an I-PhilHealthy Card. Sponsored members should likewise apply for the card within the validity of their PhilHealth membership. Lifetime members shall be issued a "PhilHealth Gold Card" as provided by Unilab having the same privileges as that of the I-PhilHealthy Card.

• Dependents. All valid declared dependents may also obtain their own card. It should be noted that the available/offered privileges and discounts can only be enjoyed by the principal members, however, the dependent card can be presented to accredited health care facilities when availing PhilHealth benefits. A different material will be used for a dependent's I-PhilHealthy card which is somewhat similar to the material used in LRT and MRT cards.

Where to register/obtain the I-PhilHealthy Card?

• All SM outlets;
• All CIS Bayad Centers;
• Mobile and onsite registration through partnership with Prime IT Source.

The I-PhilHealthy Card is not available in any PhilHealth office, hence, you would need to go to any of the above registration sites.

As for mobile and onsite registration, members enrolled through this registration scheme will immediately be issued their corresponding I-PhilHealthy Card and members will be introduced to the National Health Insurance Program (NHIP) through the Information and Education Campaign being conducted. You may coordinate with your local barangays for the schedule of the PhilHealth onsite registration. We will also try to post or tweet the schedule if available. Moreover, you can request for an onsite registration by coordinating with the Marketing and Collection Department (MCD) or the International & Local Cooperation Department (ILCD) of PhilHealth Central Office or through the PhilHealth Regional offices.

In addition, for existing PhilHealth members, the registration sites above will not process any amendment or changes to your membership record such as correction in your name or date of birth or change in civil status. They shall only be processing addition of your declared dependents. You would need to go to any PhilHealth office for this. Hence, if there are any discrepancy found in the information you have provided upon application and the information provided by PhilHealth, your transaction cannot be processed by the registration site. You would need to first correct or update your record with PhilHealth. So to prevent this from happening, ensure that you have an updated PhilHealth record before you apply for the I-PhilHealthy Card.

The SM outlets and CIS Bayad Centers are also accepting collections or payments of your premium contributions particularly for individually paying members. They shall be accepting card and registration applications starting on September 16, 2011 within NCR and the rest of the branches will follow. You may ask directly with the SM and Bayad Centers nearest you for their exact implementation schedule.

What documents are needed to apply for an I-PhilHealthy card?

• Non-PhilHealth member. Unemployed and employed members not yet registered with PhilHealth (those without PhilHealth numbers) will be required to submit a fully accomplished PhilHealth Membership Registration Form (PMRF) with attached supporting documents for the principal member and declared dependents. Required documents are listed in the 2nd page or back page of the PMRF. For employed non-PhilHealth members, attach an ER2 to be provided by your employer;

• Existing Members. Existing members should submit an accomplished PMRF (write your PhilHealth number, name and date of birth along with the information of your dependents that will be issued their dependent card) with attached supporting documents for newly declared dependents. You can read our post on who can be declared or recognized as a valid dependent. For employed or individually paying members, photocopy of existing PhilHealth ID Card (PIC) or PhilHealth Number Card (PNC). In lieu of the PhilHealth card you may submit a photocopy of any valid ID. For OFWs, bring photocopy of your existing PhilHealth ID Card or e-receipt, a Member Data Record (MDR). OFWs may also apply for the card through authorized representatives (next of kin), just in case provide an authorization letter. For members under the lifetime membership program (pensioners, retirees and others), bring a photocopy of your Lifetime Membership Program Card. For sponsored members, bring photocopy of your PhilHealth ID Card (with effectivity);

Bring the original documents and IDs to be presented to the registration sites, however, you will only be required to submit the photocopies / xerox copies.

How much will be the cost for the Card?

• Non-PhilHealth member. New registrants shall pay a total of Php360.00 when applying in SM outlets (distributed as Php50.00 for registration and card fees, Php300.00 for one quarter payment and Php10.00 collecting fee) or Php358.00 in CIS Bayad Centers (comprising of Php50.00 for registration and card fees, Php300 for one quarter payment and Php8.00 collection fee);

• Existing member. Existing members with active coverage or payments only needs to pay the Php50.00 registration and card fees. However, inactive or non-paying PhilHealth members may also pay their premium contributions in the registration sites plus the corresponding collection fee;

• Dependents. When the principal member applies for the card, two (2) of his/her dependents will be issued their own I-PhilHealthy Card free of charge. The member may opt to provide all his/her declared dependents with their individual card in excess of the two free dependent cards for a corresponding fee. We will be posting the fee once the official advisory comes out.

How to use the I-PhilHealthy Card

There is no need to activate the card and the member is eligible to avail the privileges as long as the member is actively or regularly paying the corresponding premium contributions. The I-PhilHealthy Card of the principal member can be used to avail privileges in the form of discounts or incentives offered in any partner merchants.

Discounts offered is not on top of the 20% Senior Citizens Discount, hence Lifetime Members should choose which discount to use when transacting with the partner establishments.

The partner merchants may require you to present a valid ID when availing the privileges to ensure your identity.

Who are the partner merchants / Where can you use the I-PhilHealthy Card (a separate post will be provided to list all services and privileges being offered)

• Qualifirst Health Inc.;
• GlaxoSmith Kline;
• United Laboratories, Inc.;
• Watsons Personal Care stores;
• Fresenius/ FMC Renal Care Corp.;
• PQ Health Shield;
• Rose Pharmacy Inc.;
• South Star Drugstore;
• Vivian Sarabia Optical Corp.;
• J&W Drug Testing, Inc.;
• SM outlets;
• CIS Bayad Centers;
• Prime IT Source;
• e-Soluzione;
• 1abx;
• All Cards Plastic Philippines;
• and more to come...

Mechanics in Applying for an I-PhilHealthy Card

• The member will go to any registration site and submit the needed documents;
• The Partner Registration Facility (PRF) shall verify the completeness of the documents;
• The PRF shall encode all needed information from the PMRF into the system;
• The PRF will ask you to confirm correctness of encoded / retrieved information. For existing members, you will be informed to coordinate with PhilHealth if there is any discrepancy found in your record. The discrepancy should first be resolved in order to be issued an I-PhilHealthy Card;
• Once member information is confirmed the PRF will generate a PhilHealth number and encode the two dependents, generate a PhilHealth number for the dependents for the issuance of their own free dependent cards. You may ask the PRF to encode more than two dependents for issuance of the PIN and dependent card at a given cost;
• The PRF will provide a claim stub for the claiming of the I-PhilHealthy Card. The stub also contains the date when the card can be picked-up which is at least two (2) weeks from the date of your application. The I-PhilHealthy Card can be claimed at the site where you have registered or lodged an application;
• The PRF will forward unclaimed cards after one year of issuance to corresponding PhilHealth branches. Hence you would need to coordinate with the PhilHealth Office to claim your I-PhilHealthy Card. Call any PhilHealth office near your area on what branch you can claim the card. PhilHealth might also mail the card based on the address in your membership record.

Replacement of Lost / Stolen Card

• Submit an Affidavit of Loss, a request letter for replacement and the documentary requirements for existing members. You will be required to pay for the Php 50.00 registration and card fee and may claim the replacement card at the registration site you have filed your request.

In our personal opinion, since the I-PhilHealthy Card might not be considered a valid ID card by other institutions or establishments due to the unavailability of the cardholder's picture, it is therefore recommended that you hold onto or request for a PhilHealth ID Card. This is especially recommended for those individuals who do not own an ID card since they will need one for transacting with PhilHealth or encashing of check payment issued by PhilHealth (for directly filed claims).

As PhilHealth has not yet released an official advisory or Circular on these, the information contained here will be updated based on the final information release from PhilHealth. So keep checking back on this post for updates.

New PhilHealth Card

For info on the new I-PhilHealthy Card, read our post here.

PhilHealth Outpatient Anti-Tuberculosis Directly Observed Treatment Short-Course (TB-DOTS) Benefit Package

The Anti-Tuberculosis Directly Observed Treatment Short-Course or more commonly known as TB-DOTS is a benefit package under the case payment scheme being implemented by PhilHealth since 2003. The said benefit amounts to Php 4,000.00 per case where payment of Php 2,500 will be given after completion of the intensive phase and the remaining Php 1,500 at the end of the maintenance phase.

Eligibility requirements for utilization of this package are:

• All primary members and valid dependents who meet the required number of premium contributions for employed and individually paying members;


• All primary members and valid dependents whose enrollment in the DOTS center is within the coverage or validity period of membership effectivity for sponsored, lifetime and Overseas Filipino Workers (OFWs);


• Treatment of new cases of pulmonary and extrapulmonary tuberculosis for children and adults. New cases denotes that a patient has never had a treatment for TB or taken anti-tuberculosis drugs for less than one month.

PhilHealth shall not pay for:

• Failure case;


• Relapse case;


• Return after default (RAD) case;


• Additional services or extension of treatment.

Outpatient Services covered for the package:

• Diagnostic work-up;


• Consultation services;


• Anti-TB drugs.

Documents required by PhilHealth:

• Claim Form 1;


• Claim Form 2;


• NTP Treatment Card (to be submitted upon registration to TB Management Information System and an updated NTP card upon claiming of benefit).

Date of filing: 60 days from end of every treatment phase

Payable to: PhilHealth accredited TB-DOTS facility

Submit to: Any PhilHealth office corresponding to your area

Other references:

1. PhilHealth Circular No. 19 s-2003


2. How to fill-out the Claim Forms


3. TB-DOTS Benefit

PhilHealth Benefit Packages - Case Payment Rates

This post contains a list of benefit packages, under the case payment scheme, that are available to active PhilHealth members.

Name of Benefit Package	Case Rate (Php)
Maternity Care Package (MCP)	6,500.00
Normal Spontaneous Delivery (NSD) Package	6,500.00
TB-DOTS Package	4,000.00
SARS Package	50,000 - 100,000
Avian Influenza Package	50,000 - 100,000
New Born Care Package (NCP)	1,000.00
Bilateral Tubal Ligation (BTL) Package	4,000.00
Vasectomy Package	4,000.00
Malaria Package	600.00
Influenza A (H1N1) Package	75,000 - 100,000
NSD with BLT Package	10,500.00
Outpatient HIV / AIDS Treatment Package	30,000.00
Dengue I (dengue fever and DHF Grades I and II)*	8,000.00
Dengue II (dengue hermorrhagic fever grades III and IV)*	16,000.00
Pneumonia I (moderate risk)*	15,000.00
Pneumonia II (high risk)*	32,000.00
Essential Hypertension*	9,000.00
Cerebral Infarction (CVA I)*	28,000.00
Cerebro - vascular Accident with Hemorrhage (CVA II)*	38,000.00
Acute Gastroenteritis (AGE)*	6,000.00
Typhoid Fever*	14,000.00
Asthma*	9,000.00
Cesarian Section (CS)*	19,000.00
Dilatation and Curettage (D&C)*	11,000.00
Hysterectomy*	30,000.00
Mastectomy*	22,000.00
Appendectomy*	24,000.00
Cholecystectomy*	31,000.00
Herniorrhaphy*	21,000.00
Thyroidectomy*	31,000.00
Radiotherapy*	3,000.00
Hemodialysis*	4,000.00
Cataract Package*	16,000.00

* PhilHealth will be directly paying the health care facility inclusive of the professional fee, hence, this is directly deducted to the bill of the eligible PhilHealth member. Will also take effect for claims with admission date September 1, 2011.

This list will be updated once additional benefit packages become available. We shall also be discussing each of these packages in detail in succeeding posts so stay tuned.

What is a PhilHealth MDR (Member Data Record)?

Whenever you need to avail of your PhilHealth benefits, you will always be asked to provide the health care institution (hospital) a copy of your MDR to be attached to the claim forms. For those who are new to the term, an MDR, short for the Member Data Record is a system-generated document being issued by PhilHealth as a primary attachment to the Claim Form 1.

What does the MDR contain?

The document contains the member's basic information such as the PhilHealth Identification Number, full name, address (local and/or foreign), civil status, date of birth, contact information and for those employed or under the KaSAPI Program the PhilHealth number, name and address of the employer or organized group is reflected.

Aside from the basic information of the member, a list of valid dependents (with their complete name, birth date and other info) who may avail PhilHealth benefits are also displayed along with payment information for OFW members and the validity or effectivity date for sponsored members.

What is the purpose of the document?

With the release of PhilHealth Circular No. 07 s-2007, the Member Data Record (MDR) was made a primary document for claim applications which aims to:

• Reduce incidents of returned claims due to lacking supporting documents;
• Lessen claims that are doubtful in nature.

In addition to this, prior the implementation of the MDR requirement, members are required to submit supporting documents (e.g. birth certificate of dependent who was confined, marriage contract etc.) to be attached to their claim form in order to avail PhilHealth benefits. Supporting documents are necessary for PhilHealth to establish the relationship of the member and the patient or the person that was confined to prevent unauthorized usage of the member's annual 45-days allowable period. Hence, there is no need for a member with an updated MDR to attach several supporting documents to avail PhilHealth benefits as hospitals may refer to the MDR to establish the relationship of the patient to the member.

What to do if you are not able to get the document?

Although the MDR is a primary document, PhilHealth does not say that a member cannot avail benefits if this document was not provided. For those members that are unable to provide the MDR, the corresponding supporting documents must be attached to the claim forms in order to avail the benefits.

Where do you get this document?

Any PhilHealth Office (with system access) can provide or issue the MDR.

For purposes of consistency and to prevent any problems during availment of benefits, ensure that the MDR is always updated. To update your PhilHealth record refer to this post "How to Update Your Membership Record with PhilHealth".

Directory: Accredited Hospital Under PhilHealth Regional Office Batangas

Accredited hospitals listed below with their corresponding accreditation period are under the area of jurisdiction of PhilHealth Regional Office IV B - Batangas City, hence, submission and processing of your claim applications will be handled by this PhilHealth Branch. To know the status of your claim, you may coordinate with their Claims Section.

• Asumpta Medical Hospital (Level 1), to expire on April 30, 2012;
• Batangas Health Care Hospital (Level 3), to expire on April 30, 2012;
• Batangas Regional Hospital (Level 4), to expire on April 30, 2012;
• Bauan Doctors General Hospital (Level 3), to expire on April 30, 2012;
• Calatagan Medicare Hospital (Level 1), to expire on April 30, 2012;
• Central Azucarera Don Pedro Hospital (Level 2), to expire on April 30, 2012;
• Daniel O. Mercado Medical Center (Level 4), to expire on April 30, 2013;
• Divine Care Hospital (Level 2), to expire on April 30, 2012;
• Divine Love General Hospital (Level 2), to expire on October 31, 2011;
• Dr. Mario D. Bejasa General Hospital (Level 2), to expire on October 31, 2011;
• Dra. Araceli D. Mendoza Memorial Medical Clinic (Level 1), to expire on April 30, 2013;
• Golden Gate General Hospital (Level 3), to expire on April 30, 2012;
• Gonzales Medical & Children's Hospital (Level 2), to expire on April 30, 2012;
• H.M. Corachea General Hospital (Level 2), to expire on April 30, 2012;
• Hospital De San Juan Bautista (Level 2), to expire on April 30, 2012;
• Laurel Memorial District Hospital (Level 2), to expire on April 30, 2012;
• Lemery Doctors Medical Center (Level 3), to expire on April 30, 2012;
• Lipa City District Hospital (Level 2), to expire on April 30, 2012;
• Lipa Medix Medical Center (Level 3), to expire on April 30, 2014;
• Little Angels Medical Center (Level 1), to expire on April 30, 2012;
• Lobo Municipal Hospital (Level 2), to expire on April 30, 2012;
• Madonna General Hospital (Level 2), to expire on April 30, 2012;
• Mahal na Virhen Maria Sto. Rosario District Hospital (Level 2), to expire on April 30, 2013;
• Martin Marasigan Memorial Hospital (Level 2), to expire on April 30, 2012;
• Mary Mediatrix Medical Center (Level 4), to expire on April 30, 2013;
• Metro Lemery Medical Center (Level 3), to expire on April 30, 2013;
• Metro Lipa Medical Center (Level 3), to expire on April 30, 2012;
• Metropolitan Medical Center Nasugbu Branch (Level 2), to expire on October 31, 2011;
• N.L. Villa Memorial Medical Center (Level 3), to expire on April 30, 2012;
• Our Lady of Caysasay Medical Center (Level 3), to expire on April 30, 2013;
• Palma-Malaluan Hospital (Level 2), to expire on April 30, 2012;
• Queen Mary Hospital (Level 2), to expire on April 30, 2012;
• Saint Andrew Hospital (Level 2), to expire on April 30, 2012;
• Saint James the Greater General Hospital (Level 2), to expire on April 30, 2012;
• Saint Patrick's Hospital Medical Center (Level 4), to expire on April 30, 2012;
• Saint Vincent De Paul Hospital (Level 2), to expire on April 30, 2012;
• Salazar Polyclinic (Level 2), to expire on April 30, 2012;
• San Jose District Hospital (Level 2), to expire on April 30, 2013;
• San Juan District Hospital (Level 2), to expire on October 31, 2011;
• San Juan Doctors Hospital (Level 2), to expire on October 31, 2011;
• Santo Tomas General Hospital (Level 2), to expire on April 30, 2012;
• Silva's Medical Clinic (Level 1), to expire on April 30, 2012;
• Sto. Rosario Hospital (Level 2), to expire on April 30, 2012;
• Taal Polymedic Hospital and Medical Center (Level 3), to expire on April 30, 2012;
• Untalan General Hospital (Level 2), to expire on April 30, 2012;
• Zigzag Hospital (Level 1), to expire on April 30, 2012;
• Abra De Ilog Municipal Hospital (Level 1), to expire on October 31, 2011;
• Occidental Mindoro Provincial Hospital (Level 2), to expire on October 31, 2011;
• San Sebastian District Hospital (Level 1), to expire on April 30, 2012;
• St. Martin's Mission Hospital (Level 1), to expire on April 30, 2012;
• Westmin United Doctor's Hospital (Level 1), to expire on April 30, 2012;
• Bongabong Community Hospital (Level 1), to expire on April 30, 2012;
• Bulalacao Community Hospital (Level 1), to expire on October 31, 2011;
• Children's Medical Clinic (Level 1), to expire on April 30, 2012;
• Gloria Medicare Hospital (Level 1), to expire on April 30, 2012;
• Grace Mission Hospital (Level 1), to expire on April 30, 2012;
• Hospital of the Holy Cross (Level 2), to expire on April 30, 2012;
• MMG Hospital & Health Services Coop. of Oriental Mindoro (Level 3), to expire on April 30, 2012;
• Oriental Mindoro Provincial Hospital (Level 2), to expire on April 30, 2012;
• Roxas District Hospital (Level 1), to expire on April 30, 2012;
• Sta. Maria Village Clinic (Level 2), to expire on April 30, 2012;
• Palawan Adventist Hospital (Level 3), to expire on April 30, 2012.

Previous accredited hospitals whose accreditation period has lapsed as per listing in PhilHealth website is no longer included in this post. This will be updated as soon as the other hospitals have renewed their accreditation period.

Ontario, Canada-based OFWs PhilHealth Payment thru Mabini Express, Inc.

A PhilHealth Advisory has been issued informing the public that Overseas Filipino Workers (OFWs) based on Ontario, Canada may pay through the Mabini Express Inc., a tie-up of the Philippine Veterans Bank (PVB) with the following branches:

• Sheppard Centre (subway station)
• Location: 4841 Yonge St. Unit 133, 2nd Flr. North York Ontario (see map)
• Mabini Contact no: 416-222-1178
• Store hours: Mon-Wed (9:30am-7pm), Thu-Fri (9:30am-9m), Sat (9:30am-6pm) and Sun (11:30am-5pm)


• T & T Promenade
• Location: Prominade Circle, Thornhill Ontario M2N5X2 (see map)
• Store hours: Mon-Fri (9am-10pm), Sat-Sun (9am-10pm)


• T & T Milliken (Middlefield & Steels)
• Location: 5661 Steeles Avenue East, Scarborough Ontario M1V 5P6 (see map)
• Store hours: 9am-10pm


• T & T Ottawa (Hunt Club Rd. & Riverside Drive)
• Location: 224 Hunt Club Rd. Ottawa Ontario ON K1V 1C1 (see map)
• Store hours: 9am-10pm

The Official Receipt issued by the Mabini Express Inc. shall serve as your proof of payment for the paid applicable period. You would need to continue paying your premium contributions based on the current premium rate for the year prior end of your effectivity period. Please note that you would need to indicate your PhilHealth Identification Number (PIN). You may refer to the linked Advisory for the image of the official receipt.

Sample PhilHealth Request Letter

Due to numerous requests for a sample request letter that may be used for PhilHealth transactions, we have devised this template for requesting:

• Issuance of PhilHealth ID Card;
• Issuance of Member Data Record (MDR);
• Certificate of Premium Payment (CPP);
• Certification for lost payment receipt.

This is free to download and use, however, note that this template did not come from nor is it mandated or required by PhilHealth. The letter is in PDF format so you may need a PDF reader if your PC doesn't have one installed like Adobe Reader.

You may download the template here or click the image below.

Directory: Accredited Hospital Under PhilHealth Regional Office V - Legazpi

Accredited hospitals listed below with their corresponding accreditation period are under the area of jurisdiction of PhilHealth Regional Office V - Legazpi City, hence, submission and processing of your claim applications will be handled by this PhilHealth Branch. To know the status of your claim, you may coordinate with their Claims Section.

• Ago General Hospital (Level 3), to expire on April 30, 2012;
• Albay Doctor's Hospital (Level 3), to expire on April 30, 2012;
• Aquinas University Hospital Foundation Inc. (Level 3), to expire on April 30, 2014;
• Bicol Regional Training and Teaching Hospital (Level 4), to expire on October 31, 2011;
• Dr. Amando D. Cope Memorial Hospital (Level 2), to expire on April 30, 2012;
• Jaime B. Berces Memorial Hospital (Level 2), to expire on April 30, 2012;
• Lumbis-Rances General Hospital (Level 2), to expire on October 31, 2011;
• Rico's Hospital (Level 1), to expire on April 30, 2012;
• Leon D. Hernandez Memorial Hospital (Level 3), to expire on April 30, 2012;
• Our Lady of Lourdes Hospital (Level 3), to expire on October 31, 2011;
• Rosary of Virgin Mary Hospital (Level 1), to expire on April 30, 2012;
• Santissima Trinidad Hospital of Daet (Level 3), to expire on April 30, 2012;
• Naga City Hospital (Level 1), to expire on October 31, 2011;
• Ocampo Municipal Hospital (Level 1), to expire on October 31, 2011;
• Ragay District Hospital (Level 1), to expire on October 31, 2011;
• Salvacion Clinic (Level 1), to expire on April 30, 2012;
• San Jose Medicare Community Hospital (Level 1), to expire on October 31, 2011;
• St. Jude Clinic and Hospital (Level 1), to expire on April 30, 2012;
• St. Raphael Hospital (Level 1), to expire on April 30, 2012;
• Dr. Robosa Hospital (Level 2), to expire on April 30, 2012;
• Lourdes Hospital (Level 2), to expire on April 30, 2012;
• Our Lady of Mediatrix Hospital (Level 2), to expire on October 31, 2011;
• St. John Hospital (Level 2), to expire on October 31, 2011;
• Sta. Maria Josefa Hospital Foundation Incorporated (Level 2), to expire on October 31, 2011;
• St. John Hospital Inc. (Level 3), to expire on April 30, 2012;
• USI - Mother Seton Hospital (Level 4), to expire on April 30, 2012;
• Balud Municipal Hospital (Level 1), to expire on April 30, 2012;
• Cawayan Municipal Hospital (Level 1), to expire on April 30, 2012;
• De Castro Hospital Foundation Inc. (Level 1), to expire on April 30, 2012;
• Masbate Doctor's Hospital (Level 2), to expire on April 30, 2012;
• Masbate Provincial Hospital (Level 3), to expire on April 30, 2012;
• Donsol District Hospital (Level 1), to expire on April 30, 2012;
• Pantaleon G. Gotladera Memorial Hospital (Level 1), to expire on April 30, 2012;
• Prieto Diaz Municipal Hospital (Level 1), to expire on October 31, 2011;
• Irosin District Hospital (Level 2), to expire on October 31, 2011;
• Sts. Peter and Paul Hospital (Level 2), to expire on April 30, 2012;
• Dr. Fernando B. Duran, Sr. Memorial Hospital (Level 3), to expire on October 31, 2011;
• Sorsogon Med. Mission Group Hosp. and Health Services Coop. (Level 3), to expire on April 30, 2012.

Previous accredited hospitals whose accreditation period has lapsed as per listing in PhilHealth website is no longer included in this post. This will be updated as soon as the other hospitals have renewed their accreditation period.

Emailed Questions: PhilHealth Benefits for Outpatient Surgery

Would like to inquire what/how much are the benefits/rates I can get for the outpatient surgery from PhilHealth.

Surgeon, anesthesiologist, actual procedure, OR, etc.

I may need to undergo arthroscopic surgery.

Thanks.

Name withheld

---

We cannot give you the actual amount that you will receive from PhilHealth since it varies depending on a number of factors. However, you may use the benefit table here http://www.philhealth.gov.ph/forms/others/lifetime_benefits.pdf to compute for the approximate amount. Same PhilHealth benefits are being provided for all member categories.

Hope this helps.

PhilHealth 101

---

How about if I can be reimbursed even if the hospital is not yet accredited?

I read in the site:

What if the hospital is not accredited? Will I still get paid?

Claims of members confined in non-accredited hospitals shall not be compensated unless all of the following conditions are met:

Case is emergency as determined by PhilHealth

The hospital or facility has a current DOH license

Physical transfer/referral to an accredited facility is impossible as determined by PhilHealth.

The hospital PGH FMAB is still undergoing the Philhealth accreditation. Will I still be reimbursed even if they are not yet accredited?

---

If the hospital or doctor is not accredited PhilHealth may not reimburse the doctor's fee or the hospital charges. You can try to call the PhilHealth Office or call center for the status of the accreditation of your hospital or doctor. If you are to call the PhilHealth Office, directly look for the accreditation department and inquire the new accreditation period of your hospital. Moreover, if the hospital/doctor has submitted all required documents and PhilHealth approves the renewal, the start date of the accreditation period will be the date of submission of the document or the expiry date and since filing of the renewal application is before the expiration of the accreditation period, there is a chance of continuity of the accreditation and if this happens then you will be paid for hospital charges or professional fees.

PhilHealth 101

Note: Emailed questions may sometimes be edited for brevity and/or clarity.

Using the Electronic Premium Reporting System (EPRS)

This is in reference to our previous post introducing the new online reporting scheme implemented by PhilHealth last September 2010. The said scheme is used by employers in submitting their monthly remittance report (RF-1) containing a list of their employees and corresponding premium contributions that have been deducted.

For those who are already registered under the new scheme, you may download the user guide or user manual (in PDF format) through this link. You may also post or share your experiences on our Facebook page so that we may get your feedback.

For those employers who haven't already registered under this scheme, we recommend you to implement the online reporting scheme as the report will be automatically processed and recorded in PhilHealth's database, hence a timely updating of your employee's premium contributions. Access to the status of your submitted online reports are also provided in this facility.

Continuing PhilHealth Coverage for Separated Employees

This post is intended to guide newly separated employees on how to continue being eligible to receive PhilHealth benefits. There are two ways by which you may continue your PhilHealth coverage, the first is by becoming a qualified dependent of an active PhilHealth member and the second is by continuing your coverage by being a contributing member under the Individually Paying Program of the Corporation.

Continuing Coverage as a Qualified Dependent

You will need a certification from your previous employer that you are no longer connected with them. This will be used by PhilHealth as basis to deactivate your member record and facilitate your coverage as a dependent.

For married individuals, if your spouse is an active PhilHealth member, you may enroll under your spouse as a valid dependent. Your spouse should fill-out the PhilHealth Membership Registration Form (PMRF) reflecting you as a dependent, attach a copy of your Marriage Certificate, your birth certificate and the certification from your previous employer.

For single individuals, if you are already 21 years old or above, you can no longer be covered as a dependent of any of your parent. If you are however below 21 yrs old and unmarried, any one of your parents (not both) may declare you as a dependent. They would need to fill-out the PhilHealth Registration Form (PMRF) reflecting you as a dependent and attach your birth certificate and the certification from your previous employer.

If you cannot be covered as a dependent, then you may choose to be a contributing PhilHealth member under the Individually Paying Program.

Continuing Coverage as an Individually Paying Member

To prevent creating a gap with your coverage, you should immediately begin paying the premium contribution as a voluntary member of PhilHealth. It is important for you to know your PhilHealth Identification Number (PIN) as this will be used when paying the contributions. To know more, please read these posts:

• Knowing my PIN through contacting the Call Center
• How much should I pay?
• When is the deadline for payment?
• What do I need to pay my contributions?
• Where do I pay my contributions?

You should also ensure that you have an updated membership record with PhilHealth so that if you would be needing your Member Data Record (MDR), there will be no inconsistencies with your profile.

• When should you update your PhilHealth records?
• How to update your membership record with PhilHealth?

Additional Information

We strongly recommend that you immediately continue your coverage so as not to hamper your eligibility to avail of PhilHealth benefits by being a qualified dependent or continuing to be a contributing member.

Moreover, we would like to stress that for married individuals, you may be able to maximize your PhilHealth benefits by both becoming a contributing member. As a contributing member, you may both declare each of your parents (aged 60 years old and above), and if you have more than one child, for example four children, then you may each declare your two children to maximize the 45-days allowable limit shared by your dependents. This would mean a wider PhilHealth coverage for your family.

PhilHealth Maternity Benefits

Since Nov. 1, 2009, PhilHealth has been giving the following benefits for all normal spontaneous deliveries performed in accredited hospitals/lying-in clinics:

P2,500.00 - Hospital (room and board, drugs and medicines, laboratories, supplies, ancillary procedures, other medically necessary charges);
P2,500.00 - Physician (actual deliver, immediate postpartum care, counseling);
P1,500.00 - Prenatal care.

Total benefit amount is P6,500.00.

Note that this applies only the first four (4) low-risk normal spontaneous deliveries.

The basis for this revised maternity benefit package is Circular No. 39, s. 2009 pursuant to PhilHealth Board Res. No. 1282, s. 2009.

You can read PhilHealth's media release regarding this benefit package here.

Disclaimer - A Reiteration

We would just like to reiterate that this blog and it's associated Facebook account, Facebook page, and Twitter account are NOT officially sanctioned by the Philippine Health Insurance Corporation.

This is a PRIVATE blog, plain and simple. We do not get paid to do this, we do not receive any support from PhilHealth, we do this on our own time, using our own resources, on our own internet connections...which tend to be flaky every now and then. We also have jobs and other responsibilities, so we get to do this only during breaks, or after the day's work has been completed.

It just turns out that we have some knowledge of the National Health Insurance Program and it's benefits and other activities, arising from experience, prior knowledge and from inputs from some of our friends who are directly connected with the program.

Unfortunately, PhilHealth is a bit old-fashioned, preferring to stick with traditional media such as newspapers, television and radio. Most of us are now aware that traditional media is no longer sufficient to address the needs of a significant number of Filipinos, especially those who now turn to the internet for most of the media they consume, particularly social networking sites like blogs, Facebook, and Twitter.

This is a niche that PhilHealth officially has not seen fit to exploit yet, despite the vast numbers of Filipinos it could potentially reach.

So we thought to ourselves, if PhilHealth is a bit slow in embracing the new social media...why don't we do it ourselves? Hence we came up with this blog, the Facebook and Twitter accounts. We find it rewarding to help people with their PhilHealth related concerns, especially since hardly anyone else is doing this in this manner.

We will continue to do this for as long as we find the experience rewarding, and there are people who need our help. Once PhilHealth officially makes it's presence on blogs, Facebook and Twitter known, maybe then we'll take a step back and let the professionals do their thing.

For now, we simply ask that our readers, friends and followers just put their expectations in check. WE ARE NOT PHILHEALTH. We are just doing our bit to help. If the help we provide is insufficient, you can always get directly in touch with PhilHealth via its official webpage, through its hotline at 441-7442, or though the closest PhilHealth office in your location.

We hope this clears up everything.

Suspension of the 9-over-12 Premium Requirement

A PhilHealth Advisory and PhilHealth Circular No. 09 s-2011 were released to inform the public of the suspension of the Nine (9) over Twelve (12) months premium requirement for availment of benefits that is supposedly due for implementation this July 2011 under PhilHealth Circular No. 25 series 2010.

Hence, employed and voluntary members may still avail PhilHealth benefits with only three months contributions within a six month period prior to the date of confinement. Availment of other benefits such as maternity package are still requiring 9-over-12 premium requirement for voluntary members.

Register Your Company with PhilHealth

Whether you own a new company or you're a new employer with household help, be sure to register with PhilHealth as an employer so that you could provide your employees with social health insurance coverage as administered by PhilHealth.

Below is your guide on how to register the company to PhilHealth.

Basic Documentary Requirements for private employers:

• Single Proprietorships:
• Business permit and/or license to operate;
• Department of Trade and Industry (DTI) Registration.
• Partnerships and Corporations:
• Business permit and/or license to operate;
• Securities and Exchange Commission (SEC) Registration.
• Foundation and Non-profit organizations:
• Business permit and/or license to operate;
• Securities and Exchange Commission (SEC) Registration.
• Cooperatives:
• Business permit and/or license to operate;
• Cooperative Development Authority (CDA) Registration.
• Backyard industries/ventures and micro-business enterprises:
• Business permit and/or license to operate;
• Barangay Certification and/or Mayor's Permit.

What to do?

• Fill-out the Employer Data Record (ER-1) Form in two (2) copies. You may download the form here;
• Attach the documentary requirements in the ER-1 form and submit to any PhilHealth Offices near you;
• When PhilHealth has finished processing your application, you will receive your PhilHealth Employer Number (PEN) and a copy of the Employer Data Record as well as the Certificate of Registration;
• Post your Certificate of Registration in your office as proof that you have been registration.

Preparing for PhilHealth Sabado 2 set on June 25, 2011

The Nationwide PhilHealth Registration Day (NPRD) or what is commonly known as "PhilHealth Sabado, Magseguro, Magparehistro" is a nationwide activity conducted by PhilHealth to fast-track the registration/enrollment under the National Health Insurance Program (NHIP). This is a continuing advocacy program which aims to provide an easier method for non-members of the NHIP to register and pay the one quarter premium contribution by putting up various registration sites aside from PhilHealth Offices that may be open to new registrants or existing members that will be updating their membership record.

With the success of the PhilHealth Sabado conducted last October 2, 2010, PhilHealth shall be conducting the same activity this coming June 25, 2011. If you are planning to join the event, we suggest you to:

1. Accomplish or fill-out the PhilHealth Membership Registration Form (PMRF) for new registrants and those updating their membership record. The PMRF can be downloaded here. Make sure that you entered your current and complete address including the name of your barangay;
2. Prepare the necessary supporting documents that you would need to attach to the PMRF such as birth certificates of you and your dependents, marriage certificate (if married), adoption papers of your parent/child (if applicable), annulment/separation papers (if applicable) and others. You may click here to know who you can declare as dependents;
3. Prepare the premium amount equivalent to a quarter payment for new registrants. You will only be given a PhilHealth ID Card once payment of at least a quarter is made. If you do not pay the premium, you will only be provided a copy of your PhilHealth Identification Number (PIN);
   
4. For requests on printing of PhilHealth ID Card / Member Data Record (MDR) please prepare the documentary requirements. For PhilHealth ID Card requests requirements are discussed in this post. For MDR requests, you might be asked to bring with you a request letter, photocopy of two (2) valid ID Cards;
5. Bring any valid ID Card to be presented during registration/updating.

Depending on the number of registrants and the connectivity of the registration site, there may be cases when your registration forms and attachments will only be received and your Member Data Record (MDR), Open Category Slips or PhilHealth ID Card will be mailed to the address you have provided after the backroom processing of your registration form. This will usually be done by PhilHealth to manage the number of transactions and to maintian a speedy process. Hence, you may take note of the date when the registration form is received and contact the Call Center to follow-up on your registration.