PhilHealth launches new electronic innovations

Health Secretary Dr. Enrique Ona, PhilHealth President Dr. Eduardo Banzon, and PhilHealth CIO Dr. Alvin Marcelo at e-Innovations launch.

PhilHealth has recently updated the way it delivers services to its clients via its website. These include:

• A new, refreshed look for it's corporate website;
• An online mapping service (allows clients to view the location of all PhilHealth branches and accredited health care providers);
• Electronic registration;
• A new Health Insurance Card;
• An online method of determining member eligibility.

We will be providing more information about these improvements as we learn about them. For further details, you may read PhilHealth's news release here.

PhilHealth Benefit Packages - Case Payment Rates

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

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

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

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

Disclaimer - A Reiteration

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

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

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

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

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

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

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

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

We hope this clears up everything.

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.

Deactivate or Cancel My PhilHealth Membership - Is this possible?

Some of you might be wondering if it is possible to deactivate or cancel your PhilHealth membership and how this can be done. Your reason might be because you have not availed of any PhilHealth benefits yet or you may have had a bad experience with the corporation.

Employed individuals whether in a private or government company/agency will not be able to discontinue paying the PhilHealth premium contribution until such time that they are no longer employed. This is because the employers are mandated or required by law to enroll and deduct the said premium from their employees as they will be penalized for non-compliance. Household help also belong under this category.

For individually paying members or those individuals directly paying PhilHealth premium contributions, you would only need to discontinue payment. You will still be considered registered under the program but your membership will now be set to inactive. If you discontinue payment however, you may no longer be able to avail of PhilHealth benefits if you or any of your registered dependents are hospitalized. You may reactivate your membership upon payment of the required premium contribution for a given quarter, semester or year. Your eligibility to avail of PhilHealth services will be determined by the number of consecutive payments you contribute to the program.

For those under the sponsored sector, membership is automatically set to be inactive once the coverage period reflected in the PhilHealth ID Card (PIC) has expired. Prior to expiry of the coverage however, it is common for the local government units and/or sponsor to enroll or renew the membership to ensure eligibility of PhilHealth benefits.

For the Overseas Filipino Workers, it is mandatory to pay the premium contribution for a one year coverage before departure from the Philippines either directly through the POEA or PhilHealth. Upon expiry of the one year, you may continue paying the premium to ensure that you and your dependents are eligible to avail of PhilHealth benefits.

It is however recommended that before you give up on the program, you should get feedback from other individuals who have availed of PhilHealth benefits. We are sure that although there are some who finds the program below their expectations, there are also those that have a high regard for its existence. We hope that you would be able to choose the right option to secure both you and your family's health. You may check out the reasons why others stay with PhilHealth by clicking here.

Do you have an inactive account with PhilHealth? Know how you can reactivate it by clicking here.

PhilHealth's New Vision and Mission Statement

mPhilHealth has just changed its Vision and Mission statement which was announced in the PhilHealth Circular No. 04, s-2011.

Vision Statement

Adequate and Affordable Social Health Insurance Coverage for ALL Filipinos

Mission Statement

To ensure adequate financial access of every Filipino to quality health care services through the effective and efficient administration of the National Health Insurance Program (NHIP).

With the changes in the vision and mission statement of the Corporation, we hope to see great improvements in the services and the manner in which these services are delivered.

Who are under the Individually Paying Members (Professional) Category of PhilHealth?

In PhilHealth Circular No. 24 s-2010, PhilHealth introduced the Individually Paying Member - Professional category. As you will notice, the premium contribution for this type of membership now has a higher rate currently at Php600.00 per quarter for the first year of implementation and will eventually be Php900.00 per quarter in the succeeding years.

Below are members that fall under this category:

• Accountant;
• Architect;
• Criminologist;
• Customs Broker;
• Dentist;
• Dietician;
• Aeronautical Engineer;
• Agricultural Engineer;
• Chemical Engineer;
• Civil Engineer;
• Electrical Engineer;
• Electrical Communications Engineer;
• Geodetic Engineer;
• Marine Engineer;
• Mechanical Engineer;
• Metallurgical Engineer;
• Mining Engineer;
• Sanitary Engineer;
• Geologists;
• Landscape Architect;
• Law Practitioner;
• Librarian;
• Marine Deck Officer;
• Marine Engineer Officer;
• Master Plumber;
• Medical Technologist;
• Medical Doctor;
• Midwife;
• Naval Architect;
• Nurse;
• Nutritionist;
• Optometrist;
• Pharmacist;
• Physical and Occupational Therapist;
• Professional Teacher;
• Radiologist and X-ray Technician;
• Social Worker;
• Sugar Technologist;
• Veterinarian;
• Agriculturist;
• Artist;
• Businessman/Business Owner;
• Consultant;
• Environmental Planner;
• Fisheries Technologist;
• Forester;
• Guidance Counselor;
• Interior Designer;
• Industrial Engineer;
• Media (Actor / Actresses);
• Media (Director);
• Media (Scriptwriter);
• Media (News correspondent);
• Professional Athlete, Coach, Trainor, Referee etc.

Those members not belonging or practicing any of these professions will be categorized as Individually Paying Members (Non-Professional).

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.

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.

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.

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.