When is the best time to transact with PhilHealth?

This post is intended to answer inquiries of some members on the office hours of PhilHealth or when is the best time to transact with PhilHealth.

Generally, you may transact with PhilHealth from Monday to Friday from 8:00 AM to 5:00 PM at any PhilHealth Office nationwide. The same office hours are also being implemented in the operation of PhilHealth's Call Center that can address your concerns through phone. PhilHealth Offices also comply with the legal and special holidays as declared by the government.

You should also avoid the periods below if you don't want to wait for a long time as there will be more persons transacting with PhilHealth during these periods:

• 10th day of the month - deadline of premium payment of employers;
• last day of the quarter - deadline of premium payment for individual members;
• 15th day of the month - deadline of submission of the employer remittance report.

Hopefully, you won't have too difficult a time transacting with PhilHealth. Also be sure to share your experiences with us through Facebook and/or Twitter so that we may help PhilHealth improve its services through your feedback.

Are doctors or hospitals allowed to directly deduct PhilHealth benefits from their fees?

Yes, doctors or hospitals are allowed to directly deduct PhilHealth benefits from their fees, (assuming they are accredited). However, this is not mandatory, hence members have the option to pay in full the doctor's fees or hospital charges and then directly reimburse from PhilHealth.

The doctor and the patient should come to terms with the following:

• Is the patient a PhilHealth member or dependent?
• How much is the doctor's fee (if not a PhilHealth member)?
• How much will be the PhilHealth deduction?
• Will the member opt to directly file reimbursement or will the member allow the doctor or hospital for the outright deduction or availment of PhilHealth benefits?

Please note that in the real world, physicians sometimes charge differently depending on whether the patient is a PhilHealth member or not, and sometimes, the deductions representing the PhilHealth benefits made by the doctor or the hospital do not reflect the maximum possible amount. For this reason, check the Benefit Payment Notice (BPN) that you will be receiving, You may use this document to validate if the amount deducted by the hospital and doctor tallies with the amount they received from PhilHealth. If the amount they received from PhilHealth is greater than the amount they have deducted, then you may request for a refund from the hospital and the doctor. If the balance was returned to PhilHealth you may contact the PhilHealth Office near you.

For other tips regarding availment of PhilHealth claims, you can read this blog post.

PhilHealth One Run for Health – June 11, 2011

How long does it take PhilHealth to process a claim?

Sixty (60) days.

If the claim is under investigation, it may take longer.

Reference: Sec. 3 j) R.A. 7875, Sec. 47 o., IRR of R.A. 7875

Can registration, PIN inquiry, viewing of contributions be done online?

Unfortunately, the answer at this time is no.

Online services are still not available for the following PhilHealth Services:

• Member registration or amendment/updating of member profile;
• Employer registration (currently in development through the DTI-PBR facility);
• Inquiry of contributions or premium payment;
• Inquiry on status of claim or benefit availment;
• Checking of existing PhilHealth Identification Number (PIN) (The previous mobile service is no longer available).

Online Services or Facilities that are available are:

• Electronic Premium Reporting System (EPRS) that facilitates the preparation and submission of the Monthly Employer Remittance Report (RF-1/RF1) online;
• PhilHealth-DepEd Textfile Uploading Facility that facilitates registration of DepEd employees and submission of the RF-1/RF1;
• eGroup System used by the organized groups such as the MFIs, Cooperatives and others participating in the KaSAPI Program which facilitates enrollment of their members and payment of their members' premiums.

We will be posting updates if the available online facilities change.

National PhilHealth Registration

Is PhilHealth coverage mandatory for all Filipinos?

Yes. Put another way, PhilHealth membership is compulsory.

SEC. 6. Coverage. - All citizens of the Philippines shall be covered by the National Health Insurance Program. In accordance with the principles of universality and compulsory coverage enunciated in Section 2 (b) and 2 (1) hereof, implementation of the Program shall, furthermore, be gradual and phased in over a period of not more than fifteen (15) years: Provided, That the Program shall not be made compulsory in certain provinces and cities until the Corporation shall be able to ensure that members in such localities shall have reasonable access to adequate and acceptable health care services. (underlining supplied)

Reference: Art. III, Sec. 6, R.A. 7875 

SECTION 4. Objective – It is the main objective of the NHIP to provide all Filipinos with the mechanism to gain financial access to quality health care services within the first 15 years of its implementation. Coverage of the employed members in the government and private sectors, individually-paying, retirees, and indigent families shall be ensured. (underlining supplied)

Reference: Title III, Rule 1, Sec. 4, IRR of R.A. 7875

Please note though, that membership and eligibility to avail of benefits are two different things. You may be a member, but if you are not paying your PhilHealth contributions with the required frequency, you are not eligible to avail of your PhilHealth benefits.

This applies to everyone who is employed, regardless if it is with the government or the private sector, or Overseas Filipino Workers (OFWs).

Individually Paying Members (IPMs) may or may not choose to register or pay premiums under the IPM program. If they choose not to, they are not eligible for PhilHealth benefits. It is strongly recommended that those qualified as IPMs register and pay their contributions.

Lifetime members need not pay as they are already retired and have already made at least 120 monthly contributions.

The contributions for those belonging to sponsored program are paid for by government or private entities.

For further information on who can enroll or register as a PhilHealth member, read this post.

Who can Enroll or Register as a PhilHealth Member?

This post aims to discuss the different types of membership programs of the National Health Insurance Program. PhilHealth members are divided into five (5) main categories broken down as follows:

• Employed;
• Individually Paying Members (IPM);
• Sponsored Members;
• Lifetime Members;
• Overseas Filipino Workers.

The Employed category are basically those individuals that are employed either in a private or government institution and are therefore further classified into Private/Government. Individuals under this category are enrolled in PhilHealth through the employers in compliance with the law.

Individuals that are classified under the Individually Paying Member (IPM) are those that are directly paying their premium contributions to PhilHealth and belong to either of the cases below. Participation under this scheme is voluntary.

• Professional individuals are those whose professions are included in this list;
• Non-professional individuals which include individual farmers and fisherfolk;
• Individuals who are separated from work;
• Parents not qualified as legal dependents, sponsored members or lifetime members;
• Children not qualified as legal dependents;
• Unemployed individuals not qualified as a sponsored member;
• Citizens of the Philippines residing in other countries;
• Citizens of other countries (foreigners) residing/or working in the Philippines.

Sponsored members are those who are being paid for by local government units, government agencies or private institutions which fall under the implementation of the government subsidy program. Members under this category are usually covered on a yearly basis. Availment of PhilHealth benefits depends on the effectivity or coverage period as reflected in their membership.

Lifetime members generally covers retirees/pensioners who have reached the retiring age as defined by law and have met the required 120 monthly PhilHealth premium contributions. Individuals under this classification no longer need to be paying members in order for them or their dependents to avail of PhilHealth benefits.

Overseas Filipino Workers (Land-based) were previously under the IPM category. Due to the differences in the needs of the members under this category and the efforts with which these were addressed, PhilHealth decided to separate the monitoring and evaluation of those individuals who are working out of the country, hence a separate category was created. OFWs are required to enroll and pay a one-year premium contribution prior to leaving the country and to continue being an active member, OFWs would need to pay continuously to the program after the expiry of the one-year coverage.

Reference: Title III-Section 5 of the Implementing Rules and Regulations of the National Health Insurance Act of 1995

Do you get deducted for premium contributions if you are not a PhilHealth member?

You can't NOT be a PhilHealth member if you're employed.

Membership, coverage, and premium contributions are compulsory/mandatory for those with employment (formal sector).

Reference: Title III, Rule I, Implementing Rules and Regulations of the National Health Insurance Act.

Directory: Accredited Hospitals under PhilHealth Regional Office Lucena

Accredited hospitals listed below with their corresponding accreditation period are under the area of jurisdiction of PhilHealth Regional Office IV - Lucena 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.

• Metro South Medical Center (Level 3), to expire on April 30, 2012;
• St. Dominic Medical Center, Inc. (Level 3), to expire on April 30, 2012;
• Biñan Doctors' Hospital, Inc. (Level 3), to expire on April 30, 2012;
• Christian General Hospital (Level 2), to expire on April 30, 2012;
• Community General Hospital of San Pablo City (Level 3), to expire on April 30, 2012;
• Laguna Doctors Hospital (Level 2), to expire on April 30, 2012;
• Los Baños Doctors Hospital and Medical Center (Level 3), to expire on April 30, 2012;
• Sta. Rosa Hospital and Medical Center (Level 3), to expire on April 30, 2012;
• UPH - Dr. Jose G. Tamayo Medical Center (Level 4), to expire on April 30, 2012;
• Lucena United Doctors Hospital (Level 3), to expire on April 30, 2012;
• Mount Carmel Diocesan General Hospital (Level 3), to expire on April 30, 2012;
• San Diego De Alcala General Hospital (Level 2), to expire on April 30, 2012;
• St. Peter General Hospital (Level 2), to expire on April 30, 2012;
• Tayabas Community Hospital, Inc. (Level 3), to expire on April 30, 2012;
• De La Salle University Medical Center (Level 4), to expire on April 30, 2013;
• Medical Center Imus (Level 3), to expire on April 30, 2013;
• Our Lady of the Pillar Medical Center (Level 3), to expire on April 30, 2013;
• Tagaytay Hospital and Medical Center (Level 3), to expire on April 30, 2013;
• Calamba Doctor's Hospital (Level 3), to expire on April 30, 2013;
• New Sinai MDI Hospital (Level 3), to expire on April 30, 2013;
• San Pablo Doctors Hospital (Level 3), to expire on April 30, 2013.

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.

Directory: Accredited Hospitals under PhilHealth Regional Office III

Accredited hospitals listed below with their corresponding accreditation period are under the area of jurisdiction of PhilHealth Regional Office III - Pampanga, 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.

• Bataan Doctor's Hospital (Level 2), to expire on April 30, 2012;
• Bataan St. Joseph Hospital (Level 3), to expire on April 30, 2012;
• Jose C. Payumo Jr. Memorial Hospital (Level 2), to expire on April 30, 2012;
• Orani District Hospital (Level 2), to expire on April 30, 2012;
• Grace Memorial Hospital Foundation, Inc. (Level 2), to expire on April 30, 2012;
• Dr. Paulino J. Garcia Mem'l. Research and Med. Center (Level 4), to expire on April 30, 2012;
• Angeles Medical Center (Level 3), to expire on April 30, 2012;
• Dr. Amando L. Garcia Medical Center (Level 3), to expire on April 30, 2012;
• Mother Teresa of Calcutta Medical Center (Level 3), to expire on April 30, 2012;
• Our Lady of Mt. Carmel Medical Center (Level 4), to expire on April 30, 2012;
• Pampanga Medical Specialist Hospital (Level 3), to expire on April 30, 2012;
• Sacred Heart Medical Center (Level 3), to expire on April 30, 2012;
• St. Catherine of Alexandria Foundation & Medical Center (Level 3), to expire on April 30, 2012;
• Jecsons Medical Center (Level 3), to expire on April 30, 2012;
• Señor Sto. Niño Hospital (Level 3), to expire on April 30, 2012;
• Our Lady of Lourdes International Medical Center (Level 3), to expire on April 30, 2012;
• Angeles University Foundation Medical Center (Level 4), to expire on April 30, 2013.

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.

If I lapsed with my 1st quarter PhilHealth payment can i still pay it?

Normally, no.

There are exceptions though.

As per PhilHealth Circular No. 06, series of 2001, retroactive payments are not allowed except when a member can show proof of sufficient regularity of premium contributions or payment of nine (9) consecutive months or three consecutive quarters within the last 12 months prior to the missed quarter. If you meet this condition, you shall be given a grace period of one month immediately after the missed quarter to pay retroactively including the current calendar quarter.

For newly enrolled members (with less than 12 months reckoned from date of enrollment), retroactive payment for the missed quarter including the current calendar quarter shall also be allowed within the month immediately following the missed period.

This privilege is granted only once every 12 months.

Reference: PhilHealth IPM FAQs.

However, even if you miss a quarterly payment, you may still be eligible to avail of PhilHealth benefits if there is sufficient regularity.

Save yourself the worry and just pay your premiums on time.

If I lapse one month PhilHealth payment within a year can I still avail of PhilHealth benefits?

Yes.

The keyword is sufficient regularity.

Call center print ad

Can I cancel my PhilHealth membership to be a dependent?

It depends. If you meet the requirements to be a dependent, yes. If not, no.

Does PhilHealth cover medicines?

Yes. But not all.

Paid PhilHealth for the first time, can I use it immediately?

No.

Addendum: Unless you're an OFW.

Can my brother or sister be my dependent in PhilHealth?

No.

Is Philhealth a mandatory requirement for working abroad?

Yes.

Is it important?

Yes.

Are all OFWs happy about this?

Apparently, no.

Can a deactivated Philhealth member qualify as Philhealth dependent of her spouse?

Yes.

Directory: Accredited Hospitals under PhilHealth Regional Office II

Accredited hospitals listed below with their corresponding accreditation period are under the area of jurisdiction of PhilHealth Regional Office II - Tuguegarao, 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.

• De Vera's Medical Center (Level 3), to expire on April 30, 2012;
• Tomas-Cacal Medical Clinic and Hospital (Level 2), to expire on April 30, 2012;
• St. Paul Hospital (Level 3), to expire on April 30, 2013.

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.

Directory: Accredited Hospitals under PhilHealth Regional Office CAR

Accredited hospitals listed below with their corresponding accreditation period are under the area of jurisdiction of PhilHealth Regional Office - CAR, 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.

• Notre Dame De Chartres Hospital (Level 3), to expire on April 30, 2012;
• SLU Hospital of the Sacred Heart (Level 4), 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.

Directory: Accredited Hospitals under NCR North Branch

Accredited hospitals listed below with their corresponding accreditation period are under the area of jurisdiction of PhilHealth Regional Office - NCR North Branch, 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 or PhilHealth's Call Center.

• GAT Andres Bonifacio Memorial Medical Center (Level 3), to expire on April 30, 2012;
• Metropolitan Medical Center (Level 4), to expire on April 30, 2012;
• Ospital ng Sampaloc (Level 2), to expire on April 30, 2012;
• Our Lady of Lourdes Hospital Inc. (Level 4), to expire on April 30, 2012;
• San Lazaro Hospital (Level 4), to expire on April 30, 2012;
• Chinese General Hospital & Medical Center (Level 4), to expire on April 30, 2013;
• Dr. Victor R. Potenciano Medical Center (Level 4), to expire on April 30, 2013;
• Manila Doctor's Hospital (Level 4), to expire on April 30, 2013;
• MCU-FDT Medical Foundation Hospital (Level 4), to expire on April 30, 2013;
• Medical Center Manila (Level 4), to expire on April 30, 2013;
• UP - Philippine General Hospital (Level 4), to expire on April 30, 2013.

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.

Directory: Accredited Hospitals under NCR South Branch

Accredited hospitals listed below with their corresponding accreditation period are under the area of jurisdiction of PhilHealth Regional Office - NCR South Branch, 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 or PhilHealth's Call Center.

• Air Force General Hospital (Level 3), to expire on April 30, 2012;
• Alabang Medical Clinic - Muntinlupa Branch (Level 2), to expire on April 30, 2012;
• Las Piñas City Medical Center (Level 3), to expire on April 30, 2012;
• Manila Adventist Medical Center & Colleges, Inc. (Level 4), to expire on April 30, 2012;
• Mission Hospital (Level 2), to expire on April 30, 2012;
• Ospital ng Makati (Level 4), to expire on April 30, 2012;
• Ospital ng Makati Acute Care Center (Level 2), to expire on April 30, 2012;
• Ospital ng Muntinlupa (Level 3), to expire on April 30, 2012;
• Parañaque Doctor's Hospital (Level 3), to expire on April 30, 2012;
• Research Institute for Tropical Medicine (Level 4), to expire on April 30, 2012;
• Asian Hospital and Medical Center (Level 3), to expire on April 30, 2013;
• Makati Medical Center (Level 4), to expire on April 30, 2013;
• MPI-Medical Center Muntinlupa (Level 3), to expire on April 30, 2013;
• San Juan De Dios Educational Foundation, Inc. (Level 4), to expire on April 30, 2013;
• The Medical City (Level 4), to expire on April 30, 2013;
• University of Perpetual Help Rizal Medical Center, Inc. (Level 4), to expire on April 30, 2013.

Previously 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.

Directory: Accredited Hospitals under NCR Central Branch

Accredited hospitals listed below with their corresponding accreditation period are under the area of jurisdiction of PhilHealth Regional Office - NCR Central Branch, 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 or PhilHealth's Call Center.

• AFP Medical Center (Level 4), to expire on April 30, 2012;
• Capitol Medical Center (Level 4), to expire on April 30, 2012;
• East Avenue Medical Center (Level 4), to expire on April 30, 2012;
• Philippine Children's Medical Center (Level 4), to expire on April 30, 2012;
• Quezon City General Hospital (Level 4), to expire on April 30, 2012;
• San Lorenzo Hospital Health Management, Co., Inc. (Level 2), to expire on April 30, 2012;
• SDS Medical Center, Inc. (Level 2), to expire on April 30, 2012;
• St. Victoria Hospital (Level 2), to expire on April 30, 2012;
• U.E.R.M Memorial Medical Center (Level 4), to expire on April 30, 2012;
• Cardinal Santos Medical Center (Level 4), to expire on April 30, 2013;
• Dr. Fe Del Mundo Medical Center (Level 4), to expire on April 30, 2013;
• FEU - NRMF Medical Center (Level 4), to expire on April 30, 2013;
• National Children's Hospital (Level 4), to expire on April 30, 2013;
• National Kidney & Transplant Institute (Level 4), to expire on April 30, 2013;
• Philippine Heart Center (Level 4), to expire on April 30, 2013;
• Quirino Memorial Medical Center (Level 4), to expire on April 30, 2013;
• St. Luke's Medical Center (Level 4), to expire on April 30, 2013.

Previously 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.

How to Check Your Premium Payment Contributions

Discussed herein are methods with which to check your premium contribution payments, whether you are paying as an individual or are being remitted/paid by your employer. Individuals can request for a copy of your premium contribution history which will reflect your payments as an individually paying member or the payments remitted by your employers as posted in the PhilHealth database.

• Phone Inquiry
• You may contact the PhilHealth Call Center at (02) 441-7442;
• You may call the Collection Section of the nearest PhilHealth office.

• Email Inquiry
• Email your request for a copy of your premium contribution history to info@philhealth.gov.ph.

• Online Inquiry
• PhilHealth currently does not provide an online facility for you to view your premium contributions online. We will update this as soon as the service is available.

You may request for a copy of your premium contribution history to be emailed to you in any of the above methods. You would need to inform them of your PIN, full name, birth date and your current employer (if any).

Preparing the PhilHealth Employer's Remittance Report (RF-1) using the PPRS

The PhilHealth Premium Remittance System (PPRS) is a stand-alone application that is being distributed by PhilHealth since 1999. The system is designed in such a way as to facilitate the payment and generation of the RF-1 Remittance Report of the employers in a softcopy or text format. This post is intended to give you a bit more information on the PPRS as another reporting scheme.

Advantages in using the PPRS:

• Security enabled features which include user accounts to access the functionality of the system as well as system roles to determine which modules/functionalities may be accessible for a given type of user account;
• Facilitates preparation of reports for multiple employers;
• Printing of the RF-1 hardcopy, M5 summary and a transmittal list;
• Provides utilities such as backup of the database, restoration of database, management of users, employee transfers and others;
• Prepare the remittance report in advance prior payment so as to easily determine the actual payment to be made;
• Captures monthly remittance and report generation;
• Ease in updating the compensation bracket for the employer and employee share;
• Automatic computation of the bracket based on compensation/salary defined in the employee profile.

Disadvantages:

• There is minimal support being provided for the system;
• PhilHealth no longer provides updates to the functionality or enhancement of the system.
• Although the system can generate the remittance report monthly in text file format the old RF-1 layout is being used in the hardcopy.

Though no further updates are being provided by PhilHealth, the system is still considered as an option for the generation of the remittance report in softcopy or text format. If you wish to download an installer of the application click here. To download the User Manual click here.

The system is for those who are not at ease in using the Excel format or hardcopy, employers that see the need to have a back-up of their remittance reports, those who are not able to use the Electronic Premium Reporting System (EPRS) or those who do not have the capability or resources to develop a system to aid in the preparation of their remittance report.

Preparing the PhilHealth Employer's Remittance Report using the Excel Template

Aside from the PhilHealth Remittance Reporting System (PPRS), employers are also given the option to prepare the remittance report using the Excel template being released by PhilHealth. The Excel template is a good alternative for a minimal number of employees, probably not more than 50. For a higher number of employees, it would be better to have a maintenance facility for your employees so a system would be recommended.

Advantages

• Facilitates generation of the RF-1 hardcopy and softcopy format;
• Easy to use.

Disadvantages

• Limited validations are available in the template;
• When compensation bracket changes, you will need a new Excel template.

Recommended versions are Microsoft Excel 2007 or above and you should enable the use of MACROs to use the Excel template. You can get the Excel template by clicking here.

In preparing a report, it is important for you to not overwrite the existing report. You may do this by opening the Excel file of your recent previous report and then go to File and choose Save As. Rename your Excel file using the convention Reporting Month+Year+PEN+ReportType. After which you can continue editing your report for the current reporting period. It is important to maintain or retain a copy of your remittance reports so that if PhilHealth requires or request for you to reproduce the report it would be a lot easier on your part.

Proofs of Payment recognized by PhilHealth and Accredited Health Providers

This post serves to remind  members of the National Health Insurance Program the proofs of payment  recognized by PhilHealth and accredited health care facilities. For one thing, the PhilHealth Premium Payment Slip (PPPS) is NOT recognized as an official receipt. Below is the list of proofs of payment that may be presented to the health care facilities when required.

Individually Paying Members

• For the Remittance-by-Air (payment through mobile phone) facility, printed proof of payment from PhilHealth website or Certificate of Premium Payment issued by PhilHealth;
• Duly validated Bayad Center Payment Form;
• Certificate of Premium Payment issued by PhilHealth (for Organized Groups);
  
• Certificate of Premium Payment issued by PhilHealth (for KaSAPI members);
• Duly validated LBC Bills Express Payment Receipt;
• Duly validated LBC Bills Express Collection System Acknowledgement Receipt;
• MLhuiller Sendout Form (for online transactions);
• MLhuiller Sendout Form Remote Transaction (for offline transactions);
• MI-5;
• PhilHealth Agent's Receipt (PAR);
• PhilHealth Official Receipt (POR).

Overseas Filipino Workers (OFWs)

• Duly validated Remittance Forms of Development Bank of the Philippines tie-up ENJAZ, Philippine Veterans Bank tie-up BTI Money Transfer Pte., Ltd. and iRemit Singapore Pte Ltd.;
• DBP Remittance Center HK Ltd. Official Receipt;
• OEC Receipt of POEA;
• PhilHealth Official Receipt (POR);

Employed Members

• Duly validated LBC Bills Express Payment Receipt;
• Duly validated LBC Bills Express Collection System Acknowledgement Receipt;
• MLhuiller Sendout Form (for online transactions);
• MLhuiller Sendout Form Remote Transaction (for offline transactions);
• ME-5;
• PhilHealth Agent's Receipt (PAR);
• PhilHealth Official Receipt (POR);

This information was taken from the  Advisory of PhilHealth dated April 03, 2011. Click here to view the Advisory and the images of the honored proof of payment. Make sure that the information such as your name, PIN, applicable period of payment, date and amount reflected in your payment receipts are correct.

What PhilHealth is not...

This post is intended to clarify the misconceptions of some members with regard to the National Health Insurance Program (NHIP), PhilHealth as the administrator of the NHIP and benefits it offers.

• PhilHealth does not provide a pension nor can you withdraw your contributions.
Contrary to the belief of some members, PhilHealth does not provide any financial benefits to members such as loans or pensions as compared to the other government institutions such as the Social Security System or the Government Service Insurance System. Moreover, unlike the GSIS or Pag-IBIG Fund where you are able to withdraw all or a portion of your contributions, the contributions you pay to PhilHealth cannot be withdrawn, unless in the case discussed here;


• PhilHealth does not reimburse all expenses incurred when you are hospitalized.
At the present time, PhilHealth only covers or reimburses a portion of your hospitalization bills. As we see it, PhilHealth should eventually cover all of them, however, due to unavailable standards in the health industry such as standard professional fees, hospital room rates or prices of drugs and medicines, there is difficulty in setting the amount that may be reimbursed by PhilHealth, not to mention the fact that PhilHealth is maintaining the program's viability;


• PhilHealth does not pay for all medical related services.
Unlike HMOs, PhilHealth does not cover preventive healthcare such as annual physical check-ups, counseling or routine immunization except those covered in the prenatal care package. The corporation also does not pay for oral health services, unless those requiring hospitalization;


• PhilHealth does not provide different health coverage or packages.
Whether you are contributing more or less to the program, PhilHealth only offers a uniform or standard benefit service or rates. This means that no specific packages are available for those wanting to increase PhilHealth benefit rates or coverage;


• PhilHealth only covers a limited number of out-patient benefits.
Among these benefits are day surgeries, dialysis and cancer treatments, treatment on tuberculosis through TB-DOTS health care facilities, normal spontaneous delivery up to the 4th child, new born care package, voluntary surgical contraception procedures, OPB malaria package, cataract package and the influenza AH1N1 package;


• PhilHealth does not cover all drugs and medicines.
PhilHealth only covers the drugs and medicines as enumerated in the Philippine National Drug Formulary (PNDF) for the listing of compensable drugs and medicines click here. You may refer to this PhilHealth Advisory.

We will try to include additional information in relation to this post once we gather more data.

Avail PhilHealth Benefits for Confinements Abroad

Here are some things you need to know in order to avail PhilHealth benefits for confinements abroad. This is applicable to OFWs, lifetime, individually paying and employed members of the NHIP.

Documentary Requirements

• PhilHealth Claim Form 1 (signed by member or authorized representative);
• Member Data Record (MDR) or supporting documents;
• Proof of applicable premium payments;
• Original official receipts for hospital, doctor, medicines and services (in English);
• Statement of Account with itemized charges (in english) should reflect rates for room and board, medical supplies, laboratory procedures, operating room fee and others;
• Medical Certificate (indicating final diagnosis, confinement period, services rendered in English).

Things you need to know:

• Claim should be filed within 180 days upon discharge in any PhilHealth Regional and Branch Offices;
• You will be paid equivalent to the level 3 hospital benefit rates;
• You may still file for PhilHealth reimbursement even if your employer abroad has a health insurance benefit;
• If you are unavailable to sign or submit your claim application for reimbursement, the person/s below may act as your representative. The members should provide an authorization letter (indicating your name and name of your authorized representative), and a photocopy of two (2) valid IDs of both the member and representative. PhilHealth might require your representative to present the original ID for authentication purposes.
• Spouse;
• Children 18yrs and above;
• Parents for unmarried member;
• Brother / Sister / Guardian;
• Other individuals as duly authorized representative.
• You may verify the status of your claim application by emailing philhealth_hk@philhealth.gov.ph or calling +63 917 5129149 for OFW members or 441-7442 and info@philhealth.gov.ph for non-OFW members. In your inquiry state the following information:
• Patient's complete name;
• Date of confinement;
• Hospital information.
• If you wish to name the cheque to your spouse you would need to submit a Special Power of Attoryney (SPA) or a letter authorizing PhilHealth to use the name of your spouse for the cheque with attached two (2) valid IDs of you and your spouse and Marriage Contract.

For other information visit these links:

• OFW benefits
• FAQs Benefit Availment related
• Individually Paying Member benefits

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How to Request for a New PhilHealth ID Card

PhilHealth has recently introduced the new design layout of the PhilHealth Number Card that is currently being released to the employed and individually paying members per PhilHealth Circular No. 11 s-2010. The major difference is that the new design is now being recognized as a valid PhilHealth ID thus the name has been changed from PhilHealth Number Card (PNC) to PhilHealth ID Card (PIC).

Steps/Tips in Requesting for a new PhilHealth ID Card (PIC):

• Prepare a letter of request (cite your complete name, PIN and reason for replacement);
• For lost ID, prepare an Affidavit of Loss as attachment to the letter request (use this as reference);
• For damaged ID, be sure to bring your damaged ID. PhilHealth might require you to present or surrender it;
• Bring one (1) recent 1x1 ID Photo to be used for your replacement ID;
• A Letter of Authorization will be required if you will be designating a representative to receive the re-issued/replacement PIC on your behalf. Attach a photocopy of your ID and the ID of your representative to the Letter of Authorization. PhilHealth may also require you to present the actual IDs used for verification.

Submit your request to the respective PhilHealth Regional Offices (PhROs), Service Offices (SOs) or PhilHealth Member Assistance Center (PMAC). Bring a valid ID.

Normally you can just wait for the ID to be issued to you when you submit your request. However, your waiting time would depend on the number of persons that are transacting with PhilHealth at the time you submit your request.

Addendum: If you are looking for information on the new I-PhilHealthy Card with privileges and discounts, read this post.

What is Sufficient Regularity of Premium Payment?

Sufficient Regularity is defined as "payment of premium contribution of at least nine (9) months within the twelve (12) month period immediately prior to the month of availment" as cited in Section 3-iii of the Revised Implementing Rules and Regulations of PhilHealth. Now what does this mean for us NHIP members particularly since the release of PhilHealth Circular No. 25 s-2010?

• Who are covered by PhilHealth Circular No. 25 s-2010?
NHIP members under the Individually Paying Program and Employed members are covered in this circular. Availment of members belonging to the sponsored program and OFWs will still be based on their effectivity period defined by the date of coverage or payment. OFWs are covered for one year starting with the date of their payment while sponsored members have their corresponding one year NHIP coverage period. Lifetime members no longer have this eligibility criteria as they are no longer considered as paying members of the NHIP.

• What does this have to do with availment of benefits?
This now indicates that before the date of your or your dependent's admission, you should have nine (9) months contribution within a twelve (12) month period. Members covered in this Circular that do not meet this requirement will not be able to avail of PhilHealth benefits.
• How does this relate to our payment of premium contributions?

• Premium payment paid on or during the confinement period will be credited to the succeeding applicable period. Example, if the date of confinement/availment is on March 13, 2011 then payment for the first quarter (1st Qtr) should be made before March 13, 2011 so that the amount shall be credited to the first quarter. If payment was made on March 13 or during the confinement period, the payment will immediately apply to the 2nd Quarter. In short, pay your premium contribution before the date of your or your dependent's admission.

• For payments under the rules of sufficient regularity, payment should be made on the last day prior to confinement or availment of benefits in order to be considered or credited to the quarter being paid. This simply means no retroactive payments on the start, during or after the confinement/availment date will be allowed previously permitted under Section 7 of PhilHealth Circular No. 24 s-2003.

• All benefits shall be covered under this eligibility criteria including treatment or out-patient benefits.

The nine (9) over twelve (12) months contribution eligibility criteria shall take effect starting on July 2011 admission / treatment date. For additional information or clarification you may refer to the PhilHealth Circular No. 25 s-2010 or you may coordinate / inquire with PhilHealth's call center or the nearest PhilHealth office.

How to Prepare the Employer Remittance Report (RF-1)

Here are pointers you need to know to help you prepare / accomplish the PhilHealth Employer Remittance Report Form (RF-1) as required by PhilHealth.

• The report shall be prepared on a monthly basis;
• Deadline of submission shall be every 15th day of the month following the applicable month;
• Employers should attach the PhilHealth Membership Registration Form (PMRF) for reported employees that do not have a corresponding PhilHealth Identification Number (PIN) including the ER-2. The ER-2 is a document certifying the employees of the company. In this way, the registration of your employees will be facilitated prior posting of their contributions (PhilHealth Circular No. 13 s-2010);
• Employees that have not been deducted their premium contributions in your payroll should still be included in the report. The bracket and amount of contribution that should be reflected is zero (0), with the remarks and date of remark effectivity required. If the employee was not paid for the month but is still with the company then the remark shall be NE for No Earning, if the employee is no longer part of the company due to retirement, termination or separation then the remark shall be Separated (SP), for newly hired employees simply reflect NH for Newly Hired. For Separated remark, reflect the date when the employee was separated, date hired for Newly Hired and for the No Earning reflect the date when of no earning. (PhilHealth Circular No. 13 s-2010);
• The report may be prepared/submitted through hardcopy, softcopy or online. Use the method that is best for you. Employers with more than ten (10) employees however, are required to prepare and submit a softcopy or electronic report. Those that do not have the capability to do so should inform the nearest PhilHealth Office as compliance is being monitored pursuant to PhilHealth Circular No. 02 s-2010;
• Hardcopy reports can be submitted through walk-in, dropbox or mail. Dropbox or mailed submission are not recommended for softcopy report. Submission through email for softcopy reports are not yet allowed as copies of the payment receipts are still being attached to the report;
• There are alternatives in preparing the softcopy report. The first is by using a Microsoft Excel based template distributed by PhilHealth, the second is for the system generated file from your payroll system that is compliant to the file specifications released by PhilHealth, and the last is to manually create the file compliant to the file specifications by using either Notepad or Excel. Stay tuned as we will be providing the guide in preparing the softcopy using the Excel template and the file specification guidelines;
• There are two alternatives in which to submit the softcopy report. The first is by personally submitting it to any PhilHealth Office. The second is by submitting it through an online facility developed by an accredited bank/agent designed for the Electronic Payment Scheme (EPS). To know more about the EPS click here;
• Employers would also have the option to prepare and submit the report online through a web-based facility being provided by PhilHealth. This is the Electronic Premium Reporting System (EPRS) which is the online version of the previously released application named the PhilHealth Premium Remittance System (PPRS). To know more about this scheme click here;

We personally recommend you to try the Electronic Premium Reporting System (EPRS) as it is the easiest alternative and would readily facilitate the posting of reported premium contributions of the employees. However, this reporting scheme is not advisable for those that are often offsetting their payments due to over or under remittances of their employees' premium contributions.

Region I: Directory of PhilHealth Offices

PhilHealth Regional Office I

Esperacion Building #23 M.H. Del Pilar Dagupan City, Pangasinan

Tel no. (075) 515-3333, 515-1111, 523-3127

• Batanes Service Office
Capitol Building, National Road, Kayhovukan, Basco, Batanes
Tel no. 0920-9045228
• Candon Service Office
G/F Old City Hall, National Highway, San Juan, Candon City, Ilocos Sur
Tel no. (077) 742-1111
• Mangatarem Service Office
2/F Sison Commercial Building, cor. Calvo and Mc Arthur St., Mangatarem Pangasinan
Tel no. (075) 546-1111
• San Carlos Service Office
2/F New San Carlos City Public Market, San Carlos City, Pangasinan
Tel no. (075) 532-1111
• Alaminos Service Office
2/F Perez Building, Marcos Ave., cor. Montemayor St. Alaminos City, Pangasinan
Tel no. (075) 552-1111
• Laoag Service Office
Jommel Building A Castro St., Laoag City, Ilocos Norte
Tel no. (077) 771-2222
• San Fernando Service Office
Juanita Commercial Building, Quezon Avenue, San Fernando City, La Union
Tel no. (072) 700-1778
• OWP San Fernando
3/F AGZ Building, Quezon Avenue, San Fernando City, La Union
Tel no. (072) 700-1111
• Urdaneta Service Office
3/F Sanctuary Building, Mc Arthur Highway, Nancayasan, Urdaneta City Pangasinan
Tel no. (075) 568-1111
• Vigan Service Office
Galleria De Vigan, Plaza Burgos, Vigan City Ilocos Sur
Tel no. (077) 722-1960
• Dagupan Service Office
M.H. del Pilar St., Dagupan City
Tel no. (075) 515-333 locals 156 - 158