Glossary of PhilHealth forms and download links

Membership

PMRF: PhilHealth Member Registration Form - Download

Claims

Claim Form 1: Member and Patient Information - Download
Claim Form 2: Provider Information - Download
Claim Form 3: Patient's Clinical Record - Download

Employers

ER1: Employer Data Record - Download
ER2: Report of Employee-Members - Download
ER3: Employer Data Amendment Form - Download
RF1: Employer's Remittance Report - Download

Accreditation

Institutional

IAF: Institutional Accreditation Form - Download
MMHR: Monthly Mandatory Hospital Report - Download
SOI: Statement of Intent for Hospital, ASC and FSDC - Download
SOI: Statement of Intent for OPB, MCP and DOTS Providers - Download

Professional

PAF: Professionals Accreditation Form with Warranties for Accreditation and Checklist of Requirements - Download

Collecting Agents

CAAF: Collecting Agents Accreditation Form - Download

Payment

PPPS: PhilHealth Premium Payment Slip - Download

eClaims

HCPAP: Health Care Provider Account Profile application form - Download

Reference: http://www.philhealth.gov.ph/downloads/
 

OC: Philhealth, naglagay na ng accredited foreign tie-up

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.

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.

How to Update Your Membership Record with PhilHealth

In our previous post, we discussed about the instances on when to update our membership record with PhilHealth and its importance. Here we will discuss the procedure and required documents to update your membership record.

Steps in updating your member record:

1. Fill-out the PhilHealth Membership Registration Form (PMRF);
2. Submit the PMRF with attached supporting documents to any PhilHealth Office near you;
3. Validate that the changes requested have been correctly reflected in your newly released Member Data Record (MDR);
4. For correction/change in your name, ensure that you are issued a new PhilHealth ID Card (PIC) reflecting the corrected/updated name.

Accomplishing the PMRF:

• Accurately write your PhilHealth Identification Number (PIN) in the form;
• Put a check mark in the "For Updating" under the PURPOSE;
• Write your name and date of birth. This will be used by PhilHealth to verify the member record retrieved using the PIN. If purpose is for correction of your name, write your correct name;
• Write the necessary information that you would need to update or correct, there is no need to provide all the information in the form. If you are going to update your address, just write in the address portion, to register new dependents, just write your dependent's information and so on;
• Affix your signature and write the date the form was accomplished.

Documents that are normally being required:

• ID card/s issued by a government official authority;
• Birth Certificate for correction on member's/dependent's name or date of birth and/or for declaring of new dependents;
• Marriage Certificate or Contract / Affidavit of Marriage issued by Office of Muslim Affairs to update your civil status, change your last name (for females) and/or to declare your spouse as a dependent.

Other documentary requirements can be found in the second page of the PMRF.

Cases for Amending or Updating Your PhilHealth Records

As PhilHealth Members, it is your responsibility to ensure that your information recorded in PhilHealth's database is up-to-date and accurate. If you want to know how to go about updating your information then read on.

When should you update your information?

• Correction in member profile
If you are issued a Member Data Record (MDR), immediately validate the accuracy of the reflected information. If you find that there is a discrepancy in your name, date of birth or any other information, you should amend or update your record immediately;


• Correction in dependent's profile
This can also be checked in the MDR. Check whether the name and date of birth of your declared dependents have been accurately recorded by PhilHealth as this might become a problem in availment of benefits;


• Change in address
If you relocated to another residence or address, immediately amend your PhilHealth record. It is important for PhilHealth to have your current address as notices/letters are being mailed based on your location registered in PhilHealth;


• Change in civil or marital status
PhilHealth will require a copy of your marriage certificate, or Affidavit of Marriage issued by the Office of the Muslim Affairs, or annulment papers in order to effect the change in your last name. You should also request for a new PhilHealth ID Card and MDR.
Males should likewise update their membership record to reflect the change in civil status and to include their spouse as a dependent;


• Change in membership category
For separated employees wishing to continue their coverage with PhilHealth, they should amend their record to be under the Individually Paying Member category (refer to this post for distinction between Professional and Non-Professional). The premium amount that you will be required to pay would depend on your membership category, so it is important for you to update it;


• Adding new dependents
If you wish to include your parents, spouse or child/ren under your PhilHealth coverage, they should be registered with PhilHealth as your dependents. For guidance on the declaration of dependents you may refer to this post. Siblings however cannot be declared as a dependent.

There are instances when you will no longer be required to go to PhilHealth in order to update your PhilHealth MDR. Among them are:

• If your member profile reflected in Claim Form 1 (CF1) is different from your membership record, PhilHealth will use the information contained in the CF1 to update your membership record. (Pursuant to PhilHealth Circular No. 08 s-2007);

• For the employed sector, if you are reported as a newly hired employee, then your membership category will automatically be updated to Private/Government depending on your company type. For separated employees, your membership record will reflect that you are already separated from the company. Those who transferred from another company, your record will display the new company. These information shall be captured using the Employer Remittance Report (RF-1). (Pursuant to PhilHealth Circular No. 13 s-2010);

• Retiring employees in the private/government institutions will be covered as Lifetime Members provided that the member is at least 60 years of age, has met the 120 monthly contributions and that their employer facilitated their enrolment at least three months prior to the date of retirement. (Pursuant to PhilHealth Circular No. 28, s-2010.

However, it is still recommended that you to check your current MDR so that any further discrepancies can be immediately amended. To know how to amend / update your membership information click here.

Members: Declaring PhilHealth Dependents - Qualifications for Valid Dependents

This blog post is for those:

• Members who are wondering who to declare as PhilHealth dependents in the PhilHealth Membership Registration Form (PMRF), and;
• Those whose Member Data Record (MDR) did not reflect the dependents previously declared.

Who to Declare as a Dependent:

1. Biological Mother;
2. Biological Father;
3. Step Mother (if biological mother already deceased);
4. Step Father (if biological father already deceased);
5. Adopted Mother (with adoption papers or Court Decree/Resolution of Adoption);
6. Adopted Father (with adoption papers or Court Decree/Resolution of Adoption);
7. Biological Son/Daughter;
8. Step Son/Daughter;
9. Adopted Son/Daughter (with adoption papers or Court Decree/Resolution of Adoption);
10. Legal spouse (non-member or membership is inactive).

Qualifications of a valid dependent:

1. For Parents (birth certificate)

• Should be 60 years old and above;
• Non-member or inactive member;
• Unemployed.

2. For Spouse (with marriage certificate/contract)

• Non-member or inactive member;
• Unemployed;
• A Muslim member can declare more than one wife (with attached Affidavit of Marriage issued by OMA).

3. For Children

• Should be below 21 years old;
• Unmarried;
• Unemployed;
• 21 years old and above with congenital disability either physical or mental;

Additional Guidelines:

• A dependent is qualified if they are not registered as PhilHealth members or if their membership is no longer active;
• Generally, PhilHealth requires the submission of supporting documents to establish the relationship of the declared dependents to the member. Dependents without supporting documents will not be visible in the Member Data Record (MDR);
• A dependent cannot be declared more than once, as in the case of both parents declaring the same child as their dependent, or siblings both declaring their parent;
• There is no limit as to the number of dependents that you can declare. However, you should take note of the 45 days allowable limit shared by your dependents.

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.