Employers: The PhilHealth Online Access Form (POAF)

The PhilHealth Online Access Form or POAF for short is used by employers to register or enroll in the Electronic Premium Reporting System (EPRS) or the PhilHealth-DepEd Text File Uploader System (DTFUS).

How can I get a copy of the POAF?

The POAF will be distributed to the employers during the conduct of training for the EPRS or DTFUS. Employers would need to fill-out the form with the corresponding information. Or you can click here to download the POAF. You will still be required to undergo training to be assigned an account to access the EPRS or DTFUS.

How to fill-up the POAF

Discussed from Left to Right.

• Name of Employer* = enter the complete registered name of the employer;
• PhilHealth Employer Number* = enter the number issued by PhilHealth upon registration of your company. If the registering office is a branch, the branch office should not use the PEN of the head office. Instead you may register first with PhilHealth to get your own PhilHealth Employer Number (PEN);
• Business Address* = complete address of the employer;
• Division Code / Station Code = this is used by the Department of Education to register corresponding offices. For other agencies just leave these blank. These are required for DepEd offices;
• Name and Position of Signatory* = the head of agency or the authorized representative of the employer;
• Signature* = of the signatory which grants approval to the user to access the EPRS or DTFUS in his/her behalf;
• Email address* = this is the email address of the signatory;
• Name and Position of User* = complete name of the authorized user;
• Email Address* = email address of user. This is required as the user account information will be sent in this email address;
• Account ID* = desired user name that will be used by the user;
• Mobile no. = Mobile number of the user. This may be used to contact the user relative to the user's account in the system.

* denotes required information and should not be left blank

For EPRS Use:

One POAF would correspond to one employer, hence in the case of a user handling or preparing reports of more than one employer, you would need to fill-out the POAF which corresponds to the number of employer accounts you have. Each employer should properly fill-out the Name and Position of Signatory and affix their signature signifying their consent to be represented by the user.

For previous users of the program which are no longer connected to the employer, the employer would need to fill-out a new POAF to register a new user. The previous user will be deactivated and a new password will be emailed to the new user.

OFWs: How to Avail PhilHealth Benefits (Local Confinement)

Are you currently out of the country and want to know how to avail your PhilHealth Benefits? Then read on.

Am I eligible to avail of PhilHealth Benefits?

1. You and your dependents are covered for one year per payment of 900.00 Php starting from the date of your payment. This is shown in your Member Data Record (MDR) provided by PhilHealth upon registration or updating of your membership record;
2. You have not exhausted the 45 days allowable period (explained here);
3. The hospital and doctor are accredited by PhilHealth;
4. Confinement period should not be less than 24 hours except in emergency cases;
5. The laboratory procedures, surgical procedures and medicines are compensable with PhilHealth; and
6. Claim is not within the single period of confinement (to be explained in succeeding posts).

The same is true for the other membership categories, except for item no. 1 where other categories would qualify if there is a 9 month contribution within a 12 month period prior confinement (starting July 2011).

Requirements for Local Confinement:

1. Automatic Deduction from Hospital

• Hospital may require you to present your PhilHealth Identification Card (PIC);
• Fully accomplished PhilHealth Claim Form 1 (PCF 1);
• Updated Member Data Record (MDR) or in case of undeclared dependents attached supporting documents such as birth certificate;
• Submission to the hospital's billing section the PCF 1 and MDR;
• Receipts for payment of the balance of the professional fees (should display amount deducted from PhilHealth);

Some hospitals would request you to submit the original receipts from medicines/drugs purchases, receipts for payment of laboratory and/or surgical procedures and doctor's fees for them to complete the PhilHealth Claim Form 2. Be sure to retain a photocopy of what you will give them and request for a copy of the Statement of Account from the Hospital. The receipts that was paid fully by you should be reflected in the Benefit Payment Notice as "Pay to Member" so that reimbursement will be directly made to you through check.

2. Direct Filing of Claims / Direct Reimbursement

• Payment of the hospital bill and doctor's fee in full;
• Disclaimer/waiver of full payment from the doctor/surgeon/anesthesiologist;
• All receipts from drugs/medicines (purchased within confinement period), laboratory procedures, surgical procedures and hospital bills;
• Fully accomplished and original PhilHealth Claim Form 1 (PCF 1) and an updated MDR;
• Fully accomplished and original PhilHealth Claim Form 2 (PCF 2) by the doctor's and hospital;
• Fully accomplished and original PhilHealth Claim Form 3 for confinement in Primary Hospitals;
• Operative Record (if applicable); and
• Hospital Statement of Account (this includes breakdown of charges).

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 Form 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.

PhilHealth Misses the Mark

An unflattering assessment of PhilHealth by Malaya can be found here:

'Conservative' and 'sluggish' PhilHealth misses healthcare target

We, in all our optimism, would like to think that this article is exaggerated, but unfortunately, according to a lot of insiders, most of the allegations mentioned have echoes of  truth ringing about them. Dare we say, some are even spot on.

Like the "loan shark SVP charging 3% a month". Honestly, a senior officer in any government office should never put himself or herself in a position to make money from his subordinates. It just doesn't seem ethical or moral. How can an officer claim to be objective in deciding or giving recommendations over money matters, such as, say, release of employee benefits, if he or she stands to personally gain or lose from such recommendation or decision?

"The president would rather travel than stay in the office". Not only would the president be unable to perform his functions if he is out of the office, government funds also tend to be wasted on  unnecessary travel expenses. I guess it isn't the just the general's wives who get to be jetsetters.

Maybe a Senate probe at this time may just be the shot in the arm that PhilHealth needs in order for it to clean up its act.

PhilHealth's 45 Days Allowable Period Explained

If you are wondering what PhilHealth means by this 45-days allowable period, then read on.

The 45 days period is the maximum number of days per year that a member will be allowed to avail of PhilHealth benefits. It's the same as the cap or ceiling being implemented in HMOs, only its in days and not in amount.

A separate 45 days period is being given to the declared dependents and all dependents will share this ceiling. So as long as the 45 days allowable period has not yet been consumed by the dependents, the member may still avail the PhilHealth benefits for confinement of one of the declared dependents. However, the member cannot use his own 45 days allowable limit in cases when the 45-days limit for the declared dependents is exhausted and vice versa.

So if you have a big family and you and your spouse are members of PhilHealth, come up with a plan on how to declare your dependents. If you have, lets say 2 children, then both members can declare one child so as to maximize the 45 days allowable period for the dependents.

However, please note that PhilHealth does not allow multiple declaration of dependents, meaning a child may not be declared by both parents or a parent may not be declared by more than one child. Also note that the 45 days allowable period is just another criteria for availment, there are other criteria such as your payment regularity (3/6 or 9/12), single period of confinement, compensable procedures and medicines and accreditation of providers. We'll try to explain them one by one in succeeding posts.

Alternatives for Availment of PhilHealth Benefits - Direct Filing

Did you know that there are two ways which we could avail of your PhilHealth benefits? You already know the most common method which is for the hospital and/or doctor to immediately deduct your PhilHealth benefits from their bills and then later the hospital and/or doctor would file a claim to PhilHealth reimbursing the amount deducted from your total charges. The not so common alternative is to pay the hospital and doctor's bill in full and then directly file the claim with PhilHealth - direct filing.

In practice, the direct file method is preferable if you are capable of paying your bills in full. This is because you can maximize the amount that you can reimburse from PhilHealth though it would still take the same processing time of 3 months before you can expect to receive a check from PhilHealth.

Do you know that in some cases, hospitals and doctors are not actually deducting the maximum amount of your benefit? This is a safety net for them as they are not certain if the medicines, procedures etc. will be slashed (reduced cost) or if you have fully used up your PhilHealth benefits. Then later they will reimburse the full amount from PhilHealth meaning they will reimburse more than they actually deducted from your bill.

How will you know that what they deducted from your bill is less than their actual reimbursement? You can validate this through the Benefit Payment Notice (BPN) that will be mailed every time a claim or request for reimbursement under your record is filed. This notice illustrates or details the amount paid to the hospital and/or doctor. You can use this to compare the amount that was deducted from your bill using the Statement of Accounts provided by the hospital and the actual amount the hospital/doctor received from PhilHealth as reflected in the BPN. You will know if the doctor or hospital maximized their deduction if the amount received matches with the deduction from your bill.

Now, what happens when the amount received from PhilHealth is more than the amount that was actually deducted from you? You can go to the hospitals to get the remaining amount or in cases when the hospitals have already returned the excess amount to PhilHealth, you can go to PhilHealth to claim your benefits. PhilHealth usually announces the claiming of refunds through a publication. The links below will take you to more information for this case.

• SunStar "Aquino: Keep those billing statements" contains additional guides.
• PhilHealth Circular No. 42, s-2009: Revised Provision for the Recovery and Disposition of the Unclaimed Refunds from Accredited Institutional Health Care Providers (IHCPs)
• PhilHealth Circular No. 14, s-2007: Granting of Reward for Information Leading to the Discovery and Recovery of Unclaimed PhilHealth Reimbursements

Take note, you should always have a copy of the Statement of Accounts and official receipts from the hospital and doctor and compare it to the mailed Benefit Payment Notice (BPN). Make sure that you have an updated member record, particularly your current address so that you will receive the BPN in your mailbox.

Email your questions!

Any questions regarding your PhilHealth membership? Your benefits? How to pay premiums? How to file claims? On what documents you need? Or just need practical advice on anything relating to PhilHealth?


Email us your questions at philhealth101@gmail.com.

We will be more than happy to feature your question on this blog and provide accurate and easy to understand answers to your PhilHealth concerns.

Alternatively, you can also try calling PhilHealth's Call Center.

Employers: Enroll under the Electronic Payment Scheme (ePAY)

The Electronic Payment System (EPS) also known as ePay is a mechanism introduced by PhilHealth since 2004 to allow the employers to remit their premium payments and submit a softcopy format of the Employer Remittance Report (RF-1) electronically through the accredited bank's online facility.

With this method employers must first prepare the remittance report and upload the report using the bank's online facility, after which the bank facility shall automatically deduct the total amount of premium to be paid from the bank account of the employer. PhilHealth will then download the remittance report submitted through the bank's online facility and process the report for posting of individual contributions. Through this facility, underremittance or overremittance will be minimized as the bank's system ensures that the correct total contribution amount will be deducted from the employer's bank account as payment to PhilHealth.

How to enroll under this scheme:

1. The employer should have its own PhilHealth Employer Number (PEN).

2. The employer must have an account in the ePay accredited bank.

3. The employer should conform to the layout of the RF1 softcopy. (Employers would need to contact the nearest PhilHealth Office for the guidelines on softcopy reporting.)

4. The employer needs to directly register with the ePay accredited bank.

The accredited banks implementing the ePay are:

1. Union Bank of the Philippines (OneHub)

2. Bank of the Philippine Islands (ExpressLink)

3. Citibank (CitiConnect)

4. Security Bank (Digibanker)

You have to go to the corresponding banks to enroll and you will be provided with an online user account that you would need to access their system. Additional banks may be registered under the ePay so stay tuned to this blog as we will post updates once new banks are enrolled.

Where Do I Pay my Premium Contributions?

If you were wondering where to pay your premium contributions aside from the PhilHealth Offices, check out the List of Accredited Collecting Agents below.

LOCAL

BANKS

• Allied Banking Corporation
• Asia Trust Bank
• Asia United Bank
• Asian Hills Bank, Inc.
• Banco de Oro - EPCI
• Bank of Commerce
• Bank One Savings and Trust Corp.
• Bukidnon Cooperative Bank
• Century Rural Bank, Inc.
• Century Savings Bank
• China Banking Corporation
• Citibank N. A.
• Citystate Savings Bank
• Country Rural Bank of Taguig, Inc.
• Development Bank of the Phils.
• Enterprise Bank, Inc.
• Export & Industry Bank
• Green Bank of Caraga (A Rural Bank)
• Gulf Bank (Rural Bank of Lingayen, Inc.)
• Land Bank of the Philippines
• Maybank of the Philippines, Inc.
• Metropolitan Bank and Trust Company*
• Money Mall Rural Bank, Inc.
• One Network Bank, Inc.
• Peninsula Rural Bank, Inc.
• People's Bank of CARAGA
• Philippine Business Bank
• Philippine National Bank
• Philippine Postal Savings Bank
• Philippine Veterans Bank
• Planters Development Bank
• Premiere Development Bank
• Producer's Rural Banking Corp.
• Progressive Bank
• RCBC Savings Bank
• Rizal Commercial Banking Corp.
• Robinson's Savings Bank
• Rural Bank of Bambang (NV), Inc.
• Rural Bank of Jose Panganiban (CN), Inc.
• Rural Bank of Sta. Catalina (Negros Oriental), Inc.
• Security Bank
• United Coconut Planters Bank

NON-BANKS

• CIS Bayad Center (see Branch List)
• Philippine Postal Corporation (for Regions 2, 4A, 4B, V, VI, VIII, X, XI & XII)
• E-Soluzione (thru the Remittance By Air Project)
• MLhuillier Phils. Inc. (Region VI only)
• LBC Express Inc.
• Local Government Units
• SM Branches (Cubao, Megamall, South Mall, Makati, North Edsa, Fairview and MOA)

- Region IV-A

> Calauag, Quezon
> Catanauan, Quezon
> Guinayangan, Quezon
> Perez, Quezon
> San Narciso, Quezon

> Tagkawayan, Quezon

> Unisan, Quezon
- Region IV-B

> Taytay, Palawan

- Region VIII

> Bato, Leyte

> Laoang, Samar

> Leyte, Leyte

- Region X

> Calamba, Misamis Oriental

> Initao, Misamis Oriental

> Kibawe, Bukidnon

- Region XII

> Banicilan, Cotabato Province

OVERSEAS

• Development Bank of the Philippines (tie-ups)
• Philippine Veterans Bank (tie-ups)
• i-Remit, Inc. (branches/tie-ups)

For Employers under the Electronic Payment Schemes (ePAY) refer to the next post.

Paying PhilHealth Premiums using your Mobile Phone

Do you know that individuals already registered as PhilHealth Members can pay their contributions using the load in your mobile phone?

Individually paying members no longer need to wait or stand in line in accredited banks in order to pay your contributions. And guess what, you can now pay on a monthly basis through this service and even view your contributions on the PhilHealth's website!

The service PhilHealth payment thru text also known as Remittance By Air, is open to all Smart and Talk n Text prepaid subscribers. You would need to have at least Php115.00 load to use the service. The Php100.00 will be for the PhilHealth premium and the Php15.00 transaction fee.

One phone can be used for payment of more than one registered member. Hence you may even pay for your loved ones contributions using one smart or talk n text SIM, you only need enough load to do this. Another innovation from PhilHealth in making payments more accessible to the public.

To use the service, follow these steps:

1. Type PHIC(space) PhilHealth Identification Number (PIN) and send to 7442. Ex. PHIC 123456789012
2. Validate the text that you will receive and if correct type PHIC YES to 7442.
3. Once you receive a health advisory and your reference number it means that payment has been sent.

The applicable month of payment will be based on the month you have used the service. So if you used the Remittance By Air this March, then you are paying for your March contribution. You may use the service anytime within April to pay for your April contribution and so on. You may find related info by clicking here.

If you have already used this service, tell us your experience by leaving a comment below.

Continuing as a PhilHealth Member

Are you a previous PhilHealth voluntary member or a previous employed member contributing to the program but are currently no longer paying the premium contribution? Do you want to continue being a PhilHealth Member and reactivate your PhilHealth account?

If you answer yes to these questions, then you can simply go on paying your succeeding contributions in order to reactivate your membership. PhilHealth does not offer any retroactive payments, hence in order to avail the PhilHealth benefits you would need to wait for 9 months worth of contribution out of 12 months before availment. Payments may be made in any PhilHealth Accredited Collecting Agents (see list) or you can pay directly to any PhilHealth office near you. You would need your PhilHealth Identification Number (PIN) prior payment so that you will be sure that your contribution will be credited under your name.

What will happen to my previous contributions? Your previous contributions will still be counted to determine if you will be eligible to enroll under the Lifetime Membership. You may qualify under this program once you reach the age of 60 and have 120 months of contributions. Under this program, you will no longer be required to pay the monthly premium (except in cases when you are still employed) but will still be able to avail of the PhilHealth benefits.

Also, ensure that you have an updated membership record in PhilHealth which includes your current contact information, updated dependent list and civil status. You can update your registered profile by filing out the PhilHealth Membership Registration Form (PMRF) and submit all supporting documents as required by PhilHealth.

Register with PhilHealth and be an NHIP Member

In these difficult times, more and more of Filipinos have realized the importance of being a member of the National Health Insurance Program (NHIP). Although as of now PhilHealth does not cover all medical expenses, it does provide significant financial aid. Health issues sometimes come unannounced and it would be great if there is assistance in lessening the financial burden of paying for medical services.

For only 100.00 pesos per month, you can be a member of PhilHealth under the Individually Paying Member - NonProfessional or a 200.00 pesos per month contribution for self-employed individuals such as practicing doctors, lawyers and others to be registered under the Individually Paying Member - Professional.

How can you be a member of PhilHealth?

1. Accomplish the PhilHealth Membership Registration Form (PMRF). Simply click on the link to download the form.
2. Submit the PMRF together with the required supporting documents. Primary documents for membership is you and your dependent's birth certificate and Marriage License for the declaration of your spouse. Other required documents may be seen in the PMRF form.
3. Once you are issued your PhilHealth Identification Number, you can pay the corresponding premium contribution for the current quarter to activate your membership.

You can also sponsor your loved ones that are not yet a member to provide them the health coverage you are getting. Simply ask them to fill-out the form and submit it to PhilHealth and you can start paying their premium using their corresponding PIN.

Moreover, do you know that as a contributing member, you are also helping our less fortunate countrymen avail of the NHIP? Protect others as you protect yourself and your loved ones from health financial burdens through the socialized health insurance model being implemented by the government.

To know more about becoming a PhilHealth member click here.

Prepare and Submit the PhilHealth Employer Remittance Report (RF1) Online using the Electronic Premium Reporting System (EPRS)

A new reporting scheme has been launched on October 1, 2010 enabling the online preparation and submission of the Employer’s Remittance Report (RF1) by using the Electronic Premium Reporting System (EPRS). The availability of the online reporting scheme was announced under Circular No. 30, s-2010 published on October 28, 2010 in the PhilHealth website.

The EPRS is a web-based application which facilitates not only the posting of individual premium contributions but also the assignment of the PhilHealth Identification Number (PIN) for unregistered members.

There are three (3) major advantages in using this scheme:

1. Facilitates the assignment of PhilHealth Identification Numbers (PIN) to unregistered NHIP members.

2. Faster posting of employee contributions as the report directly prepared by the employer will be automatically posted in the PhilHealth database upon PhilHealth validation.

3. Ensures that the total contributions of the report would tally with the actual payment made as the report will be prepared prior payment of contributions.

Requirements in using the EPRS:

1. The reporting employer should have its own PhilHealth Employer Number (PEN). The PEN will be issued to the employer once the employer registers with PhilHealth.

2. The employer should be directly remitting or paying to any PhilHealth office.

3. The period and amount of the report being prepared and that reflected in the receipt should be the same.

The employer would need to be trained in using the web-based application. You will be required to fill-out a PhilHealth Online Access Form (POAF). The user account will be electronically sent in the email address you specified in the form so be sure to provide a valid and active email address. To request for the training schedule, contact any PhilHealth office near you.

I just hope that this will be the starting point of PhilHealth in providing an easier means to access their services and that the infrastructure of PhilHealth is capable in maintaining this facility.

PhilHealth Call Center

PhilHealth recently unveiled its new call center to address the numerous calls and queries regarding PhilHealth services and benefits.

The access number is 441-7442. Outside Metro Manila, you may need to append the area code (02). Again, the access number for PhilHealth's call center is (02) 441-7442.

It is manned by ten customer relations agents, and is available weekdays from 8:00 AM to 5:00 PM.

Honestly speaking, I don't think this is nearly enough. If it were up to me, it would be open 24 hours a day, 7 days a week in order to address the PhilHealth concerns of members. Imagine someone rushing a loved one to the hospital during the wee hours of the morning with no one to talk to about their PhilHealth benefits. Sure, hospitals have their own designated PhilHealth officers. But the sad truth is sometimes these PhilHealth officers are not fully aware of the correct guidelines when availing of PhilHealth benefits...or worse, have their own procedures which may even be totally different from the actual ones.

Private hospitals are businesses first and foremost, meant to earn profit. Sometimes the procedures they give to the members are meant to benefit the hospital, and not necessarily the member.

Well enough about that, let's explore that aspect in a future post. For now at least, PhilHealth should be more accessible to members queries and concerns.

If you do try calling the hotline, let us know how it worked out for you. Feel free to enter whatever comments or observations you may have. We're pretty sure someone from PhilHealth will get to visit this blog sooner or later and pick up on your feedback...whether good or bad.

PhilHealth 101

This blog is our humble attempt to make the National Health Insurance Program understandable by the masses. From our experience, it would seem that a significant number of Filipinos are still unaware of PhilHealth and how it affects them personally. Things like how to be a registered member, the benefits PhilHealth offers, or how such benefits can be availed, among others, may seem arcane or convoluted to the average Juan, but all of these bits of information and procedures are really pretty simple if explained the right way...the easy to understand way.

Hence...PhilHealth 101.

This blog is not officially connected to, or endorsed by PhilHealth. As such, we cannot claim that the information we will be sharing here is 100% correct or accurate. However, we will try to provide the most accurate information we can, and perhaps toss in a constructive criticism or commentary here and there.

Perhaps, in this small way, we can help our fellow Filipinos, and even contribute to the continued success and growth of the NHIP.

Stay tuned.