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.

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

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.