Increase on PhilHealth Premium for Individually Paying Members to start on October 1, 2012

PhilHealth through the Advisory No. 07-01-2012 has announced that the increase in premiums for Individually Paying Members (IPM) from Php100.00 to Php200.00 per month shall take effect this coming October 1, 2012.

Hence, IPMs may still pay the quarterly premium of Php300.00 for the 3rd quarter. Payment for the 4th Quarter will still be Php300.00 if done before October 1. As a means to promote continuity of coverage, PhilHealth is granting its voluntary members the option to pay their annual premiums for Jan-Dec 2013 using the current rate of Php1,200 per year if paid before the effectivity of the premium increase.

The advisory is applicable to all Individually Paying Members except professional and those average monthly earnings is more than Php25,000.00

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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/
 

Premium Payment and Benefits for Individually Paying Members, KaSAPI and Organized Group Enrollees

Increase in Premium Contributions Starting CY 2012

The newly released PhilHealth Circular No. 22 s-2011 "New Premium Contributions to the National Health Insurance Program (NHIP) in Support to the Attainment of Universal Health Care and Millenium Development Goals (MDG)", has announced the implementation of new premium rates for CY 2012.

Affected programs are the Sponsored Program (SP), Individually Paying Program (IPP), Overseas Workers Program (OWP) and the employed program. Below summarizes the new rates per program classification.


Sponsored Program

• Members included in the DSWD NHTS-PR list will be covered for 2 years. Annual premium shall be Php2,400.00 effective January 1, 2012;
• Annual premiums for the partial subsidy will be increased from Php1,200 to Php2,400 effective JULY 2012. 
• For sponsors who enroll and pay their contributions within the first semester, the annual premium shall be Php1,200.00;
• For sponsors who enroll and commits to pay for its members a period of two (2) consecutive years, the annual premium shall be Php1,200.00.

Individually Paying Members

• Starting JULY 2012, the annual premium contribution will be Php2,400.00, quarterly payment shall be Php600.00 and monthly premiums will be Php200.00;
• Self-employed professionals earning an average monthly income of more than Php25,000 will pay an annual rate of Php3,600. For self-employed professionals earning Php25,000 or less, they will be required to present an ITR as proof of income;
• Members paying their annual contributions within the first semester 2012 will still be able to pay the Php1,200 annual premium;
• Members paying for two (2) consecutive years within the first semester of 2012 will be paying for the annual premium rate of Php1,200.00.

Overseas Filipino Workers (OFW)

• Starting January 2012, the annual premium contribution for OFWs will be increased from Php900.00 to Php1,200.00;
• Starting July 2012, the annual premium to be implemented will be Php2,400.00;
• For payment of two (2) consecutive years within the first semester of 2012, the annual rate to be applied will still be Php1,200.00.

Employed Sector

• Effective January 2013, the premium contributions for the employed sector shall be three percent (3%) of the basic monthly salary of the employee shared equally by the employer;
• Monthly Salary Base = Php7,000.00 and Monthly Salary Ceiling = Php50,000.00.

The need of increasing the members' premium contribution have been cited by PhilHealth President Dr. Eduardo P. Banzon as reported by SunStar (see article here) last November 2011 as necessary in sustaining the enhanced PhilHealth benefits.

Ontario, Canada-based OFWs PhilHealth Payment thru Mabini Express, Inc.

A PhilHealth Advisory has been issued informing the public that Overseas Filipino Workers (OFWs) based on Ontario, Canada may pay through the Mabini Express Inc., a tie-up of the Philippine Veterans Bank (PVB) with the following branches:

• Sheppard Centre (subway station)
• Location: 4841 Yonge St. Unit 133, 2nd Flr. North York Ontario (see map)
• Mabini Contact no: 416-222-1178
• Store hours: Mon-Wed (9:30am-7pm), Thu-Fri (9:30am-9m), Sat (9:30am-6pm) and Sun (11:30am-5pm)


• T & T Promenade
• Location: Prominade Circle, Thornhill Ontario M2N5X2 (see map)
• Store hours: Mon-Fri (9am-10pm), Sat-Sun (9am-10pm)


• T & T Milliken (Middlefield & Steels)
• Location: 5661 Steeles Avenue East, Scarborough Ontario M1V 5P6 (see map)
• Store hours: 9am-10pm


• T & T Ottawa (Hunt Club Rd. & Riverside Drive)
• Location: 224 Hunt Club Rd. Ottawa Ontario ON K1V 1C1 (see map)
• Store hours: 9am-10pm

The Official Receipt issued by the Mabini Express Inc. shall serve as your proof of payment for the paid applicable period. You would need to continue paying your premium contributions based on the current premium rate for the year prior end of your effectivity period. Please note that you would need to indicate your PhilHealth Identification Number (PIN). You may refer to the linked Advisory for the image of the official receipt.

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.

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.

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).

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 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.

Members with Multiple Employment Can Avail Refund or Adjustment for Overpayment of Personal Share

Overpayment of Premium Contribution due to multiple employment is a situation where a person is employed in more than one employer and both employers are remitting PhilHealth contributions as mandated by Section 18-20 of the Implementing Rules and Regulations of R.A. 7875.

To resolve this situation, PhilHealth has released PhilHealth Circular No. 05 s-2009. In this circular PhilHealth members are given the option to apply the overpayment to succeeding months or to request for a refund of the personal share. The personal share is the amount being deducted to the employee. Discussed below are the two options.

Overpayment of Personal Share Applied to Succeeding Months

• Adjustment can be done only once.
• The following qualifications/conditions must be met by the requesting member:
• Member is currently unemployed;
• Aggregate monthly premium contribution is greater than the maximum premium rate in the prescribed premium contribution schedule (this may be based on the current rate at the time of the contribution);
• Overpayment occurred due to multiple employment;
• Overpayment incurred from January 2009 onwards (based on effectivity of the Circular);
• The period covered for adjustment is posted in PhilHealth's contribution database and Treasury database. (This means that you should be included in the monthly report prepared by your employer and the employer is paying the contribution as evidenced by the record in the Treasury database.)
• The overpayment of the personal share shall be reflected or adjusted as an advance payment of the premium contribution for the Individually Paying Member.

This alternative may be used by those shifting to the Individually Paying Member (IPM) category. It is advised however, that prior to paying the premium contribution as an IPM, you may request for the adjustment so that you will only be paying the remaining balance of your premium contribution dues for the current year.

Request for Refund of Personal Share

• This alternative is only available to members under the Lifetime membership program or eligible members of the said program.
• Qualifications are as follows:
• Overpayment was due to multiple employment;
• Overpayment was incurred only upon effectivity of the Circular;
• The period covered for adjustment is posted in PhilHealth's contribution and treasury database (This means that you should be included in the monthly report prepared by your employer and the employer is paying the contribution as evidenced by the record in the Treasury database.);
• Member is no longer employed;
• Member is 60 years old and above and has paid the 120 monthly premium contributions.
• Only the personal share shall be refunded to the member.

Documentary Requirements to avail of the Two (2) Options:

• Filled-out request form/letter requesting of adjustment or refund of overpayment in personal share (specify the period where you are being deducted more than once, include the names of your employers for the corresponding period);
• Copy of any 2 valid IDs with photo;
• Copy of Employment Contract reflecting monthly income and status of employment from each of your employers;
• Certificate of Employment with monthly income and status of of employment signed by the employers;
• Other documents required by the Collection Section of PhilHealth.

Before going to the PhilHealth Office, call the Collection Section first so that you will be sure what other documents they will be requiring you to bring.

Discussion board on the EPRS on FB

If you have a Facebook account, please feel free to post any of your queries regarding the Electronic Premium Reporting System on our Facebook account discussion board. If you don't have a Facebook account, just enter your comments or questions here or email us at philhealth101@gmail.com.

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.

PhilPost as a PhilHealth Accredited Collecting Agent

As of January 2011, there are additional PhilPost Offices that are collecting PhilHealth premiums. Among them are:

• Manila Central Post Office
• Makati Central Post Office
• Quezon Central City Post Office
• Kalookan Central Post Office
• Pasay Central Post Office
• Muntinlupa Central Post Office
• Marikina Post Office
• Parañaque Post Office
• Araneta Post Office
• Novaliches Post Office

Payments from employers and individual members are accepted in PhilPost.

If you will be paying at a PhilPost Office, you should provide them the following information:

• PhilHealth Employer Number (PEN) / PhilHealth Identification Number (PIN)
• Name of employer / member
• Applicable month or period to be paid
• Amount to be paid

As a safety precaution, always double check the receipt given to you to ensure that the above information has been correctly captured by the collecting agent and PhilHealth as well. Any discrepancies require that the  agent correct the information and you should have the corrected copy of the receipt or payment return form.

Download the PhilHealth Premium Payment Slip (PPPS)

For employers and PhilHealth members who are paying their premium contributions or remitting their payments through accredited collecting agents of PhilHealth, the PhilHealth Premium Payment Slip is now downloadable.

The PhilHealth Premium Payment Slip is currently being used by accredited collecting agents. The employer/member would need to fill-out the slip, present the slip and the payment to the agent. You should ensure that the slip is properly filled-out as the details you have reflected will be recorded in PhilHealth's database.

To avoid the long lines and ensure availability of the form, PhilHealth is now allowing access to the form in softcopy format. You may download the PhilHealth Premium Payment Slip here.

Schedules of PhilHealth Premium Payments

This is a reminder on when to pay your premiums.

For OFWs:

• OFWs are required to pay their premiums prior to departure covering a one year period.
• The date of payment will be the starting date of your coverage to PhilHealth so for regularity of payment, you would need to pay after the expiry of your coverage which is a year starting from the date of your payment. Payment on January 13, 2010 will expire on January 12, 2011, hence you would need to immediately pay the premium on January 13, 2011.

For Individually Paying Members

• For quarterly payments, deadline is the last working day of the applicable quarter. Payment of the 1st Quarter should be made on or before the last working day of March.
• For semi-annual/semestral payment, deadline shall be the last working day of the first quarter of the applicable semester. Deadline of payment for Jan-June shall be on or before the last working day of March, while payment for July-December may be made on or before the last working day of September.
• For annual payment, deadline shall be on or before the last working day of the 1st quarter of the applicable year.
It is recommended to pay your premiums prior the last day of payment to avoid long queues in PhilHealth Offices.

For Employers:

• Payment is made every month, deadline of which is the 10th calendar day of the month following the applicable month. As an example, remittance of the contributions of January should be on or before February 10.

If the deadline of payment falls within a holiday, the member/employer should pay prior the said deadline.

Reference: PhilHealth Circular No. 27 s-2010

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).

PhilHealth Premium Contribution Payment Rates

As with most insurance and HMO companies, PhilHealth members are required to pay a premium contribution in order to be qualified to receive PhilHealth benefits. Regularity of the payment will ensure uninterrupted availability of benefits from PhilHealth.

For individual members of the program,

• Overseas Filipino Workers (OFW) are required to pay the one year premium of Php900.00. However, members have the option to pay the corresponding amount as an advance payment dependent to the number of years reflected in the contract period. Payment should be made to the POEA or directly to any PhilHealth office prior to departure. You may continue to pay your premiums through the accredited remittance centers shown here.
• Individually Paying Members (Non-Professional) are required to pay Php300.00 per quarter to remain an active member of PhilHealth. You may also opt to pay semi-annually or annually directly to PhilHealth offices or through Accredited Collecting Agents. Payment on a monthly basis equivalent to Php100.00 is available only through the Remittance-By-Air facility. If your occupation is not included in this list then you belong to the Non-Professional classification.
• Individually Paying Members (Professional) are required to pay the amount of Php600.00 per quarter or Php2,400.00 per year on the first year of implementation starting October 1, 2010.
For the succeeding years, members shall pay Php900.00 per quarter or Php3,600 per year. For those whose family income in the last 12 months is Php25,000.00 and below premium rate of the Non-Professional will be used. Payments may be made directly with PhilHealth or through the Accredited Collecting Agents.

If you are in a government or private institution (employed member), the employers will be deducting your PhilHealth premium based on your basic salary with the corresponding employer share. Refer to the table of Premium Contribution here.