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

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.

Six top reasons to enroll in PhilHealth

For those thinking of deactivating, cancelling, or otherwise not participating in the National Health Insurance Program as administered by PhilHealth, here are six reasons why you should continue:

1. PhilHealth is pro-Filipino;
2. PhilHealth is affordable;
3. PhilHealth covers your whole family;
4. PhilHealth is pro-poor;
5. PhilHealth assures quality;
6. PhilHealth is supported by experience from other countries.

 Read the full Philippine Star article here.