PhilHealth FAQs

Tamang Sagot (TS)
PhilHealth’s Frequently Asked Questions
Philippine Health Insurance Corporation

May 2012
Updated May 20, 2012
Table of Contents
A. THE ORGANIZATION .............................................................................................................................................................. 9
What is PhilHealth? ............................................................................................................................................................................................................. 9
What is the National Health Insurance Program (NHIP)? .................................................................................................................................. 9
What are the underlying principles/concepts behind the NHIP? ................................................................................................................... 9
What is PhilHealth’s purpose of being? ..................................................................................................................................................................... 9
When was PhilHealth created? ...................................................................................................................................................................................... 9
What are its enabling laws or legal bases? ............................................................................................................................................................... 9
What is its vision? ................................................................................................................................................................................................................ 9
What is its mission? ............................................................................................................................................................................................................ 9
What is the role of PhilHealth’s Board of Directors? Who composes it? .................................................................................................. 10
What is PhilHealth’s classification as a government agency?........................................................................................................................ 10
What are its fund sources? ........................................................................................................................................................................................... 10
Why does PhilHealth have to keep a reserve fund? .......................................................................................................................................... 10
With what organizations is it affiliated? .................................................................................................................................................................. 10
How do I contact PhilHealth? ...................................................................................................................................................................................... 10
B. MEMBERSHIP .........................................................................................................................................................................11
Who can be members of PhilHealth? ...................................................................................................................................................................... 11
What are the different membership types at PhilHealth? ............................................................................................................................... 11
Who can enrol under these different programs? ............................................................................................................................................... 11
What are the fundamental processes that each member should know? ................................................................................................. 13
What is my proof that I am already a registered member? ........................................................................................................................... 13
C. REGISTRATION/ENROLLMENT ............................................................................................................................................13
Who should enrol? ........................................................................................................................................................................................................... 13
Is there any age limit for prospective members?................................................................................................................................................ 13
How do members enrol into the program? Where can they enrol?........................................................................................................... 13
What are the documents required for the registration of employers (and their employees) in the Government Sector and
Private Sector? ................................................................................................................................................................................................................... 16
How can LGUs enrol their underprivileged constituents into the Sponsored Program? ................................................................... 16
Who can be declared as legal dependents? ......................................................................................................................................................... 16
How do I activate my membership? ......................................................................................................................................................................... 16
Where else can I register? ............................................................................................................................................................................................. 17
 Situationers for Registration/Enrolment ............................................................................................................ 17
Can foreign nationals working in the Philippines enrol? .................................................................................................................... 17
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Can minors and orphaned children enrol? ............................................................................................................................................... 17
In case of early retirement, can I already register as a Lifetime Member? .................................................................................. 17
Is it true that retiring employees can now be automatically enrolled by the employer in the Lifetime Member
Program? ................................................................................................................................................................................................................. 17
Can foreign spouses of Filipino nationals be declared as dependents? ...................................................................................... 17
Can unmarried members declare nephews or nieces as dependents? ........................................................................................ 18
If both parents are members, can they both declare their children as dependents? ............................................................. 18
How can a member declare his spouse whose membership is inactive as a dependent? ................................................... 18
If all siblings are active members, can each of them declare their parents as dependents? .............................................. 18
Can disabled parents (physically or mentally incapacitated) who are below 60 years old be declared as
dependents? .......................................................................................................................................................................................................... 18
Can my live in partner be declared as a legal dependent? How about our children? ........................................................... 18
My daughter who’s still my dependent (under 21) is about to give birth. Will my membership be able to cover
her? ............................................................................................................................................................................................................................ 18
Do I need to personally submit my registration documents or can I ask my representative to do so? ......................... 18
D. UPDATING MEMBERSHIP RECORDS ..................................................................................................................................18
When should I update my MDR? How is this done? ......................................................................................................................................... 18
How do I shift membership categories? ................................................................................................................................................................. 19
Are we going to use the same PhilHealth Identification Number (PIN) if we are shifting to another membership
category?.............................................................................................................................................................................................................................. 19
 Situationers for Updating Membership Records ................................................................................................ 19
I was given a PhilHealth card by our LGU, but my name was misspelled and data provided were also erroneous.
How do I correct this information? .............................................................................................................................................................. 19
E. CONTRIBUTIONS AND MEMBERSHIP RENEWAL ..............................................................................................................19
Why must a member pay his premiums regularly? ........................................................................................................................................... 19
How much is the premium contribution rate? ..................................................................................................................................................... 19
Why is there a need for an increase in premium contributions? ................................................................................................................. 20
Are overtime pay, commissions, and allowances included in the computation of premium contributions of employees?
.................................................................................................................................................................................................................................................. 20
Where can the members remit their contributions? ......................................................................................................................................... 20
Aside from paying through service offices and collecting agents, is there another way for me to pay my premiums
easily? .................................................................................................................................................................................................................................... 21
What if I want to view my payment history for Text 7442? ............................................................................................................................ 21
When is the deadline for paying my premium contribution? ....................................................................................................................... 21
What is the effectivity date of PhilHealth coverage? ........................................................................................................................................ 23
What are the requirements for eligibility? When is a member eligible to claim? ................................................................................. 23
How do I maintain my eligibility? .............................................................................................................................................................................. 23

If I missed paying in the past quarters, can I still pay for this now to become eligible again? ....................................................... 24
What is the tolerable delay for paying premiums for a member to still be able to use his/her benefits? ................................. 24
 Situationers: Contributions and Renewal .......................................................................................................... 24
Can contributions be refunded by the member who was not able to use it? ........................................................................... 24
If I stopped paying my premium for a considerable amount of time, can I still use my benefits? Do I need to pay
the missed contributions to be able to avail of the benefits again? ............................................................................................. 24
If an employed member who was separated from service last October 2011 wants to continue his membership as
an Individually Paying Member in March 2012, can he retroactively pay the premiums for Nov-Dec 2011 and first
quarter 2012, in March 2012? ........................................................................................................................................................................ 25
A new governor/mayor was elected in our area. Am I still considered a member under the Sponsored Program
even with this change in leadership? .......................................................................................................................................................... 25
What if I have multiple jobs? Can I just pay my contributions once? ........................................................................................... 25
I am an employed member, but I recently found out that my employer stopped paying our contributions even
though he continues to deduct the premiums from our salaries. How do we go about this? .......................................... 25
What if the member passes away? Can the dependents still use their benefits? .................................................................... 25
If a member has paid his premium for one year and he died during the first half of the year, can his dependents
refund his premium? .......................................................................................................................................................................................... 26
I already have a lifetime member card, but my current employer still continues to pay for my premiums. Can these
premium contributions be credited to my son/daughter’s membership when I retire? ...................................................... 26
What if a Lifetime Member is re-hired, must he resume contributing to PhilHealth through salary deduction? ...... 26
Is membership transferrable? ......................................................................................................................................................................... 26
Are the payments for OWWA Contributions and PhilHealth premiums different?................................................................. 26
If I stopped paying my premium for a considerable amount of time, how will I reactivate my membership? Do I
need to apply for a new membership/PIN? ............................................................................................................................................. 26
How can a SP member continue PhilHealth membership when his/her PhilHealth ID expires? ....................................... 26
I used to be employed, but am now self-employed. Can I still continue paying for my premiums? How do I go
about this? .............................................................................................................................................................................................................. 26
I am a PhilHealth member sponsored by an LGU; is it still necessary for me to pay my membership as an OFW? . 27
Why do I have to renew my PhilHealth membership every time I leave the country and work as an OFW? .............. 27
What is the grace period of OFW membership renewal? .................................................................................................................. 27
I am currently abroad and my coverage is about to expire. How do I continue paying for my PhilHealth in case
there are no available payment centers where I am? .......................................................................................................................... 27
If a member has dual citizenship, can he/she still renew his/her membership and avail of the benefits whenever
he/she is in the Philippines? ........................................................................................................................................................................... 27
I am already an immigrant here in the US. Can I still continue my membership with PhilHealth? .................................. 27
Where can I pay my premium contributions? ......................................................................................................................................... 27
F. SPECIAL SECTION: INCREASE IN PREMIUM FOR OFW MEMBERS ..................................................................................27
Why is there a need to increase the annual premium of OFW members? .............................................................................................. 27
What was the basis for pegging the new premium rate at P2,400 per year? ......................................................................................... 28
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Were OFW members consulted by PhilHealth before the increase was approved? ........................................................................... 28
How much is the increase? When is this effective? ........................................................................................................................................... 28
When was the last time that premium contributions of OFW members increased? ........................................................................... 28
Can OFW members whose families were affected by Typhoon Sendong be exempted from paying the new premium
rate? ....................................................................................................................................................................................................................................... 28
Where can they pay their premium contributions in the Philippines? How about abroad? ............................................................ 28
If an OFW’s membership coverage expires while he is still abroad, will he be required to pay, through his kin in the
Philippines, the new rate when he renews his coverage? ............................................................................................................................... 28
How much is the premium if an OFW decides to pay in advance?............................................................................................................. 29
What additional benefits can an OFW member expect from PhilHealth? ............................................................................................... 29
Will the increase in premium mean additional benefits for OFWs and their dependents as well? ............................................... 29
Are these benefits available to the OFW member even while he is abroad? ......................................................................................... 29
When can OFWs expect the increase in benefits? .............................................................................................................................................. 29
How do you plan to inform OFWs about the new premium rate in less than two weeks’ time? ................................................... 29
Is PhilHealth making any representation with Philippine Embassies and consulates overseas to inform OFWs about the
increased premium? ........................................................................................................................................................................................................ 30
Since PhilHealth has no physical presence overseas, how do you plan to discuss the new premium rates with OFWs and
OFW organizations at this time? ................................................................................................................................................................................ 30
Where can OFW-members refer their inquiries pertaining to the new premium rates? ................................................................... 30
G. SPECIAL SECTION: UMID CARD ACTIVATION AND BIOMETRIC CAPTURE ...................................................................30
Why must I undergo biometric capture with PhilHealth? ............................................................................................................................... 30
Can I choose not to have my biometric data captured by PhilHealth? ..................................................................................................... 30
What does ‘biometric capture’ mean?..................................................................................................................................................................... 30
Am I going to pay any fee for biometric capture? ............................................................................................................................................. 30
Where can I have my biometric data captured by PhilHealth? ..................................................................................................................... 30
If I missed the schedule of biometric capture in our office premises, can I proceed to any PhilHealth Branch for this? .... 31
Are there forms I need to fill out before biometric capture day? ................................................................................................................ 31
Is there a recommended attire for the biometric process? ............................................................................................................................ 31
How will the biometric capture procedure go? ................................................................................................................................................... 31
Will the biometric capture process eat up a lot of my time from work? .................................................................................................. 31
What do I need to bring on biometric capture day? ......................................................................................................................................... 31
Are there things I must ensure before I proceed with biometric capture? .............................................................................................. 31
Can I update my MDR on the day of biometric capture through the UMID Mobile Team? ............................................................ 31
Once my biometric data have been captured, what are the next steps? ................................................................................................. 31
Where can I call if I have further questions regarding the biometric capture?...................................................................................... 31
 UMID Card Activation ..................................................................................................................................... 32
Why must I activate my UMID card with PhilHealth? .......................................................................................................................... 32

Can I choose not to activate my UMID card with PhilHealth? ......................................................................................................... 32
What does ‘card activation’ mean? .............................................................................................................................................................. 32
What are the requirements to activate my UMID card with PhilHealth? ..................................................................................... 32
Where can I activate my UMID card with PhilHealth? ......................................................................................................................... 32
If I missed the schedule of card activation in our office premises, can I proceed to any PhilHealth Branch to have
my UMID card activated? ................................................................................................................................................................................. 32
How long does the card activation process take? ................................................................................................................................. 32
Can I update my MDR on the day of card activation through the UMID Mobile Team? ..................................................... 33
What are the card activation procedures? ................................................................................................................................................ 33
How will I use my PhilHealth-activated UMID cards? .......................................................................................................................... 33
What are the contact numbers if I have further questions regarding the UMID card activation?.................................... 33
H. BENEFITS AND BENEFITS AVAILMENT ..............................................................................................................................33
What benefits can a member avail himself of under the NHIP? .................................................................................................................. 33
Where can these benefits be availed of?................................................................................................................................................................ 35
How can these benefits be availed of? .................................................................................................................................................................... 36
Do legal dependents enjoy the same benefits as the member? .................................................................................................................. 36
What documents must a member submit to be able to avail of the benefits? ..................................................................................... 36
Where and when should these documents be submitted? ............................................................................................................................ 37
How can the member avail himself of PhilHealth benefits if he has an existing coverage with a health maintenance
organization? ...................................................................................................................................................................................................................... 37
Can a senior citizen avail himself of both the PhilHealth benefits and his senior citizen privilege when confined? ............. 37
Can overseas Filipino worker-members reimburse their hospitalization expenses with PhilHealth? ........................................... 37
I’ve been paying my premiums regularly, but I still haven’t availed of any benefits. When will I be able to benefit from
my membership? .............................................................................................................................................................................................................. 37
 Situationers: Benefits and Benefits Availment .................................................................................................... 38
How will the member know if the PhilHealth benefit deducted from his total hospital bill is correct? ......................... 38
What if the amount deducted as PhilHealth benefit is less than what PhilHealth actually paid to the provider for
the member’s confinement? ........................................................................................................................................................................... 38
If siblings are all active members, can each of them file a claim for the confinement of their parents? ....................... 38
If both spouses are members, can each of them file a claim for the confinement of their children? ............................. 38
If the spouse’s, child’s or parent’s name is not listed in the member’s MDR at the time of confinement, how can
the member avail himself of the benefits? ............................................................................................................................................... 38
How can members separated or resigned from employment avail themselves of maternity benefits? ........................ 38
I. SPECIAL SECTION: CASE RATES FOR 23 MEDICAL AND SURGICAL PROCEDURES ........................................................39
What is case payment? .................................................................................................................................................................................................. 39
How is this different from the old system? ........................................................................................................................................................... 39
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Why shift to case rate payments? What advantages will this form of benefit payment bring, especially to the members?
.................................................................................................................................................................................................................................................. 39
Who are entitled to these new case rate packages? ......................................................................................................................................... 39
Can I avail of this benefit now?................................................................................................................................................................................... 39
How will cases be reimbursed? .................................................................................................................................................................................. 39
What will happen to doctor’s professional fees? ................................................................................................................................................ 39
How much will be allocated to the doctors’ PF? ................................................................................................................................................. 39
What are the surgical cases under Case Rate that can be reimbursed in particular facilities? ....................................................... 39
How will hospitals be paid for 2 or more surgical case rates performed in a single confinement? ............................................. 40
How will the procedures be reimbursed if a procedure performed has laterality (e.g., cataract)? ................................................ 40
What will happen to major surgical procedures done in Level 1 hospitals? ........................................................................................... 40
Is Case Rate covered by the rule on single period of confinement? Will the 45 days allowance apply for case rates? ....... 40
If a member’s total hospital fees for dengue I is beyond the case rate amount listed by PhilHealth, will the member
shoulder the balance? .................................................................................................................................................................................................... 40
A member is admitted for dengue I for three days, and another member is admitted for dengue I for five days, will they
be entitled to the same case rate amount for dengue I of P8,000.00? ..................................................................................................... 40
What medical cases under Case Rate can be reimbursed in Level 1 hospital? Level 2 hospitals?................................................. 40
For medical case rate, how will PhilHealth pay for a patient admitted for several conditions? ..................................................... 41
In case the member was transferred to another hospital, will PhilHealth pay for both facilities? ................................................. 41
For cases not included in the Case Rates table, how will PhilHealth reimburse those cases? ......................................................... 41
J. SPECIAL SECTION: NO BALANCE BILLING POLICY ............................................................................................................41
What is “No Balance Billing” (NBB) and to whom it will be applicable? ................................................................................................... 41
Why is this being introduced only for Sponsored Program members? .................................................................................................... 41
What are the conditions for availment of benefits of SP members under the NBB policy? ............................................................. 41
Is the NBB policy also applicable to other PhilHealth membership types? ............................................................................................. 41
If the Sponsored member under NBB bought drugs and medicines or other supplies, will he be able to reimburse then?
How? ...................................................................................................................................................................................................................................... 42
In case a sponsored member/dependent was admitted in a government hospital where the only available room that
time for the patient is a private room, can the sponsored member be admitted in any room or private room of a
government hospital? Will the NBB policy still apply? ..................................................................................................................................... 42
What if a sponsored member is admitted in a private hospital? Will the NBB policy still be applicable? ................................. 42
Are there sanctions for violations in NBB policy? ............................................................................................................................................... 42
K. SPECIAL SECTION: ANIMAL BITE PACKAGE.......................................................................................................................42
Tamang Paggamot sa Kagat ng Hayop ................................................................................................................ 42
Ano ang unang dapat gawin kapag nakagat ng hayop? ................................................................................................................... 42
Bakit kailangang magpabakuna kung nakagat ng aso? ..................................................................................................................... 42
Gaano katagal ba ang bisa ng bakuna? ..................................................................................................................................................... 42

Ilang beses ba akong bibigyan ng bakuna? ............................................................................................................................................. 43
Kailan dapat magpabakuna? Hihintayin pa bang mamatay ang aso bago magpabakuna? ............................................... 43
Kailangan pa ba akong ma-confine kung nakagat ng aso? .............................................................................................................. 43
Kailangan pa ba akong mabakunahan kung kumpleto naman sa bakuna ang asong kumagat? .................................... 43
Mga Paalala............................................................................................................................................................................................................ 43
Tungkol sa Animal Bite Treatment Package ng PhilHealth ...................................................................................... 43
Ano po ba ang kasama sa Animal Bite Treatment Package? ............................................................................................................ 43
Ano ang kailangang ipakita o gawin para maka-avail ng package? ............................................................................................. 43
Saan ba pwedeng maka-avail ng package? Saan ako pwedeng pumunta para magpabakuna kung nakagat ng
aso? ........................................................................................................................................................................................................................... 44
Kailangan ba akong bumili ng bakuna sa labas? Meron pa ba akong dapat bayaran kung may PhilHealth na?...... 44
Paano kung nakagat ako ulit? Ilang beses ako pwedeng makagamit ng PhilHealth para sa ganitong benepisyo?44
Covered din ba ang pamilya ko pag sila ay nakagat? ......................................................................................................................... 44
Paano kung hindi aso ang nakakagat? Kasama pa rin po ba ito sa benepisyo? ..................................................................... 44
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A. THE ORGANIZATION
What is PhilHealth?
The Philippine Health Insurance Corporation (PhilHealth) is a Government-Owned and Controlled Corporation
that was established to administer the National Health Insurance Program nationwide.
What is the National Health Insurance Program (NHIP)?

The NHIP is basically the product that PhilHealth offers. This mandatory health insurance program of the
government seeks to provide universal health insurance coverage and ensure affordable, acceptable, available,
accessible, and quality health care services for all citizens of the Philippines.
What are the underlying principles/concepts behind the NHIP?

Social health insurance is based on the principle of social solidarity. Social solidarity with respect to health care is
expressed when people support each other by contributing financial resources to a pool that will pay for
everyone’s costs of care. In this set-up, PhilHealth acts as the body that pools all the resources together and makes
it available to each member, thereby allowing the rich to support the poor, the healthy to support the sick, the
young and working to support the elderly – all in the spirit of bayanihan.
What is PhilHealth’s purpose of being?

Bawat Pilipino, miyembro
Bawat miyembro, protektado
Kalusugan natin, segurado
This battle cry captures PhilHealth’s primary purpose of being, which is to ensure that all Filipinos, especially
those who cannot afford the cost of health care, are given real financial risk protection. For PhilHealth, real
financial risk protection means that:
1. All Filipinos are enrolled into the NHIP (100% coverage)
2. Members are empowered to enjoy their enhanced benefits
3. Each member will be assigned to a primary care provider who shall address his/her health needs
4. Members have access to accredited facilities that are of superior quality
5. Every Filipino who desires to avail of the No Balance Billing (zero-copayment) policy will always have an
opportunity to do so anywhere in the country. This reduces, if not totally eliminates, debilitating out-of-
pocket health expenses that drive families deeper into poverty.
When was PhilHealth created?

PhilHealth was established on February 14, 1995.
What are its enabling laws or legal bases?

It was through Republic Act 7875 or the National Health Insurance Act of 1995 that PhilHealth was created. It
was amended by Republic Act 9241 which was passed on February 10, 2004.
What is its vision?

PhilHealth’s vision is to provide adequate and affordable social health insurance coverage for all Filipinos.
What is its mission?

Its mission is 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.
What is the role of PhilHealth’s Board of Directors? Who composes it?
The Board of Directors is responsible for providing the overall policy and strategic direction of the Corporation.
It is composed of the following members representing key government agencies and sectors of our population:
Board Chair, Secretary of Health Hon. Enrique T. Ona, MD

Board Members Chairman, Civil Service Commission Hon. Francisco T. Duque III, MD, MSc
Secretary,
Department of Interior and Local Government Hon. Jesse M. Robredo
Secretary,
Department of Social Welfare and Development Hon. Corazon J. Soliman
Secretary,
Department of Labor and Employment Hon. Rosalinda D. Baldoz
President and Chief Executive Officer,
Social Security System Hon. Emilio S. De Quiros, Jr.
President and General Manager,
Government Service Insurance System Hon. Robert G. Vergara
Representative, Health Care Providers Sector Hon. Juan M. Flavier, MD
Representative, Labor Sector Hon. Alexander A. Ayco, MD
Representative, Employers Sector Hon. Dr. Eduardo P. Banzon
Representative, Self-employed Sector Hon. Francisco Vicente F. Lopez, MD
Representative, Filipino Overseas Workers Hon. Jane M.N. Sta. Ana
Chairman,
National Anti-Poverty Council – Basic Sector Hon. Florencia Dorotan
What is PhilHealth’s classification as a government agency?

Similar to the SSS, GSIS and PAG-IBIG, PhilHealth is a government owned and controlled corporation (GOCC).
It is also an attached agency of the Department of Health (DOH).
What are its fund sources?

Unlike the Department of Health and other agencies that are financed through taxes, PhilHealth primarily gets its
funds from premiums being collected from its members. Out of the total amount collected, a percentage goes to
its Corporate Budget.
Why does PhilHealth have to keep a reserve fund?

PhilHealth, as a social health insurance, uses a pay-as-you-go scheme. This simply means that out of collected funds,
the Corporation is bound to allot funds for expenses to be incurred by members for a particular enrolment year.
The reserve fund is only kept in anticipation of calamities and other situations where members’ use of benefits will
likely exceed that of current/projected rates, therefore demanding for more resources to pay for expenses.
With what organizations is it affiliated?

PhilHealth is a member of several organizations involved in social security, such as the International Social
Security Association, ASEAN Social Security Association, and the Philippine Social Security Association
(PHILSSA), among others.
How do I contact PhilHealth?

There are many ways to reach PhilHealth:
Website: www.philhealth.gov.ph
Email: info@philhealth.gov.ph
Facebook: www.facebook.com/PhilHealth
Twitter: www.twitter.com/teamphilhealth
Trunkline: 441-7444 (connecting all departments)
Call Center: 441-7442
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B. MEMBERSHIP
Who can be members of PhilHealth?

All Filipino citizens are mandated to enrol into the National Health Insurance Program.
What are the different membership types at PhilHealth?

There are currently five membership types/programs under the NHIP. These are:
1. Sponsored Program
2. Individually Paying Program
3. Employed Sector Program
4. Overseas Workers’ Program
5. Lifetime Member Program
Who can enrol under these different programs?

As a general rule, remember that each Filipino is entitled to become part of the National Health Insurance
Program. Your type of membership depends primarily on two things: 1) capacity to pay and 2) employment.
Those who are below 21 are generally considered as dependents, rather than primary members.
Sponsored Program
Under the Sponsored Program, indigents belonging to the lowest 40% (Quintiles 1 and 2) of the Philippine
population in terms of income may enrol, including:
1. Families listed under the National Household Targeting System for Poverty Reduction (NHTS – PR) of
the Department of Social Welfare and Development (DSWD)
2. Families identified poor by the sponsoring Local Government Units (LGUs).
Individuals are encouraged to check whether they belong to the DSWD/LGU lists. Identified members and their
dependents shall be considered part of the NHIP.
Individually Paying Program

Under the Individually Paying Program, the following may enrol:
1. Self-employed individuals. These are individuals who work for him/herself and are therefore both the
employer and employee of their businesses. These include but are not limited to the following:
a. Self-earning professionals (ex. doctors and lawyers)
b. Business partners and single proprietors/proprietresses
c. Freelancers, actors, actresses, directors, scriptwriters and news reporters who are not under an
employer-employee relationship
d. Professional athletes, coaches, trainers and jockeys
e. Farmers and fisherfolk
f. Workers in the informal sector (ex. ambulant vendors, watch-your-car boys, hospitality girls, tricycle
drivers, etc.)
2. Separated from employment. These are individuals who were previously formally-employed (with employer-
employee relationship) and are separated from employment.
3. Employees of international organizations and foreign governments based in the Philippines without agreement with
PhilHealth for the coverage of their Filipino employees in the program.
4. All other individuals not covered under the previous categories mentioned, including but are not limited
to the following:
a. Parents who are not qualified as legal dependents, indigents or retirees/pensioners
b. Retirees who did not meet the minimum of 120 monthly premium contributions to qualify as non-
paying members
c. Children who are not qualified as legal dependents
d. Unemployed individuals who are not qualified as indigents
Employed Sector Program
Under the Employed Sector Program, the following may enrol:
1. Government Sector. Employees of the government, whether regular, casual or contractual, who renders
services in any government branches, military or police force, political subdivisions, agencies, or
instrumentalities, including government-owned and controlled corporations, financial institutions with
original charter, constitutional commissions, and is occupying either an elective or appointive position,
regardless of status of appointment.
2. Private Sector. Employees who render services in any of the following:

a. Corporations, partnerships, or single proprietorships, non-government organizations, cooperatives,
non-profit organizations, social, civic, or professional or charitable institutions, organized and based
in the Philippines
b. Foreign corporations, business organizations, non-government organizations based in the Philippines
c. Foreign governments or international organizations with quasi-state status based in the Philippines
which entered into an agreement with PhilHealth to cover their Filipino employees
d. Foreign business organizations based abroad with agreement with PhilHealth to cover their Filipino
employees
e. Sea-based OFWs
f. Household employees
Overseas Workers Program

Under the Overseas Workers Program, the following may enrol:
1. Active land-based OFWs who underwent the normal process of registration as an OFW at POEA
Offices
2. OFWs who are currently abroad but are not yet registered with PhilHealth
Lifetime Member Program

Under the Lifetime Member Program, the following may enrol:
1. Old-age retirees and pensioners of the GSIS, including uniformed and non-uniformed personnel of the
AFP, PNP, BJMP and BFP who have reached the compulsory age of retirement before June 24, 1997,
and retirees under Presidential Decree 408
2. GSIS disability pensioners prior to March 4, 1995
3. SSS pensioners prior to March 4, 1995
4. SSS permanent total disability pensioners
5. SSS death/survivorship pensioners
6. SSS old-age retirees/pensioners
7. Uniformed members of the AFP, PNP, BFP and BJMP who have reached the compulsory age of
retirement on or after June 24, 1997, being the effectivity date of RA 8291 which excluded them in the
compulsory membership to the GSIS
8. Retirees and pensioners who are members of the judiciary
9. Retirees who are members of Constitutional Commissions and other constitutional offices
10. Former employees of the government and/or private sectors who have accumulated/paid at least 120
monthly premium contributions as provided for by law but separated from employment before reaching
the age of 60 years old and thereafter have reached 60 years old
11. Former employees of the government and/or private sectors who were separated from employment
without completing 120 monthly premium contributions but continued to pay their premiums as
Individually Paying Members until completion of the required 120 monthly premium contributions and
have reached 60 years old as provided for by law
12. Individually Paying Members, including SSS self-employed and voluntary members, who continued
paying premiums to PhilHealth, have reached 60 years old and have met the required 120 monthly
premiums as provided for by law
13. Retired underground mine workers who have reached the age of retirement as provided for by law and
have met the required premium contributions
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What are the fundamental processes that each member should know?
Each member ought to be familiar with the following fundamental processes:
1. Enrolling or registering into the NHIP
2. Updating their records regularly
3. Paying for their premiums on-time
4. Getting their claims from PhilHealth
5. Knowing their benefits
What is my proof that I am already a registered member?

After registering, each member should receive the following important documents:
1. PhilHealth ID – contains the member’s PIN (PhilHealth Identification Number), name, picture, and
signature. Remember that each member should have only one PIN.
2. Member Data Record (MDR) – contains the member’s name, address and legal dependents listed in the
PhilHealth database
C. REGISTRATION/ENROLLMENT
Who should enrol?

All Filipinos aged 21 years old and above (no longer qualified as dependents) must register and have their own
PhilHealth ID Number or PIN. Once a legal dependent reaches 21 years of age, he/she must apply for his/her
membership.
Is there any age limit for prospective members?

None, the NHIP promotes mandatory coverage for all Filipinos.
How do members enrol into the program? Where can they enrol?
Sponsored Program
Members whose names appear in the NHTS-PR list or LGU’s list of priority families are automatically enrolled
into the program. Their IDs may be claimed from the Local Social Welfare and Development Office. To date, the
NHTS list has been distributed to providers and has been made available online through PhilHealth’s website:
http://www.philhealth.gov.ph/members/sponsored/nhts-pr_list.html.
If members feel like they should be part of the SP, he/she can approach their local DSWD office, which in turn,
will evaluate and determine if he/she is qualified to join the program. The DSWD shall then endorse the list of
possible beneficiaries to the Local Government Unit (LGU) or any Sponsor.
Individually Paying Program

In general, these are the steps that each member has to go through to register. The following section details the
documents/protocols that are unique to each member type.
STEP 1 STEP 2 STEP 3

Fill out the PMRF Prepare supporting Go to the nearest
(2 copies) documents PhilHealth Service Office
(see list below). to submit the docs and
pay your premium.
1. Fill out two copies of the PhilHealth Member Registration Form (PMRF).
2. Attach a clear copy of the following supporting documents to this form (for the applying member and
his/her qualified dependents):
a. Member – Birth/baptismal certificate or any ID card issued by a government official authority
b. Dependents
i. Spouse: Marriage certificate/contract
ii. Children below 21: Birth certificate; court decree of adoption (for adopted children)
iii. Parents 60 and above: Birth certificate
3. Submit these documents to the nearest PhilHealth Service Office for processing.
4. Upon submission of documents, the registrant will be issued his/her PhilHealth Identification Number
(PIN) and a Member Data Record (MDR).
5. He/she shall then be asked to pay the required premium through the PhilHealth Cashier or any
accredited collecting agent (banks, local government units, etc.)
Online Registration
STEP 1 STEP 2 STEP 3

Visit the PhilHealth Fill out and submit Go to the nearest
website online registration PhilHealth Service Office
eregister.philhealth.gov.ph
form. to pay your premium.
1. Members also have an option to register online. Simply visit http://eregister.philhealth.gov.ph and go
through the procedures indicated in the site.
Employed Sector Program

1. For newly hired employees without PIN yet (Also applicable to existing employees without PIN):
a. Fill out two copies of the PhilHealth Member Registration Form (PMRF).
b. Attach a clear copy of the following supporting documents to this form (for the applying member
and his/her qualified dependents):
i. Member – Birth/baptismal certificate or any ID card issued by a government official authority
ii. Dependents
1. Spouse: Marriage certificate/contract
2. Children below 21: Birth certificate; court decree of adoption (for adopted children)
3. Parents 60 and above: Birth certificate
c. Submit these documents to the company’s HR Department that is in charge of forwarding the
documents to PhilHealth together with the ER2 Form (Report of Employee-Members).
d. After processing, PhilHealth will send the member, through the employer, his/her PhilHealth
Identification Number (PIN) and a copy of the Member Data Record (MDR).
2. Newly hired employees with PIN need only to report their PIN to their employers for them to be
specified in their ER2 (and subsequently updated in PhilHealth’s database).
Overseas Workers Program

When in the Philippines:
1. Submit the following documents to any PhilHealth office:
a. Duplicate copies of PhilHealth Member Registration Form (PMRF)
b. Supporting documents:
i. Member – Birth/baptismal certificate or any ID card issued by a government official authority
ii. Dependents
1. Spouse: Marriage certificate/contract
2. Children below 21: Birth certificate; court decree of adoption (for adopted children)
3. Parents 60 and above: Birth certificate
c. Any of the following as proof of being an active OFW:
i. Valid Overseas Employment Certificate (OEC) or E-receipt
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ii. Valid overseas employment contract or certificate of employment

iii. Valid re-entry visa
iv. Valid job contract
2. Pay the one-year premium of PhP 1,200. If you have already paid PhP900 during your last transaction,
please expect a notice from PhilHealth charging the additional PhP300 to complete your annual premium.
When abroad:
1. Submit the following documents to any PhilHealth office:
a. PhilHealth Premium Payment Slip (PPPS)
b. Duplicate copies of the PhilHealth Member Registration Form (for initial registration)
c. Supporting documents (birth certificate, baptismal certificate, POEA ECARD/SSS/Company ID,
Passport or any valid ID)
2. Pay the one-year premium of PhP 1,200. If you have already paid PhP900 during your last transaction,
please expect a notice from PhilHealth charging the additional PhP300 to complete your annual premium.
Lifetime Members Program

Members are qualified to enrol as lifetime members if they satisfy the following conditions:
1. They are 60 years old and above, AND
2. They have given at least ten years’ worth of premiums to the NHIP.
To register, simply follow these steps:

1. Submit the following to any PhilHealth Office nearest you:
a. Duly accomplished PhilHealth Membership Registration Form
b. Two (2) latest 1" x 1" ID picture
c. Certified True Copy (CTC) of the SSS or GSIS Retirement Certification or the following as
applicable:
For SSS Retirees/Pensioners:

1. Printout of Death, Disability and Retirement (DDR) from any SSS office indicating that the
type of claim is retirement in nature and the effectivity date of pension; and
2. Printout of contributions issued by any SSS office indicating the latest contributions (if
he/she retires after March 4, 1995.
For GSIS Retirees - any of the following:

1. Certification/Letter of Approval of Retirement from the GSIS indicating the effectivity date
of retirement;
2. Service Record issued by the employer/s indicating not less than 120 months of service
excluding leave of absences without pay;
3. Certification/retirement Gratuity from the employer indicating not less than 120 months of
service.
For AFP, PNP, BFP and BJMP Retirees/Pensioners - those who are in active military service until they
retire at age 56 and those separated by retirement or other reasons prior to the said age but have
reached the age of 60, shall submit any of the following:
1. Statement of Services issued by previous employer indicating not less than 120 months of
service excluding leave of absences without pay;
2. Certification/Letter of Approval of Retirement from the GSIS indicating not less than 120
months of service;
3. General, Bureau or Special Order indicating the effectivity date of retirement.
d. Certified true copy (CTC) of Birth Certificate or any two of the following:
1. CTC of Baptismal Certificate
2. CTC of Marriage Contract/Certificate
3. Passport
4. Driver's License
5. SSS Members ID
6. Alien Certificate of Registration (ACR)
7. Service Record/s
8. Employee ID
9. School records
10. Voter's ID
11. Senior Citizens ID
12. Duly notarized joint affidavit of two disinterested persons attesting to the fact of birth of the
registrant
e. Any other valid documents acceptable by PhilHealth
2. After submission and processing, member will be issued his/her PhilHealth Lifetime Member Card,
which shall serve as a valid ID to be used in all PhilHealth transactions.
What are the documents required for the registration of employers (and their employees) in
the Government Sector and Private Sector?
For Government Employers:
1. Employer Data Record or ER1 (in duplicate)
2. PMRF for each employee (in duplicate)
For Private Employers:

1. Employer Data Record or ER1 (in duplicate)
2. Business Permit/license to operate and/or any of the following as applicable:
1. Single proprietorships – Department of Trade & Industry (DTI) Registration
2. Partnerships & Corporations – Securities & Exchange Commission (SEC) Registration
3. Foundations & Non-profit Organizations – Securities & Exchange Commission (SEC) Registration
4. Cooperatives – Cooperative Development Authority (CDA) Registration
5. Backyard industries/ventures and micro-business enterprises – Barangay Certification and/or
Mayor’s Permit
3. PMRF for each employee (in duplicate)
How can LGUs enrol their underprivileged constituents into the Sponsored Program?
LGUs that wish to enrol their constituents through the Partial Subsidy Scheme must go through the following
steps:
1. Submission of letter of intent
2. Submission of certified list of enrolees and accomplished PMRF
3. Payment of premium contribution
Who can be declared as legal dependents?

The following can be declared as a principal member’s legal dependents:
1. Legal spouse (non-member or membership is inactive)
2. Child or children
b. Legitimate, legitimated, acknowledged and illegitimate (as appearing in birth certificate), adopted or
step below 21 years of age, unmarried and unemployed
c. 21 years old or above but suffering from congenital disability, either physical or mental, or any
disability acquired that renders them totally dependent on the member for support
3. Parents (non-members or membership is inactive) who are 60 years old and above, including stepparents
(biological parents already deceased) and adoptive parents (with adoption papers).
How do I activate my membership?

In order to activate your membership, you must immediately remit your premium contribution. More details on
this in the next section.
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Where else can I register?

Aside from PhilHealth Offices, you may also enrol through our registration partners in SM malls, Bayad Centers,
and mobile registration sites. The same procedures and requirements apply for these partners.
 Situationers for Registration/Enrolment

Can foreign nationals working in the Philippines enrol?
Yes, the Implementing Rules and Regulations of RA 7875, as amended by RA 9241, provide for the inclusion to
the NHIP the citizens of other countries residing and/or working in the Philippines. If the foreign national is
employed, he/she shall be registered under the Employed Sector Program.
Meanwhile, if he/she is self-employed or merely residing in the country, he may enrol as an Individually Paying
Member. He/she only needs to accomplish the following documents and submit these to any PhilHealth office:
1. PhilHealth Member Registration Form (PMRF)
2. Photocopy of his/her Alien Certificate of Registration (ACR) issued by the Bureau of Immigration (BI)
to prove his/her residency in the country.
Can minors and orphaned children enrol?

Yes, minors are allowed to enrol into the NHIP. They must go through the following steps:
1. Submit two (2) copies of the PhilHealth Member Registration Form (PMRF) which must be signed by the
minor-enrolee and countersigned by the guardian.
2. A Notarized Affidavit of Guardianship is required as a supporting document for the purpose.
3. Upon submission of documents, the minor-enrolee has to pay the required contributions.
In case of early retirement, can I already register as a Lifetime Member?

One is qualified to register as a Lifetime Member if the both of the following conditions are met:
1. He/she is already 60 years of age
2. Member has made at least 120 monthly contributions to PhilHealth and the previous Medicare
Hence, if you retired for instance, at the age of 50, you must continue paying premiums as an Individually Paying
Member until you reach the age of 60 and have made the required number of premium contributions.
Is it true that retiring employees can now be automatically enrolled by the employer in the
Lifetime Member Program?
Yes. As per PhilHealth Circular No. 28, s-2010, retiring employees in the government and private sectors must be
enrolled into the Lifetime Member Program and their enrolment must be facilitated by their employers at least
three (3) months prior to the date of retirement.
The application for Lifetime Member Program shall be filed with PhilHealth as soon as the employee's retirement
application has been approved by the employer. The employer's Human Resource Management Office, through
its authorized representative, shall ensure that the documentary requirements for registration are forwarded to
PhilHealth for processing.
Can foreign spouses of Filipino nationals be declared as dependents?

Yes, foreign nationals who are spouses of Filipino nationals can be declared as legal dependents. The principal
member has to submit a copy of their marriage contract so that the foreign national-spouse can be included in the
member’s MDR.
Can unmarried members declare nephews or nieces as dependents?
Nephews and nieces are not considered as qualified legal dependents of principal members under Section 1 of RA
9241.
If both parents are members, can they both declare their children as dependents?
PhilHealth does NOT allow multiple declaration and application of PhilHealth entitlements of both spouses. We
advise you to decide who among you will declare and provide for the PhilHealth coverage of your only
child/children as dependents.
How can a member declare his spouse whose membership is inactive as a dependent?
The active member-spouse must submit the following at any PhilHealth Office:
1. 2 copies of duly accomplished PhilHealth Member Registration Form
2. Clear copy of Marriage Certificate/Contract with registry number (original copy to be presented for
validation)
3. Request letter to be declared as legal dependent signed by the inactive/unemployed spouse
After processing, PhilHealth will issue a new (updated) Member Data Record which indicates the name of the
spouse (inactive) as legal dependent.
If all siblings are active members, can each of them declare their parents as dependents?
Multiple declarations of dependents are not allowed. Members are advised to decide who among them will declare
their parents as dependents.
Can disabled parents (physically or mentally incapacitated) who are below 60 years old be
declared as dependents?
No; only parents who are 60 years old and above are qualified as dependents.
Can my live in partner be declared as a legal dependent? How about our children?
While the live in partner cannot be declared as a legal dependent (one of the supporting documents required is the
marriage certificate), your children can still qualify as dependents. Simply update your MDR and submit the
necessary supporting documents (i.e., birth certificate) for your children.
My daughter who’s still my dependent (under 21) is about to give birth. Will my
membership be able to cover her?
Do I need to personally submit my registration documents or can I ask my representative to

do so?
There is no need for you to personally submit your registration documents. Your representative is allowed to
submit your documents to PhilHealth for processing as long as you have affixed your signature/thumbmark
(whichever is applicable) on the registration form.
D. UPDATING MEMBERSHIP RECORDS
When should I update my MDR? How is this done?

Ideally, members should update their MDR when:
1. They have to shift membership categories (e.g. individually paying to employed)
2. They get married
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3. New dependents shall be declared

4. There’s incorrect information in the old MDR
To update your MDR, simply submit an updated PMRF to the nearest PhilHealth Office, along with the necessary
supporting documents (marriage certificate, birth certificate, etc.).
How do I shift membership categories?

1. Fill out two (2) copies of the PhilHealth Member Registration Form indicating the new membership
category and submit these to any PhilHealth office
2. Await a copy of the member’s updated MDR
Are we going to use the same PhilHealth Identification Number (PIN) if we are shifting to
another membership category?
Your PhilHealth Identification Number (PIN) is your PhilHealth number for life. Hence, if you are shifting to
another membership category, you will be using the same PIN.
 Situationers for Updating Membership Records
I was given a PhilHealth card by our LGU, but my name was misspelled and data provided
were also erroneous. How do I correct this information?
If there’s incorrect information in your ID/MDR, you will have to update your MDR by going through the
following steps:
1. Submit two (2) copies of the PMRF with the corrected information to the nearest PhilHealth Office,
along with the necessary supporting documents (birth certificate of any valid ID)
2. Wait for your updated MDR and ensure that the information has been corrected
E. CONTRIBUTIONS AND MEMBERSHIP RENEWAL
Why must a member pay his premiums regularly?

Regularly contributing to the NHIP assures the member of hassle-free availment of hospitalization benefits when
medical needs arise. This will also ensure the member’s qualification/eligibility to register under the Lifetime
Member Program upon reaching the age of 60 years old, provided he has paid at least 120 monthly premium
contributions.
How much is the premium contribution rate?

The premium contribution that each member has to pay is detailed in the following table:
Overseas Employed Sponsored Individually Paying Member

Workers (IPM)
NHTS-PR LGU Professionals Low Income
How much?
Jan-June P1200/year Up to 3% of P2400 P1200/year for P300 monthly P200 Monthly
2012 monthly basic 2-year lock in
salary (with period)
July-Dec P1200/year P50,000 cap) P2400/year
2012
2013 P2400/year
Who Member Employer National LGU Member Member
remits? Gov’t
When? Annually Monthly Annual Annual/Biannual Quarterly Monthly
Semi-annually Quarterly
Annually Semi-annually
Annually
Effective January 2012, premium contributions will increase to a minimum of P2400, depending on the
membership category (with OFWs as an exception). Different arrangements are being crafted to give payers ample
time to prepare for this increase. Here are the updates for the different programs:
1. Sponsored Program
a. Premiums of NHTS-PR poor amounting to P2400 by January 2012 will be fully subsidized by the
National Government.
b. Through the partial subsidy scheme, LGUs and other donors may provide the full/partial subsidy to
finance the premiums of identified families within their jurisdiction. Premiums will increase to P2400
by July 2012. Prior to this increase, LGUs are given an option to avail of the two-year lock in deal
(P1200/year for two years).
2. Individually Paying
a. For high income members (monthly salary > P25000), premiums will be pegged at P300/month or
P3600/year.
b. For low income members (monthly salary < P25000), premiums will be pegged at P200/month or
P2400/year.
3. Employed. The premium contribution of each employed member is up to 3% of their basic monthly
salary (with P50000 cap). For this category, the employer and employee split the premium, which is
directly deducted from the members’ salaries and remitted to PhilHealth by the employer.
4. Overseas Workers. By January 2012, premiums of overseas workers will increase from P900 to P1200.
By January 2013, premiums for this segment will further increase to P2400. This has to be settled before
the member leaves the country.
5. Lifetime Members. Members under this category no longer have to pay their premiums, since they have
already completed their 120 monthly contributions.
Why is there a need for an increase in premium contributions?

PhilHealth is in a process of enhancing its benefits in order to provide bigger and better benefits and services to
its members. Hence, we will need to increase our collections to be able to sustain this move.
Are overtime pay, commissions, and allowances included in the computation of premium
contributions of employees?
No, they are not included. The amount of monthly premium contribution of members shall be based on the
employee’s salary or wage which is the basic monthly compensation received for services rendered.
Where can the members remit their contributions?

1. PhilHealth has over 100 service offices all over the country wherein members can pay for their
premiums.
2. PhilHealth has also accredited the following collecting agents:
a. More than 1,000 CIS Bayad Centers
b. Collecting Banks
c. MLhuillier Philippines Pawnshops
d. LBC Express outlets
e. Offices of the Philippine Postal Corporation
f. Selected Local Government Units
3. For Overseas Workers Program Members, i-Remit branches, other partner agents, and foreign offices of
Philippine Veterans Bank (UK, Abu Dhabi and Qatar) also accept premium payments.
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Aside from paying through service offices and collecting agents, is there another way for me
to pay my premiums easily?
Yes. Currently, PhilHealth in collaboration with Smart, Inc. has come up with Text 7442, an easy-to-use service
that will allow Smart/Talk N’ Text pre-paid subscribers to pay for their premiums through SMS. To avail of this
service; just remember the following steps:
1. Type “PHIC (space) <PIN>” and send to 7442. (Example: PHIC 123456789012)
2. After this, you will receive a text message containing your PIN, and name (Last Name, First Name,
Middle Name) as it appears in the PhilHealth database. (Example: PIN 12345679012 Lapuz, Harold,
Chan)
3. If the name and PIN are correct, type “PHIC (space) YES” to confirm your premium payment for the
current month. Each transaction is worth one-month of premium plus a transaction fee.
4. After sending, you will receive a confirmation message, which contains your PIN and Reference Number
for the transaction. Keep this reference number, as you’ll need it to download your proof of payment.
What if I want to view my payment history for Text 7442?

1. Simply type “PHIC (space) HISTORY (space) <PIN>” and send to 7442 to view your payment history.
2. You may also download the payment history through www.philhealth.gov.ph. Your payment history will
serve as your proof of payment when availing benefits.
When is the deadline for paying my premium contribution?

The following table summarizes when premiums have to be in for each member category:
Membership Category Deadline for Paying Premium
Overseas Worker Before leaving the country or before the last contribution expires
Employed Tenth day of the following month
Sponsored Based on the agreement between the Sponsor and PhilHealth
Individually Paying 1. Semi-Annually/Annually – last day of the third month of the first quarter
2. Quarterly – last day of the third month of a quarter
3. Monthly (through Text 7442) – last day of the month
(See tables below)
For Individually Paying

Quarterly
1. First Payment
2012
First Quarter Second Quarter Third Quarter Fourth Quarter
Jan Feb March April May June July Aug Sept Oct Nov Dec
Mar 31 June Sep 30 Dec. 31
30
2. Second Payment
2012
June
30
3. Third Payment
2012
Sep 30
4. Fourth Payment
2012
Dec. 31
Semi-Annually
2012 2013
First Quarter Second Quarter Third Quarter Fourth Quarter First Quarter
Jan Feb March April May June July Aug Sept Oct Nov Dec Jan Feb March
Mar 31 Sep30
- First Payment - - Second Payment -
2012 2013
June Dec.
30 31
2012 2013
Sept. Mar
30 31
2012 2013
Dec.
31
- First Payment -
Annually
2011 2012
J F M A M J J A S O N D J F M A M J J A S O N D
31
2011 2012
30
2011 2012
31
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2011 2012
31
What is the effectivity date of PhilHealth coverage?

PhilHealth benefit coverage starts upon payment of premium (no waiting period) and is valid for one year from
the date of payment.
What are the requirements for eligibility? When is a member eligible to claim?
In order to become eligible to claim benefits, a member must pay premium contributions regularly. If the member
missed paying for a certain period, he/she and his/her dependents may not be able to use the benefits. The table
below summarizes the eligibility requirements:
Sponsored Members Date of hospitalization/availment must be within the

effectivity period indicated in the member’s ID and
MDR.
Individually Paying 1. There are certain confinement cases wherein three
Members months’ worth of premium within the last six
months (3/6) prior to confinement is acceptable.
2. For pregnancy-related cases, dialysis, chemotherapy,

radiotherapy and other selected surgical procedures,
the member must have paid nine months worth of
premium within the last twelve months (9/12)
prior to confinement in order to become eligible.
Lifetime Member The member just has to show their Lifetime ID Card; no
need to pay premiums anymore.
Employed Members Three months worth of premium within the last six
months (3/6) prior to hospitalization
Overseas Workers Date of hospitalization/availment must be within the
coverage period specified in the member’s MDR
Just remember the 3/6, 9/12, and effectivity period requirements and you’re good to go.
How do I maintain my eligibility?

The key to maintaining eligibility is paying your premiums on-time. If there are gaps in premium contribution,
eligibility will also be affected. Here are several tips for each member category to ensure that you’ll always be able
to use your benefits:
1. Sponsored Members
 If the member’s card is about to expire already, the member must proactively inquire
whether the Sponsor will renew his/her membership.
 If not, the member may opt to register as an Individually Paying Member.
2. Individually Paying Member
 Ensure that each calendar quarter has been paid.
 If possible, pay your premiums yearly for your own convenience.
3. Overseas Workers Program Member
 Premiums must be remitted prior to your membership’s expiration.
 If your contract abroad has already terminated, make sure that you shift member category
from OWP to IPM (or other applicable categories) to be able to pay premiums again.
4. Employed Members
 For seasonal employment or if you’re going to take a leave without pay, just head to the
nearest PhilHealth Service Office to pay your contributions during those months wherein
you will not be compensated. You may continue paying your premiums as an Individually
Paying Member (IPM).
 To pay your premiums as an IPM, visit any PhilHealth office and present a copy of the RF-1
from your employer indicating that you are on leave without pay or a Certification from your
employer indicating the same.
 Once you get separated from employment, make sure that you shift category to IPM.
If I missed paying in the past quarters, can I still pay for this now to become eligible again?
This is an example of a retroactive payment. Unfortunately, PhilHealth does not accept retroactive payments to
avoid abuse of benefits. This policy has to be in place to avoid those instances when members only choose to pay
when they get sick or need to avail of benefits (and conversely stop paying when they don’t need it), which will be
unfair for those who pay their premium contributions regularly.
What is the tolerable delay for paying premiums for a member to still be able to use his/her
benefits?
None. PhilHealth strictly follows its policies on premium payment and benefit availment.
 Situationers: Contributions and Renewal
Can contributions be refunded by the member who was not able to use it?
No. PhilHealth is a social health insurance program, wherein members’ premiums are pooled into a single fund
used to pay for the benefits of sick members. Even if a member is not able to use benefits or does not get sick
within a particular enrolment year, funds are kept in the pool.
If I stopped paying my premium for a considerable amount of time, can I still use my
benefits? Do I need to pay the missed contributions to be able to avail of the benefits
again?
No. Only active members are eligible to avail of PhilHealth benefits. Member should have paid at least three
months premium contributions within the immediate six month period prior to medical confinement. However,
payment of at least nine months within the last 12 months shall be asked of Individually Paying Members availing
of the following procedures/packages:
• Pregnancy-related cases
• Dialysis (except those undergoing emergency dialysis service during confinement)
• Chemotherapy
• Cataract Extraction
• Radiotherapy
• Selected surgical procedures
Individually Paying Members and Employed Members will now be required to have at least nine (9) months
contributions within twelve (12) months prior to the month of availment for all confinements including availment
of outpatient benefits).
On retroactive payments:
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
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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 totalled from date of enrolment), 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.
If an employed member who was separated from service last October 2011 wants to
continue his membership as an Individually Paying Member in March 2012, can he
retroactively pay the premiums for Nov-Dec 2011 and first quarter 2012, in March 2012?
Yes, for the employed member who wants to continue his membership as IPM but failed to immediately pay
his/her premium within the quarter of separation, he/she shall be given a grace period of one calendar quarter
immediately after the unpaid quarterly period to retroactively settle his obligation.
A new governor/mayor was elected in our area. Am I still considered a member under the
Sponsored Program even with this change in leadership?
It is the validity period that determines your membership status. Yes, you are still considered a member even if a
new governor/mayor was elected, so long as your membership has not yet expired.
To ensure the renewal of your membership post-validity date, you can go to the local office of the DSWD that is
in charge of evaluating and determining if you are qualified to join the program. The DSWD shall then endorse
your name to the Local Government Unit (LGU) or any Sponsor for enrolment.
What if I have multiple jobs? Can I just pay my contributions once?

Section 18-20 of the Implementing Rules and Regulations of RA 7875, as amended, mandates employers to enroll
their employees, deduct from their salaries the required premium contribution, and remit the same, together with
the corresponding employer share, to PhilHealth. As each employer has to adhere to this law, those who are
engaged in multiple employment should consequently be deducted of their corresponding employee share by each
and every employer with which they are currently employed.
I am an employed member, but I recently found out that my employer stopped paying our
contributions even though he continues to deduct the premiums from our salaries. How do
we go about this?
If the employer failed to remit their employees’ contributions, the employer will have to reimburse PhilHealth’s
payment for claims filed by concerned employees or his/ her qualified dependent/s.
Employees should report through writing if they suspect that their employers are not remitting contributions to
the Corporation so that appropriate action will be taken against them.
What if the member passes away? Can the dependents still use their benefits?
In case the member dies, his/her membership privileges also terminate. However, his/ her dependents may still
avail of the PhilHealth benefits for the unexpired portion of the member’s contribution.
If a member has paid his premium for one year and he died during the first half of the year,
can his dependents refund his premium?
If the member has dependents, they can avail of PhilHealth benefits for the unexpired portion of the member’s
contributions. However, similar to other members, they are not allowed to refund his premium that has already
been channeled to the health insurance pool.
I already have a lifetime member card, but my current employer still continues to pay for my
premiums. Can these premium contributions be credited to my son/daughter’s membership
when I retire?
Since you are considered to formally employed, your employer is really mandated to continue paying for your
premiums. However, payments made are non-transferrable and cannot be credited to your son/daughter’s
membership when you retire.
What if a Lifetime Member is re-hired, must he resume contributing to PhilHealth through

salary deduction?
A Lifetime Member who acquires regular employment shall temporarily cease to be covered under the Lifetime
Member Program, and shall instead be covered under the formally employed segment. After separation from
his/her regular employment, he can resume his membership as Lifetime Member.
Is membership transferrable?
No, membership is non-transferrable.
Are the payments for OWWA Contributions and PhilHealth premiums different?
Yes, they are different. OWWA contributions serve as a life insurance of the OFW abroad while PhilHealth
premiums ensure the health benefits of the OFW and his/her dependents in case of illness or injury requiring
hospitalization.
If I stopped paying my premium for a considerable amount of time, how will I reactivate my
membership? Do I need to apply for a new membership/PIN?
There is no need to apply for a new PIN. Using your old PIN, simply carry out the following steps:
1. Fill out two (2) copies of the PhilHealth Member Registration Form indicating the new membership
category and submit these to any PhilHealth office
2. Await a copy of the member’s updated MDR, and proceed to any of PhilHealth’s accredited collecting
agent to pay for the applicable premium using the same PhilHealth identification number (PIN).
How can a SP member continue PhilHealth membership when his/her PhilHealth ID expires?
To continue his/her PhilHealth membership once his/her ID expires and granting that it has not been 'renewed',
a Sponsored Member should enroll as an Individually Paying Member and pay his/her premiums within the
calendar quarter or before the expiry date as reflected in the PhilHealth Identification Card.
I used to be employed, but am now self-employed. Can I still continue paying for my
premiums? How do I go about this?
In case you get separated from employment, you may continue your PhilHealth membership by becoming an
Individually Paying Member and paying the applicable premium. Simply accomplish the PhilHealth Member
Registration Form (PMRF) and tick the box "For Updating" and the appropriate box of the membership category
to which you are shifting. Make sure you continuously and religiously pay your premiums so as to avoid
suspension of benefits.
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I am a PhilHealth member sponsored by an LGU; is it still necessary for me to pay my

membership as an OFW?
If a member is sponsored by an LGU and the membership is still active, the member shall pay for his/her
PhilHealth membership as an OFW when the coverage of his/her sponsored membership expires.
If in case the member already paid his/her membership as an OFW while his/her sponsored membership is still
active, the member is advised to go to any PhilHealth office to make necessary adjustments on his/her
membership coverage.
Why do I have to renew my PhilHealth membership every time I leave the country and work
as an OFW?
It's not actually renewal of membership but an updating of your premiums, which shall be equivalent to the length
(in years) of your fresh contract. It will also ensure your continuous eligibility to PhilHealth benefits.
What is the grace period of OFW membership renewal?

OFWs are allowed to pay the applicable premium within one (1) month from the date of expiry. Payment within this
period shall retroactively commence the coverage of membership from date of expiration.
I am currently abroad and my coverage is about to expire. How do I continue paying for my
PhilHealth in case there are no available payment centers where I am?
You may ask your relatives in the Philippines to pay your premiums on your behalf to avoid any lapses or delays.
They only need to present a valid ID and an authorization letter from you as the member and any document that
would attest that you are still an active OFW.
If a member has dual citizenship, can he/she still renew his/her membership and avail of the
benefits whenever he/she is in the Philippines?
Yes. Those with dual citizenship still have the option to continue paying for their PhilHealth coverage also as
individually paying members. Entitlement to benefits if confined in the Philippines will depend on such factors as
the member’s qualifying contributions and the accreditation of the health care providers.
I am already an immigrant here in the US. Can I still continue my membership with
PhilHealth?
Yes. You can still continue paying for your PhilHealth coverage as an Individually Paying Member and not as an
Overseas Worker Member.
Where can I pay my premium contributions?

If abroad, you may pay at any PhilHealth Overseas Accredited Payment Centers. In the Philippines, you or your
immediate family or representative may pay at any PhilHealth Offices and Accredited Collecting Partners.
F. SPECIAL SECTION: INCREASE IN PREMIUM FOR OFW MEMBERS
Why is there a need to increase the annual premium of OFW members?

The increase in premium across all paying sectors is in line with our continuing efforts to enhance our existing
benefit packages, sustain the provision of better benefits to our members and provide true financial protection for
our members to be able to fully achieve the objectives of Universal Health Care (UHC). The increase, which is
inevitable if we want to meet our UHC goals by 2013, does not only apply to our OFW-members but also to the
Employed, Sponsored and Individually Paying members as well.
What was the basis for pegging the new premium rate at P2,400 per year?
One of the studies conducted by our Actuarial Services Sector several years ago, revealed that the premium of
the OFWs should already be set at P 1,800.00 to P 2,000.00 per year, but we decided to still peg the
annual rate for OFWs at P 900.00, the same rate they have been enjoying since we took over the Medicare
program from the OWWA in 2005. However, with the new directions of the present administration to provide
true financial protection for our members wherein PhilHealth will fully subsidize the roll out of primary care
benefits that will entitle members to basic quality health care services, the prevailing rate of P900.00 has to be
increased to P 2,400.00.
Were OFW members consulted by PhilHealth before the increase was approved?
The planned increase had been extensively discussed and debated on within our Board of Directors where the
OFW sector is adequately represented. We have commenced our media guestings and tapped print materials
(newspapers, etc.) informing the public about the new rates and we shall continue organizing round-table
discussions with our key stakeholders to address whatever other issues they may have on the matter.
How much is the increase? When is this effective?

For the NHTS-identified poor, premiums have increased to P 2,400 by January 1, 2013 (see Circular 007, s-
2012). Premiums for members, sponsored by local government units (LGUs), for Individually Paying Members
(IPMs) and OFWs will also increase to P 2,400 by July 1, 2012. For the formal employed sector, premium rates
will be pegged at 3% of the basic monthly salary by January 1, 2013 with a maximum salary base of P 50,000.00.
This means that employers whose monthly salary is P50,000 & above will be paying P750.00 and the employer will
provide a counterpart amount of P 750.00 per month.
When was the last time that premium contributions of OFW members increased?
As far as OFWs are concerned, the annual rate of P 900.00 has been in place since PhilHealth took over the
Medicare Program from the OWWA in 2005 and no adjustments have been introduced since then, despite the
series of increases in benefit packages that we have implemented across all member-types over the years.
Can OFW members whose families were affected by Typhoon Sendong be exempted from
paying the new premium rate?
No. However, PhilHealth Advisory No. 01-03-2012, extended the deadline of premium payment of members
affected by Typhoon Sendong up to March 31, 2012.
Where can they pay their premium contributions in the Philippines? How about abroad?
Overseas Worker-members may pay at the POEA, or at any of our Service Offices nationwide or through any of
our accredited collecting agencies locally or overseas.
If an OFW’s membership coverage expires while he is still abroad, will he be required to pay,
through his kin in the Philippines, the new rate when he renews his coverage?
An OFW-member may ask his kin in the Philippines to pay for his membership renewal provided he sends his kin
the following:
1. Copies of the required documents such as:
a. Valid overseas employment certificate
b. Valid working visa/re-entry permit
c. Valid job employment contract
d. Certificate of employment from employer abroad
e. Valid company ID issued by employer abroad
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2. Cash remittance from member abroad at least 2 months prior to the date of renewal or payment. If the
membership expired last December 31, 2011, the OFW, through his kin, will be required to pay the new
rate of P1,200.00, if he pays anytime between January 1 and June 30, 2012.
How much is the premium if an OFW decides to pay in advance?

OWP members can avail themselves of a lower premium, equivalent to P 1,200.00 per year, if they pay two
(2) years’ worth of PhilHealth premium between January 1 to December 31, 2012.
What additional benefits can an OFW member expect from PhilHealth?

OFWs can expect the following improvements in the benefit packages soon:
 Basic benefit package

 Inpatient and outpatient benefits
 Expansion of No Balance Billing to other member types like OFWs & employed sector when confined in
government hospitals
 Special rates for 20 identified catastrophic cases, such as cancer, etc.
 Shift in reimbursement policies (Fee for Service to Case Rates)
 Outpatient primary care package (1,000 pesos worth of benefits per member)
 Obligated preventive and diagnostics services
 Out-patient drugs and medicines (anti-hypertensive, anti-diabetics and antibiotics) and outpatient diagnostics
and specialist care
 Supplemental benefit package – PhilHealth Plus and Catastrophic Fund
 Special Benefits : rehabilitation package, vaccination package (rabies), enhanced peritoneal dialysis benefit
package, health promotion (smoking cessation)
Will the increase in premium mean additional benefits for OFWs and their dependents as
well?
Yes. Not only will there be an increase in benefits, but also an improvement in frontline services and access to
these benefits.
Are these benefits available to the OFW member even while he is abroad?
Only some of the upcoming hospitalization benefits and other selected services will be available to the OFW
while he is abroad since some packages are and will be offered by local health facilities. However, all qualified legal
dependents of OFW-members can avail themselves of these benefits locally.
When can OFWs expect the increase in benefits?

Benefit enhancements are targeted to be released by June 2012.
How do you plan to inform OFWs about the new premium rate in less than two weeks’
time?
PhilHealth intends to go full blast in its IEC initiative. The following will be conducted:
 Send advisories to all recruitment agencies, PDOS providers and accredited collecting agents abroad
 Distribute flyers at POEA
 Post tarpaulin at POEA
 Conduct orientation meetings with OFWs at POEA
 Conduct meeting with OFW organizations
 Tri-media exposures
 Post advisory at OWP and in the official Facebook and Twitter accounts
Is PhilHealth making any representation with Philippine Embassies and consulates overseas
to inform OFWs about the increased premium?
We will communicate and send advisories to all Philippine Posts abroad to help spread the word about the new
premium rates.
Since PhilHealth has no physical presence overseas, how do you plan to discuss the new
premium rates with OFWs and OFW organizations at this time?
We will seek the assistance of our Embassies and Consulates in discussing this increase together with the leaders
of OFW organizations while we send individual e-mail and text messages to our OFW contacts.
Where can OFW-members refer their inquiries pertaining to the new premium rates?
OFW members can refer their inquiries to the following:
PhilHealth Call Center 4417442
Mobile Numbers 09189635396/09175129149
OFW members can also e-mail us at:

1. owp@philhealth.gov.ph
2. itu_owp@philhealth.gov.ph
3. philhealth_hk@philhealth.gov.ph
4. philhealth_ksa@philhealth.gov.ph
5. philhealth_sg@philhealth.gov.ph
G. SPECIAL SECTION: UMID CARD ACTIVATION AND BIOMETRIC CAPTURE
Why must I undergo biometric capture with PhilHealth?

Submitting yourself to biometric capture will prepare you for the eventual generation of the Common Reference
Number (CRN) which will help facilitate the subsequent issuance of your Unified Multi-Purpose Identification
(UMID) card.
Can I choose not to have my biometric data captured by PhilHealth?

Choosing not to have your biometrics taken at this time might inconvenience you later on, especially when
PhilHealth starts issuing the UMID card to the members in the Informal Sector. Only those who have submitted
themselves to biometric capture will be prepped for UMID card issuance, thus, we advise you to proceed with
your biometric capture.
What does ‘biometric capture’ mean?

Biometric capture means that your biometric data will be captured and matched with your PhilHealth member
data, to ascertain your identity in preparation for the issuance of the CRN later on. Among the biometric data
that will be taken are as follows: facial image (photo), electronic signature and fingerprints.
Am I going to pay any fee for biometric capture?

No, PhilHealth is not charging any transaction fee for biometric capture.
Where can I have my biometric data captured by PhilHealth?

The PhilHealth UMID Mobile Team will be in your office premises on a schedule to be agreed upon with your
Human Resource Department (HRD). The schedule will be announced by your HRD days before the UMID
Mobile Team will set up shop in your office for the biometric capture.
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If I missed the schedule of biometric capture in our office premises, can I proceed to any
PhilHealth Branch for this?
You may call the UMID Project Management Office to ask for the next schedule at your office premises, or if the
UMID Mobile Team has a scheduled biometric capture activity near your office location.
Are there forms I need to fill out before biometric capture day?
It is advisable for you to fill out the UMID Registration Form (URF) before going to the biometric capture
station.
Is there a recommended attire for the biometric process?

Since the biometric capture activity will be held at your office premises during business hours, it is expected that
you come properly dressed in business or office attire.
How will the biometric capture procedure go?

The biometric capture procedure is very simple. Simply follow these steps:
1. Fill up the UMID Registration Form (URF)
2. Submit the URF to the UMID Team for encoding
3. Check if the encoded data are correct
4. Have your photograph taken
5. Sign on signature pad
6. Press the required fingers on the fingerprint scanner
7. Receive the registration receipt/claim stub from the UMID Team member.
Will the biometric capture process eat up a lot of my time from work?
No, the biometric capture process itself takes only about 6 minutes.
What do I need to bring on biometric capture day?

You have to bring one (1) valid ID card, meaning, this should have your photo and your signature. You must also
bring either a copy of your Member Data Record (MDR) or your PhilHealth ID/Number Card.
Are there things I must ensure before I proceed with biometric capture?
Make sure that your MDR is updated with PhilHealth prior to biometric capture activity and the UMID
Registration Form properly filled up.
Can I update my MDR on the day of biometric capture through the UMID Mobile Team?
Updating of MDR cannot be made on the day of the biometric capture. It is advised that you update your MDR
before the day of the biometric capture.
Once my biometric data have been captured, what are the next steps?
Your biometric data will be processed then forwarded to Central Verification System (CVS) for CRN generation
and for UMID card issuance later on.
Where can I call if I have further questions regarding the biometric capture?
Further questions on the UMID Biometric Capture may be referred to the UMID Project Management Office at
441-7444 extension 7671 or 7672.
 UMID Card Activation
Why must I activate my UMID card with PhilHealth?
Activating your UMID card will prepare you for PhilHealth’s shift to paperless transactions. Your UMID card will
eventually enable you to access health care services at accredited facilities without having to submit documentary
requirements anymore.
Can I choose not to activate my UMID card with PhilHealth?

Opting not to activate your UMID card with PhilHealth might render inconvenience for you at point-of-service,
i.e., at the hospital billing section if you or your legal dependent is hospitalized. Once PhilHealth goes into
paperless transactions, its accredited hospitals only need to swipe the members’ UMID cards to check on their
eligibility to avail themselves of PhilHealth benefits. If your UMID card is not yet PhilHealth-activated, you will
be required to submit documentary requirements to support your claim for benefits.
What does ‘card activation’ mean?

Activation of your UMID card with PhilHealth means that your Member Data Record (MDR) will be loaded
electronically into your UMID card. The MDR contains your basic information as a PhilHealth member, such as
your PhilHealth ID number, date of birth, civil status, address, employer, and your list of legal dependents. Your
premium contribution payments for the last two years (2010 and 2011) will also be loaded into your UMID card
during card activation.
What are the requirements to activate my UMID card with PhilHealth?

Do I need to pay any fee for card activation?
No, PhilHealth is not charging any transaction fee for card activation.
Are there forms I need to fill out before card activation day?
None, you will not be required to fill out any forms prior to nor during card activation day.
What do I need to bring on card activation day?

You only need to bring your UMID card.
Are there things I must ensure before I proceed with activating my UMID card?
First, make sure that your UMID card is already activated with the GSIS. There are GSIS kiosks in selected
local government units where your UMID card may be activated. Second, make sure that your MDR is
updated; otherwise, the MDR that is currently posted in our database will be loaded into your UMID card
once card activation takes place.
Where can I activate my UMID card with PhilHealth?

The PhilHealth UMID Mobile Team will be in your office premises on a schedule to be agreed upon with your
Human Resource Department. The schedule will be announced by your HRD days before the UMID Mobile
Team will set up shop in your office for the card activation.
If I missed the schedule of card activation in our office premises, can I proceed to any
PhilHealth Branch to have my UMID card activated?
You may call the UMID Project Management Office to ask for the next schedule at your office premises, or if the
UMID Mobile Team has a scheduled card activation near your office location so you can activate your card.
How long does the card activation process take?

The card activation process takes only about five (5) minutes. Since you will only be required to proceed to the
card activation venue on your appointed day and time, you need not spend hours at the venue to wait for your
turn.
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Can I update my MDR on the day of card activation through the UMID Mobile Team?
The UMID Mobile Team will be busy handling the card activation process and they will not be able to attend to
your MDR updating requirements. We advise you to do this at least three (3) days before the schedule of card
activation. Your HRD can help you update your PhilHealth records.
What are the card activation procedures?

The card activation procedure is very simple. Simply follow these steps:
1. Tap your UMID card on card reader
2. Press any of your registered fingers into the fingerprint scanner
3. Validate your Member Data shown onscreen
4. If data are accurate, choose ‘Overwrite Data on Card’; otherwise, choose ‘Cancel’
5. Press finger on fingerprint scanner to signify end of procedure
6. Remove card from card reader
How will I use my PhilHealth-activated UMID cards?

Procurement of kiosks through which the PhilHealth-activated UMID cards can be read is underway. Once these
are installed at selected locations nationwide, you can check on your PhilHealth data anytime, anywhere. You can
also use the UMID card to track the status of your PhilHealth claim, to verify if a dependent has been declared in
your MDR, or verify if your premium contributions have been posted.
What are the contact numbers if I have further questions regarding the UMID card
activation?
Further questions on the UMID card activation may be referred to the UMID Project Management Office at 441-
7444 extension 7671 and 7672.
H. BENEFITS AND BENEFITS AVAILMENT
What benefits can a member avail himself of under the NHIP?

PhilHealth offers a roster of benefits to ensure that members are given true financial risk protection. This section
provides a glimpse of these benefits that each member can enjoy.
Basic Benefit Package for Hospitalization

This package is available to all member-types based on the hospital category and type of illness of the patient. It
covers:
1. Allowance for Room and board up to P800.00/day
2. Allowance for Drugs and Medicines up to P28,000.00 per single period of confinement
3. X-ray, laboratory and others up to P21,000.00 per single period of confinement
4. Professional fees
5. Use of the Operating Room complex
Case Rates for Medical and Surgical Cases

Members may also avail of the PhilHealth benefits for Case Rate Payment for eleven (11) leading medical cases
and twelve (12) surgical cases:
Medical Cases
Dengue I P 8,000.00
Dengue II P 16,000.00
Pneumonia I P 15,000.00
Pneumonia II P 32,000.00
Essential Hypertension P 9,000.00
Cerebral Infarction P 28,000.00
Cerebro-vascular accident with hemorrhage P 38,000.00
Acute Gastroenteritis P 6,000.00
Typhoid Fever P 14,000.00
Asthma P 9,000.00
Newborn Care Package P 1,750.00
Surgical Procedures
Radiotherapy P 3,000.00
Hemodialysis P 4,000.00
Maternity Care Package P 8,000.00
NSD, Level 1 P 8,000.00
NSD, Levels 2-4 P 6,500.00
Caesarean Section P19,000.00
Appendectomy P 24,000.00
Cholecystectomy P 31,000.00
Dilatation and curettage P 11,000.00
Thyroidectomy P 31,000.00
Herniorrhaphy P 21,000.00
Mastectomy P 22,000.00
Hysterectomy P 30,000.00
Cataract surgery P 16,000.00
Outpatient Packages - Primary Care Benefit and MDG Benefits
Primary Care Benefit

The Primary Care Benefit provides a per-household capitation of PhP500 for families assigned to a
particular outpatient provider (i.e., accredited rural health units and health centers). This amount covers:
1. Provision of preventive services (consultation, BP measurement, counselling, etc.)
2. Diagnostic services
3. Drugs and medicines (for asthma, upper respiratory tract infection, acute gastroenteritis and urinary
tract infection)
In the future, a second component of this package will be rolled out, giving an additional PhP 400 for
outpatient medicines covering diseases like hypertension and diabetes. Moreover, this is coupled with a
performance incentive of PhP100 which rewards data quality, and eventually, the actual quality of care being
given to patients.
MDG Benefits
Benefit Amount Covered Description
Goal 4: Reduce Child Mortality
Newborn Care Package PhP1,750 This package for newborn dependents covers the following:
1. Necessary/essential newborn care – P500
2. Newborn screening test – P550
3. Newborn hearing screening test – P200
4. Professional fee – P500
Goal 5: Improve Maternal Health
Normal Spontaneous PhP6,500 – 8,000 The NSD Package is the benefit provided by PhilHealth for the coverage of normal
Delivery (NSD) Package deliveries of the first four births in accredited government and private hospitals.
For Level 1 Hospitals, this covers:

1. Prenatal care – P1,500
2. Facility including professional fee – P6,500
For Levels 2-4 Hospitals, this covers:

1. Prenatal care – P1,500
2. Facility including professional fee – P5,000
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Maternity Care Package PhP8,000 The MCP Package is the benefit provided by PhilHealth for the coverage of normal
(MCP) deliveries of the first four births in non-hospital facilities (lying-in clinics, maternity
clinics, birthing homes and RHUs). This covers:
1. Facility fee (including professional fee) – P6,500
2. Member’s prenatal care fee – P1,500
Goal 6: Combat HIV/AIDS, Malaria, and other Diseases
Outpatient HIV/AIDS PhP30,000 This benefit aims to increase the proportion of the population having access to
Treatment Package, effective HIV/AIDS treatment and patient education measures. This covers:
1. All necessary diagnostics – P3,000/year
2. Professional fee – P2,000/year (P400 per single check-up)
3. Retrovirals – P2,500/month
Outpatient Malaria PhP600 The case rate for this package covers the following services that the patient
Package requires:
1. Diagnostic malaria smears and other laboratory procedures
2. Drugs and medicines
3. Consultation services, including patient education and counselling
Outpatient Anti- PhP4,000 This case rate shall be paid to accredited DOTS facilities, and shall cover diagnostic
Tuberculosis/DOTS work-up, consultation services, and anti-TB drugs that the patient requires in an
Benefit Package outpatient set-up. Payment will be split as follows:
1. Intensive Phase of DOTS Treatment – P2,500
2. Maintenance Phase – P1,500
Animal Bite Package PhP3,000 Effective May 3, 2012, this benefit package aims to support the National Rabies
(Rabies Post-exposure Prevention and Control Program by defraying the cost of post-exposure
prophylaxis) prophylaxis (PEP) treatment to animal bite patients who are PhilHealth
beneficiaries. This package covers:
1. Drugs (vaccine, immunoglobulin, and antibiotics) and supplies – P2,700
2. Health staff service fee – P300
SARS and Avian Php50,000 – Amount of coverage:
Influenza Package 100,000 1. For members and their qualified dependents – P50,000 per case
2. For healthcare workers (forefront and high risk) – P100,000 per case
This amount covers:

1. Professional fees – P2,500 (pay to doctor)
2. Hospital charges – P42,500 (pay to hospital)
3. Official receipts amounting to P12,000 (P5,000 – pay to member)
Novel Influenza PhP75,000 – Amount of coverage:
A(H1N1) Package 150,000 1. Non-health worker members – P75,000
2. Health worker members – P150,000
This amount covers room and board; drugs and medicines, x-ray, lab, and others;
and professional fees.
Other Benefits
An Enhanced Outpatient Package for OWP members and dependents is also available in participating DOH-
retained hospitals nationwide. We also cover dialysis, day surgeries and chemotherapy in accredited facilities.
All lifetime members can also take advantage of the 60% discount on the pneumococcal vaccine beginning June
1, 2012 in PhilHealth-accredited hospitals.
Where can these benefits be availed of?

Members and their qualified dependents may avail of the benefits in any PhilHealth accredited hospitals,
ambulatory clinics, rural health units/health centers, and free standing clinics nationwide.
PhilHealth will also reimburse overseas confinements and shall be paid based on Level 3 Hospitals benefit rates.
How can these benefits be availed of?
Availment Conditions
Employed and KASAPI Members Payment of at least 3 monthly premiums within the
immediate six months prior to confinement
Individually Paying Members Payment of at least 3 monthly premiums within the
immediate six months prior to confinement (for some
confinement cases). Payment of 9 months premiums
within the immediate 12 month period prior to
confinement (for selected surgical procedures and
pregnancy-related cases.
OWP Members Confinement should be within the effectivity period
stated in the Member Data Record or PhilHealth
Official Receipt (MDR).
Sponsored Program Members Confinement should be within the effectivity period as
stated in the PhilHealth Identification Card and
Member Data Record (MDR)
Lifetime Members The only requirement is the PhilHealth Lifetime
Member Identification Card
Automatic Deduction of Benefits

Automatic deduction of benefits simply means that the benefits are automatically deducted from the hospital bill
prior to the patient’s discharge. For this option, simply follow these steps:
1. Prior to discharge from the hospital, submit the following documents to the hospital’s billing section:
a. Duly accomplished PhilHealth Claim From 1(original)
b. Clear Copy of Member Data Record (MDR)
c. If your dependent is the patient, and he/she is not yet listed in the MDR, submit an applicable
proof of dependency
2. Agree with your attending physicians on the professional fee that shall be covered.
3. Upon submission of all documents, the billing section will compute and deduct your benefits from your
total hospital bill.
Direct Filing/Reimbursement
If benefits were not availed of at the hospital, members still have this option to reimburse what they spent during
their last confinement. Simply submit the following documents to the nearest PhilHealth office within sixty (60)
days after discharge:
1. PhilHealth Claim Form 1 filled out by member
2. PhilHealth Claim Form 2 filled out by hospital and attending physician
3. MDR/PhilHealth ID
4. Proof of premium payment
5. Official receipts for hospital services and professional fees
6. Official receipts for medicines and procedures paid for outside the hospital while confined
7. Statement of account
8. Waiver from the hospital and physician stating that benefits were not claimed at the point of service
9. Copy of operative record (for surgical procedures)
10. PhilHealth Claim Form 3
11. Results of laboratory and diagnostic exam for case rates claims
Do legal dependents enjoy the same benefits as the member?

Yes, members and dependents will enjoy the same benefit packages. Members have 45 days in a year to avail the
benefits while his/her dependents will have another set of 45 days which will be shared among them.
What documents must a member submit to be able to avail of the benefits?

The following documents are needed to avail of the automatic deductions of the benefits from the hospital:
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 PhilHealth Claim Form 1

(For employed members, Part II must be signed by the employer)
 Photocopy of MDR and other supporting document if the patient is not reflected as dependent in the
MDR
 For IPMs: Proof of premium contribution (PhilHealth Agent Receipt, PhilHealth OR, MLhuillier Kwarta
Padala SOF/RT, duly validated Bayad Center Payment Form, LBC Payment/Acknowledgement Receipt)
 For LP and Sponsored members: Photocopy of PhilHealth ID Card
 For KASAPI members: Copy of Certificate of Premium Payment from PhilHealth
Where and when should these documents be submitted?

Members need to submit said documents to the hospital billing section to avail of outright /automatic deductions
of benefits.
How can the member avail himself of PhilHealth benefits if he has an existing coverage with
a health maintenance organization?
For PhilHealth members who have an existing coverage with a health maintenance organization (HMO),
PhilHealth benefits should be the first peso to be deducted from the hospital bill. The HMO will cover the
expenses after the deduction of PhilHealth benefits.
Can a senior citizen avail himself of both the PhilHealth benefits and his senior citizen
privilege when confined?
Yes. The senior citizen privilege is a separate benefit and the 20% discount must first be deducted from your
hospital bill prior to the application of PhilHealth benefits.
Can overseas Filipino worker-members reimburse their hospitalization expenses with

PhilHealth?
Confinement due to sickness or for an operation is compensable with PhilHealth even if it is done abroad.
Members are given 180 days or 6 months to file your claim for reimbursement at any PhilHealth office near your
local residence.
a. PhilHealth Claim Form 1 accomplished and signed by the member or his authorized representatives;
b. Photocopy of MDR or latest receipt;
c. Medical certificate with complete diagnosis, period of confinement and services rendered;
d. Statement of Account and/or Official Receipts with itemized charges; and other supporting documents.
(Items c & d should be translated in ENGLISH)
I’ve been paying my premiums regularly, but I still haven’t availed of any benefits. When will
I be able to benefit from my membership?
Perhaps you have managed to stay healthy, therefore not needing to be admitted in the hospital, which is why you
have not yet availed of any benefits. Depending on your membership type (applicable for Sponsored, OWP,
Lifetime), you may still avail of preventive services and vaccines in the outpatient setting to improve your health.
 Situationers: Benefits and Benefits Availment
How will the member know if the PhilHealth benefit deducted from his total hospital bill is
correct?
Members are sent a benefit payment notice or BPN to report the actual payments made by PhilHealth relative to
their confinement/availment. The BPN is sent to the address indicated by the member in their claim form. Should
there be discrepancies in the payments and the actual benefits deducted from your hospital and doctors' bills, you
may present your BPN, your copy of the hospital's Statement of Account/Billing Statement, and Official Receipts
to your health care provider for appropriate action to be taken.
What if the amount deducted as PhilHealth benefit is less than what PhilHealth actually paid
to the provider for the member’s confinement?
Members are sent a benefit payment notice or BPN to report the actual payments made by PhilHealth relative to
their confinement/availment. The BPN is sent to the address indicated by the member in his claim form. Should
there be discrepancies in the payments and the actual benefits deducted from your hospital and doctors' bills, you
may present your BPN, your copy of the hospital's Statement of Account/Billing Statement, and Official Receipts
to your health care provider for appropriate action to be taken.
If siblings are all active members, can each of them file a claim for the confinement of their
parents?
No. PhilHealth does not allow multiple declaration and application of PhilHealth entitlements. The siblings
should decide who will declare and provide for the PhilHealth coverage of their parents.
If both spouses are members, can each of them file a claim for the confinement of their
children?
No. PhilHealth does not allow multiple declaration and application of PhilHealth entitlements of both spouses.
If the spouse’s, child’s or parent’s name is not listed in the member’s MDR at the time of
confinement, how can the member avail himself of the benefits?
If the dependent gets hospitalized and he/she is not listed in the principal member’s MDR yet, the member may
submit a clear copy of the following as proof of dependency:
1. Spouse - marriage contract/certificate
2. Children - birth certificate
3. Parents - birth certificate of member and patient or Senior Citizen's ID
How can members separated or resigned from employment avail themselves of maternity
benefits?
After separation from employment, the member must immediately enrol/shift his/her membership from
employed to Individually Paying Program (IPM) to avoid the gap on his/her PhilHealth contributions. As an IPM
member the following documents must be submitted to the billing section of the hospital:
1. Fully accomplished PhilHealth Claim Form 1 (CF 1)
2. Clear copy of Member Data Record (MDR)
3. Proof of premium payments - nine (9) monthly premium contributions within the immediate twelve
(12) months prior to availment of benefits. If the delivery date may cover the contributions during
employment, secure copy of RF-1 (reflecting the member’s name) with proof of payment from
previous employer or “Certificate of Contribution” from any PhilHealth Office.
Page 38 of 44
Page 39 of 44
I. SPECIAL SECTION: CASE RATES FOR 23 MEDICAL AND SURGICAL PROCEDURES
What is case payment?

Case payment (also called per-case payment) is a different way of paying providers for services offered to our
members.
How is this different from the old system?

Unlike the fee-for-service system wherein fees for drugs, supplies, and doctors’ fees differ depending on the
patient’s case or hospital where the patient was admitted, case payment offers a fixed rate for each treated case. For
example, cases of appendicitis would be reimbursed at the same rate in all hospitals. It is very similar to the
concept of “pakyawan,” since all items/services necessary for a case is already covered by a single rate.
Why shift to case rate payments? What advantages will this form of benefit payment bring,
especially to the members?
With case rates, hospital charges are no longer a mystery! Since rates remain the same in all facilities, you will
immediately know how much subsidy you can get from PhilHealth for particular diseases and surgical procedures.
At the same time, this simpler method will help PhilHealth speed up its processes, which means that your claims
will be released faster.
Who are entitled to these new case rate packages?

By virtue of being a member, you and your dependents are entitled to the new case rate packages.
Can I avail of this benefit now?

Yes! The new case payments already took effect last September 1, 2011 in all accredited providers.
How will cases be reimbursed?

Reimbursement for the said case rates shall be made directly to the facility. This payment given to the hospital
already covers hospital and professional fees.
What will happen to doctor’s professional fees?

Professional fees of all accredited doctors who attended or managed a specific case are already included in the
calculated case rates.
How much will be allocated to the doctors’ PF?

1. Forty percent (40%) of the total amount for each surgical case rate
2. Thirty percent (30%) for each medical case rate
3. For hemodialysis, P500 per session is allocated
What are the surgical cases under Case Rate that can be reimbursed in particular facilities?
Level-I Hospitals:
a. D & C (Completion and Fractional Curettage)
b. Normal Spontaneous Delivery
Note: The said case shall be reimbursed as NSD package in Level I hospitals (P8,000)
c. Newborn Care Package
Ambulatory Surgical Clinics (ASCs):

a. D & C (Fractional Curettage)
b. Herniorrhaphy
c. Laparoscopic cholecystectomy
d. Cataract
Freestanding Dialysis Centers
a. Hemodialysis
How will hospitals be paid for 2 or more surgical case rates performed in a single
confinement?
PhilHealth shall reimburse all packages if two or more different surgical case rates are performed in separate
operative sessions even within a confinement period.
How will the procedures be reimbursed if a procedure performed has laterality (e.g.,
cataract)?
The hospital shall be paid once if the procedure performed has laterality (e.g., cataract), whether done in one or
different operative session in a single confinement or different confinement within 90 days.
What will happen to major surgical procedures done in Level 1 hospitals?

If the procedure is an emergency, payment shall be paid through a fee-for-service scheme based on RVU 30 but if
the procedure is considered as non-emergency the claim shall be denied.
Is Case Rate covered by the rule on single period of confinement? Will the 45 days
allowance apply for case rates?
Yes, the rule on single period of confinement still applies except for hemodialysis and radiotherapy packages,
where availment is on a per session basis but subject to 45-days allowance in a year.
If a member’s total hospital fees for dengue I is beyond the case rate amount listed by
PhilHealth, will the member shoulder the balance?
Yes. The member shall shoulder the amount in excess of what we will provide under the new case rate packages,
except for those covered under the NBB policy in government accredited facilities.
A member is admitted for dengue I for three days, and another member is admitted for
dengue I for five days, will they be entitled to the same case rate amount for dengue I of
P8,000.00?
Yes. Whether a member uses up three days or ten days for a particular medical condition, they will still be entitled
to the same amount. PhilHealth will reimburse to the health care facility the case rate amount indicated in the list.
What medical cases under Case Rate can be reimbursed in Level 1 hospital? Level 2
hospitals?
a. Dengue I (Dengue Fever and Dengue Hemorrhagic Fever Grades I and II)
b. Dengue II (Dengue Hemorrhagic Fever Grades III and IV)
Note: The said cases managed in Level I hospitals shall only be reimbursed as Dengue I package
c. Pneumonia I (Moderate Risk Pneumonia)
d. Pneumonia II (High Risk Pneumonia)
Note: The said case managed in Level I hospitals shall only be reimbursed as Pneumonia I package
e. Essential Hypertension
f. Cerebral Infarction (CVA I)
g. Cerebro-vascular Accident with Hemorrhage (CVA II)
Page 40 of 44
Page 41 of 44
Note: The said case managed in Level I hospitals shall only be reimbursed as CVA I package
h. Asthma
i. Typhoid Fever
j. Acute Gastroenteritis
k. NSD
Note: In level I hospitals the benefit amount is Php 8000 while in Levels 2-4 hospitals the benefit is Php 6500.
For medical case rate, how will PhilHealth pay for a patient admitted for several conditions?
PhilHealth shall reimburse the medical case rates based on the main condition. Therefore, cases with several co-
morbidities shall have no additional payment.
In case the member was transferred to another hospital, will PhilHealth pay for both
facilities?
The member is entitled to one package and this will be reimbursed to the referral facility. Cost incurred at the
referring facility will be shouldered by the member and the claim filed by the facility will be denied except
MCP.
For cases not included in the Case Rates table, how will PhilHealth reimburse those cases?
PhilHealth will continue to reimburse those cases through the existing benefit table of fee for service scheme.
J. SPECIAL SECTION: NO BALANCE BILLING POLICY
What is “No Balance Billing” (NBB) and to whom it will be applicable?

NBB means that no other fees shall be charged or paid for by the PhilHealth patients beyond the identified case
rates. NBB policy generally covers the Sponsored member/dependents of PhilHealth.
Why is this being introduced only for Sponsored Program members?

Among our primary objectives for introducing the case rate packages is to provide optimal financial risk
protection, especially to the most vulnerable groups which are the poorest of the poor. Through PhilHealth Board
Resolution 1441 series of 2010, the NBB policy was adopted for the most common medical and surgical
conditions experienced in the country which are identified/specified under the new case payments.
What are the conditions for availment of benefits of SP members under the NBB policy?
The NBB policy applies only to all PhilHealth Sponsored Program members and their dependents that avail of the
specified cases under the following conditions:
 When they are admitted in government facilities/hospitals in defined NBB Beds
 When claiming reimbursement for outpatient surgeries, hemodialysis and radiotherapy performed in
accredited government hospitals and non-hospital facilities
 When availing of existing outpatient packages, including Maternity Care Package and Newborn Care
Package, TB-DOTS, Malaria, HIV-AIDS, and Animal Bite Package
Is the NBB policy also applicable to other PhilHealth membership types?

The NBB policy shall also apply to any other membership type (Employed, Individually Paying, Overseas
Workers, Lifetime) who will avail themselves of the Maternity Care Package (MCP) and Newborn Care Package in
all accredited (MCP) non-hospital providers (e.g. maternity clinics, birthing homes).
If the Sponsored member under NBB bought drugs and medicines or other supplies, will he
be able to reimburse then? How?
Yes. If the Sponsored member/dependent purchased necessary items and services during confinement, the health
facility is required to attach the official receipt/s detailing the purchases in the claim application for the said
confinement.
In case a sponsored member/dependent was admitted in a government hospital where the

only available room that time for the patient is a private room, can the sponsored member
be admitted in any room or private room of a government hospital? Will the NBB policy still
apply?
Yes, with the discretion of the hospital. The sponsored member can still be admitted in any available room and
the NBB policy applies.
What if a sponsored member is admitted in a private hospital? Will the NBB policy still be
applicable?
The NBB policy will not apply, unless the private hospital voluntarily implements it. The sponsored member and
his/her dependents will pay the excess of the hospitalization costs including the PF for the attending physician/s
after deduction of the applicable case rates.
Are there sanctions for violations in NBB policy?

Yes, accredited providers that violate the NBB policy shall be given appropriate sanctions and penalties by the
Corporation.
K. SPECIAL SECTION: ANIMAL BITE PACKAGE
Tamang Paggamot sa Kagat ng Hayop
Ano ang unang dapat gawin kapag nakagat ng hayop?

Bago magtungo sa pinakamalapit na Animal Bite Treatment Center, kailangang linisin ng maigi ang sugat na
natamo mula sa kagat ng hayop. Gawin ang mga sumusunod na hakbang:
a. Kumuha ng malinis na tela at diinan ang sugat hanggang sa humupa ang pagdurugo.
b. Linisin ang sugat nang sabon at tubig.
c. Lagyan ng alcohol, povidone-iodine (halimbawa: betadine) o kahit anong panlinis ang sugat.
d. Takpan ang sugat nang malinis at tuyong gauze. Maari ring magpahid ng antibiotic ointment
upang maiwasan ang impeksiyon.
e. Matapos linisin ang sugat, magpunta agad sa pinakamalapit na Animal Bite Treatment Center.
Ang hayop na nangagat ay kinakailangang obserbahan sa loob ng dalawang linggo.
Bakit kailangang magpabakuna kung nakagat ng aso?

Ang rabies ay isang sakit na nakamamatay. Tanging ang pagbabakuna lamang ang paraan upang maiwasan ang
pagkakaroon ng impeksiyon sa rabies.
Gaano katagal ba ang bisa ng bakuna?

Panghabambuhay na ang bisa ng bakuna kung nakumpleto ang dosaheng kinakailangan. Gayunpaman, kapag
nakagat muli ng aso ang taong nakakumpleto ng bakuna, kinakailangan pa rin ng booster doses.
Page 42 of 44
Page 43 of 44
Ilang beses ba akong bibigyan ng bakuna?

Karamihan ng pasyente ay kinakailangan lamang mabigyan ng 3 dose ng bakuna. Ngunit may mga pasyenteng
nangangailangan ng pang-apat ng dose:
a. kung ang nakakagat na hayop ay napatunayang may rabis
b. kung ang nakakagat na hayop ay namatay nang hindi nagagawan ng eksaminasyon
c. kung ang nakakagat na hayop ay may sintomas ng rabis
d. kung ang nakakagat na hayop ay hindi maaring obserbahan ng 14 na araw
Kailan dapat magpabakuna? Hihintayin pa bang mamatay ang aso bago magpabakuna?
Kahit na buhay pa ang asong nakakagat, maiging kumunsulta na agad sa pinakamalapit na Animal Bite Treatment
Center para mabakunahan. Kailangan pa rin ng pasyente ng tatlong dose ng bakuna kahit na nanatiling buhay ang
aso.
Kailangan pa ba akong ma-confine kung nakagat ng aso?

Hindi lahat ng nakagat ay kinakailangang ma-confine. Kung galos o hindi naman malalim ang sugat, kinakailangan
lamang na malinisan ang sugat at mabigyan ng bakuna.
Kailangan pa ba akong mabakunahan kung kumpleto naman sa bakuna ang asong

kumagat?
Oo, sapagkat iba ang bakuna ng aso sa bakuna na para sa tao. Kahit kumpleto ang bakuna ng asong kumagat,
kinakailangan pa ring mabakunahan ang pasyente upang masiguro ang proteksiyon laban sa rabies.
Mga Paalala
a. Ipaalam sa baranggay o munisipyo kung may mga asong gala sa inyong lugar na maaaring
mangagat at maging sanhi ng rabies.
b. Pabakunahan ang inyong alagang aso at wag pabayaang pagala-gala sa labas ng bahay o bakuran.
Tungkol sa Animal Bite Treatment Package ng PhilHealth

Ano po ba ang kasama sa Animal Bite Treatment Package?
a. Bakuna laban sa rabies
b. Rabies immunoglobulin
c. Paggamot sa sugat
d. Bakuna para sa tetano
e. Antibiotics kung kinakailangan
Ito ay maaring ibigay sa mga sumusunod na kasong maituturing na Category III Rabies Exposure na naidulot ng
hayop (aso, pusa, baka, baboy, kabayo, kambing, paniki at unggoy) o pasyenteng napatunayang may rabies.
a. Kagat/kalmot ng hayop na tumagos sa balat at nagdurugo
b. Kagat o pagpasa ng laway/fluids (sa mata, ilong, maseselan na bahagi ng katawan at bukas na
sugat) ng pasyenteng mayroong rabies
c. Paghawak ng bangkay ng hayop na may rabies o pagkain ng laman ng hayop na mayroong rabies
d. Kalmot at sugat (kahit na hindi nagdurugo) na natamo sa ulo at leeg
Ano ang kailangang ipakita o gawin para maka-avail ng package?

Kapag nakagat ng aso, magpunta lamang sa kahit anong Animal Bite Treatment Center na PhilHealth-Accredited.
Upang makagamit ng package, kailangang magpadala ng patunay na ikaw ay miyembro ng PhilHealth (gaya ng
MDR). Kailangan ding tiyakin na ikaw ay eligible para sa benepisyo:
a. Para sa mga employed at IPP, kinakailangang may kontribusyon na 3 buwan sa loob ng nakalipas
na anim na buwan.
b. Para sa sponsored at OWP, tiyaking hindi pa expired ang inyong membership o within the period
of validity ang pag-avail ng package.
c. Para sa lifetime member, ipakita lamang ang inyong PhilHealth ID card.
Saan ba pwedeng maka-avail ng package? Saan ako pwedeng pumunta para magpabakuna
kung nakagat ng aso?
Pumunta lamang sa kahit anong PhilHealth-Accredited na Animal Bite Treatment Center upang makagamit ng
benepisyong ito.
Kailangan ba akong bumili ng bakuna sa labas? Meron pa ba akong dapat bayaran kung
may PhilHealth na?
Kung ikaw ay isang sponsored member, wala nang kailangan pang bilhin na gamot o bakuna. Sagot na dapat ng
Animal Bite Treatment Center ang lahat ng kakailanganin sa paggamot ng kagat.
Para sa ibang miyembro ng PhilHealth, hanggang PhP3,000 lamang na halaga ng bakuna, gamot at gamit ang
kasama sa package. Kapag naubos na ang PhP 3,000, kailangan ng bayaran o bilhin ng miyembro ang natitirang
gamit, gamot o bakuna. Tandaan na kinakailangang makumpleto ang 3 o 4 na dose ng bakuna upang ito ay maging
mabisa.
Paano kung nakagat ako ulit? Ilang beses ako pwedeng makagamit ng PhilHealth para sa
ganitong benepisyo?
Hangga’t ikaw ay lehitimong miyembro ng PhilHealth, maaari kang makagamit ng benepisyong ito kapag ikaw ay
nakagat ng hayop. Para sa mga kailangan para maka-avail ng package, tingnan ang sagot sa question #2.
Covered din ba ang pamilya ko pag sila ay nakagat?

Ang miyembro at ang lahat ng kanyang qualified dependents na nakalista sa MDR ay maaaring maka-avail ng
package.
Paano kung hindi aso ang nakakagat? Kasama pa rin po ba ito sa benepisyo?
Hindi lahat ng kagat ng hayop ay may rabies. Tanging ang kagat ng aso, pusa, baka, baboy, kabayo, kambing,
paniki at unggoy lamang ang kasama sa benepisyo. Ang kagat ng daga, guinea pig o kuneho ay hindi
nangangailangan ng bakuna laban sa rabies kung kaya’t hindi kasama sa benepisyo.
Page 44 of 44

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Tamang Sagot (TS)

PhilHealth’s Frequently Asked Questions

Philippine Health Insurance Corporation

A. THE ORGANIZATION .............................................................................................................................................................. 9

What is PhilHealth? ............................................................................................................................................................................................................. 9

What is the National Health Insurance Program (NHIP)? .................................................................................................................................. 9

What are the underlying principles/concepts behind the NHIP? ................................................................................................................... 9

What is PhilHealth’s purpose of being? ..................................................................................................................................................................... 9

When was PhilHealth created? ...................................................................................................................................................................................... 9

What are its enabling laws or legal bases? ............................................................................................................................................................... 9

What is its vision? ................................................................................................................................................................................................................ 9

What is its mission? ............................................................................................................................................................................................................ 9

What is PhilHealth’s classification as a government agency?........................................................................................................................ 10

What are its fund sources? ........................................................................................................................................................................................... 10

Why does PhilHealth have to keep a reserve fund? .......................................................................................................................................... 10

With what organizations is it affiliated? .................................................................................................................................................................. 10

How do I contact PhilHealth? ...................................................................................................................................................................................... 10

Who can be members of PhilHealth? ...................................................................................................................................................................... 11

What are the different membership types at PhilHealth? ............................................................................................................................... 11

Who can enrol under these different programs? ............................................................................................................................................... 11

What is my proof that I am already a registered member? ........................................................................................................................... 13

Who should enrol? ........................................................................................................................................................................................................... 13

Is there any age limit for prospective members?................................................................................................................................................ 13

Who can be declared as legal dependents? ......................................................................................................................................................... 16

How do I activate my membership? ......................................................................................................................................................................... 16

Where else can I register? ............................................................................................................................................................................................. 17

 Situationers for Registration/Enrolment ............................................................................................................ 17

Can foreign nationals working in the Philippines enrol? .................................................................................................................... 17

Can minors and orphaned children enrol? ............................................................................................................................................... 17

In case of early retirement, can I already register as a Lifetime Member? .................................................................................. 17

Can foreign spouses of Filipino nationals be declared as dependents? ...................................................................................... 17

Can unmarried members declare nephews or nieces as dependents? ........................................................................................ 18

D. UPDATING MEMBERSHIP RECORDS ..................................................................................................................................18

When should I update my MDR? How is this done? ......................................................................................................................................... 18

How do I shift membership categories? ................................................................................................................................................................. 19

 Situationers for Updating Membership Records ................................................................................................ 19

E. CONTRIBUTIONS AND MEMBERSHIP RENEWAL ..............................................................................................................19

Why must a member pay his premiums regularly? ........................................................................................................................................... 19

How much is the premium contribution rate? ..................................................................................................................................................... 19

Why is there a need for an increase in premium contributions? ................................................................................................................. 20

Where can the members remit their contributions? ......................................................................................................................................... 20

What if I want to view my payment history for Text 7442? ............................................................................................................................ 21

When is the deadline for paying my premium contribution? ....................................................................................................................... 21

What is the effectivity date of PhilHealth coverage? ........................................................................................................................................ 23

How do I maintain my eligibility? .............................................................................................................................................................................. 23

 Situationers: Contributions and Renewal .......................................................................................................... 24

Is membership transferrable? ......................................................................................................................................................................... 26

What is the grace period of OFW membership renewal? .................................................................................................................. 27

Where can I pay my premium contributions? ......................................................................................................................................... 27

F. SPECIAL SECTION: INCREASE IN PREMIUM FOR OFW MEMBERS ..................................................................................27

How much is the increase? When is this effective? ........................................................................................................................................... 28

How much is the premium if an OFW decides to pay in advance?............................................................................................................. 29

When can OFWs expect the increase in benefits? .............................................................................................................................................. 29

G. SPECIAL SECTION: UMID CARD ACTIVATION AND BIOMETRIC CAPTURE ...................................................................30

Why must I undergo biometric capture with PhilHealth? ............................................................................................................................... 30

Can I choose not to have my biometric data captured by PhilHealth? ..................................................................................................... 30

What does ‘biometric capture’ mean?..................................................................................................................................................................... 30

Am I going to pay any fee for biometric capture? ............................................................................................................................................. 30

Where can I have my biometric data captured by PhilHealth? ..................................................................................................................... 30

Is there a recommended attire for the biometric process? ............................................................................................................................ 31

How will the biometric capture procedure go? ................................................................................................................................................... 31

What do I need to bring on biometric capture day? ......................................................................................................................................... 31