The Philippine Health Insurance Corporation (PhilHealth) was created in 1995 to implement universal

health coverage in the Philippines. It is a tax-exempt, government-owned and controlled corporation

(GOCC) of the Philippines, and is attached to the Department of Health. It's stated goal is to "ensure a
sustainable national health insurance program for all", according to the company. In 2010, it claimed to
have achieved "universal" coverage at 86% of the population, although the 2008 National Demographic
Health Survey showed that only 38 percent of respondents were aware of at least one household member
being enrolled in PhilHealth.[2] Nevertheless, this social insurance program provides a means for the
healthy to pay for the care of the sick and for those who can afford medical care to subsidize those who
cannot. Both local and national governments allocate funds to subsidize the indigent.

Mandate and Functions

In 2010 and 2015, reform efforts were outlined to make decentralization and health insurance work more
effectively, including an expanded government subsidy for the enrollment of the poor, the creation of
local health service delivery/planning units to reduce fragmentation, and a stronger DOH role in
regulation.[5] Also the shifting from Fee-for-service to Case Rate payment scheme and IHCP Portal System
is established to provide a link between accredited institutional health care providers and Philhealth
through online connections.

PhilHealth have six major membership categories covering nearly the entire population. Those who
count under the (1) "Formal" sector are workers employed by public and private companies and other
institutions. (2) "Indigents" also called "Philhealth sa Masa" are subsidized by National Government
the National Household Targeting System for Poverty Reduction. (3) "Sponsored Members" are
subsidized by their respective Local Governments (LGU). (4) "Lifetime" (non-paying members) are
retirees and pensioners and have already paid premiums for 120 months of membership and are 60 or
older. (5) "Senior Citizen" under RA 10645 that all citizen ages 60 years old above are eligible to have
free philhealth coverage. (6) The "Informal Economy" is composed of Informal Sectors, Self-Earning
Individuals, Organized Group, Filipino with Dual Citizenship, Natural-Born Citizen. Although treated
separately, the Overseas Filipino Workers (OFW) program or Migrant Workers is as part of the Informal
Economy. Migrant Worker is sub-categorized as whether Land Based or Sea Based (for Sea Fearers).

Program summary [9][failed verification]

Group Premiums Enrollment Payment
Employer and worker each pay
Formal half, up to 2.5% (maximum of 3%) As of hire date 3 months
of income up to 10,500 pesos
Indigent
2,400 pesos annually National Government None
(NHTS)
Local Government a fully
Sponsored 2,400 pesos annually subsidizes enrollment None
annually.
Lifetime Free lifetime coverage Retirees and Pensioners
Non Paying (RA 10645), Free
Senior Citizen Age 60 years and up None
Lifetime coverage
2,400 pesos annually for members
earning P25,000 and below
Informal Enrollment date.
3,600 pesos annually for members
earning more than P25,000
No subsidy. Payment is
OFW
2,400 pesos annually Emigration date on emigration date
(Landbased)
then annually.
 Employer and worker each pay
OFW
half, up to 2.5% (maximum of 3%) As of hire date 3 months
(Seabased)
of income up to 10,500 pesos
Since 1996, the benefits package and delivery system have improved. PhilHealth now has an Outpatient
and Diagnostic Package limited to indigent beneficiaries. This addition creates nearly comprehensive
coverage for indigents. In 2011, 23 CASE RATES was introduced and in 2013, ALL CASE RATES was fully
implemented. All other beneficiaries have access to nearly comprehensive services, excluding some
outpatient care. PhilHealth has an accreditation program for private hospitals.[6]
Some key reform indicators to date include:
 Estimated coverage is 100% as of June 2013
 Average period for payment of providers is estimated at 70 to 75 days. The law requires PhilHealth to
reimburse providers and/or members within 60 days. A recent move as of December 1, 2009,
implemented a “simplified reimbursement scheme” wherein 95% of the claims amount is reimbursed
after a rapid assessment of member and provider eligibility and the remaining 25% follows after detailed
review of the claims.
On average, 90 out of every 100 claims are paid, 3 to 4 are denied, and 6 to 7 are returned to health care
providers for more information. 28% of claims were submitted by public providers and 72% by private
providers.

Funding and Revenues

Funding varies based on the population covered, although the majority of funds flow from general
taxation. Premiums from the formal sector reach up to 3% of monthly income. Premiums from both the
poor and the informal sector are 2,400 pesos annually (about 50 USD). However, the cost of insurance
for the poor is fully subsidized by the central and local governments. The National government allocates
more than 9 billion pesos annually to meet its target.
Membership Category

All premiums are pooled nationally and in effect, there is cross-subsidization across districts.
The national government payment is dependent on the availability of funds.
The benefits package is essentially the same for each membership category, philhealth deduction will
depend upon the final diagnosis. The exception is for indigents and Overseas Filipino Workers (OFWs)
who have additional outpatient primary care benefits (with the providers paid by capitation) however
these benefits are available only through public providers.

Benefits
PhilHealth and beneficiaries have access to a comprehensive package of services, including inpatient care,
catastrophic coverage, ambulatory surgeries, deliveries, and outpatient treatment for malaria
and tuberculosis. Those identified as indigent and OFW are also entitled to outpatient primary care
benefits (PCB1) or TSEKAP.[citation needed]
Inpatient care includes room and board, medicines, diagnostic and other services, professional fees and
operating room services under the "all case rate" payment scheme. The case rate amount will depend
upon the final diagnosis and each diagnosis has corresponding fix amount or package. The case rate
amount shall be deducted by the HCI from the member's total bill, which shall include professional fees
of attending physicians, prior to discharge. Catastrophic conditions, ambulatory surgeries
including ambulatory dialysis, deliveries and outpatient malaria and TB-DOTS care.
Outpatient benefits include day surgeries, radiotherapy, dialysis, outpatient blood transfusion, TB-DOTS,
malaria treatment, HIV/AIDS treatment, animal bite treatment, cataract operations and vasectomy and
tubal ligation.
Except for the outpatient primary care benefits (PCB1) that the indigents and OFWs are entitled to via
public providers, patients have free choice of providers, both public and private.
Annual or lifetime coverage limits exist. These limits are expressed in terms of volumes of services (e.g.,
days) rather than a peso coverage limit. For example, principal member are eligible for 45 days of
inpatient admission and also outpatient, and another 45 days to share among its qualified dependents.
Each day of ambulatory surgery counts as a day of admission.
Providers are allowed to charge the patient the difference between the total cost of care and what
PhilHealth pays (i.e., balance billing).
Indigent and sponsored members, lifetime members, senior citizen members and household members
are entitled to avail the free hospitalization under the no-balance billing scheme (NBB) when they are
admitted in a non-private room of public or government hospitals. NBB are not applicable under private
rooms and private hospitals so members have to pay the excess or balance after case rate amount has
been deducted.
Service delivery system
The service delivery system includes both public and private centers; on average, 61% of the network's
providers are private and 39% are public. In order to achieve accreditation, all in-network hospitals and
day-surgery centers must be licensed by the Department of Health.
The network includes hospitals, day surgery centers, maternity care clinics, midwife-operated clinics,
freestanding dialysis centers, physician clinics, dentists doing procedures in hospitals and day surgeries,
government-run health centers for primary care benefits, TB-DOTS and malaria, and private TB-DOTS
clinics.
Non-hospitals and day-surgery centers are not required to be licensed by the DOH; however, all facilities
are evaluated by an accreditation team from PhilHealth.

Structure
The scheme is entirely administered by PhilHealth, a government corporation attached to the
Department of Health. PhilHealth collects premiums, accredits providers, sets the benefits packages and
provider payment mechanisms, processes claims, and reimburses providers for their services.
PhilHealth is responsible for oversight and administration of public sector insurance schemes. It has a
governing board chaired by the Secretary of Health with representation from other government
departments (ministries) and agencies, and the private sector including the OFW sector.
PhilHealth has a governing board of 13 individuals, chaired by the Secretary of Health, with the
President and CEO of PhilHealth as Vice-Chair. While the law, RA 7875, that created the National Health
Insurance Program provides that the President and CEO has a fixed term of 6 years, with the passage
Republic Act 10149 or the "GOCC Governance Act of 2011," the President and CEO of PhilHealth now
has a term of one (1) year (Section 17, RA 10149) to be elected among the ranks of the Board of
Directors and subject to the disciplinary powers of the Board and may be removed for cause (Section
18, RA 10149).
Salaries and other operating expenses are derived from premium payments and the income of the funds
under management. PhilHealth can use up to 12% of the previous year’s premium and 3% of the income
of the fund it manages towards operating expenses.
Congress mandated that the National Institutes of Health (based at the University of the Philippines
Manila) to conduct studies to verify and validate performance.
Provider Payment Mechanism[edit]
Provider payment methods differ based on the illness or diagnosis. Case Rates are used for inpatient care,
most day surgeries, and ambulatory procedures, TB-DOTS treatment, malaria care, deliveries, surgical
contraception, and cataract surgeries, while primary care benefits providers are reimbursed based on a
capitation system.
No formal system sets deductibles or co-payments for beneficiaries, but health care providers are allowed
to “balance bill”, charging patients the balance between what PhilHealth pays and the total cost of care.
This is atypical of most government health programs around the world and can lead to abuse by providers
(e.g., overcharging) and thus limited access for the poorest. At the same time, balance billing allows
providers additional cost recovery in the case that the reimbursement for services does not cover their
cost.

Quality
PhilHealth currently leverages internally developed quality standards. A new set of standards called the
“PhilHealth Benchbook” was implemented starting January 1, 2010. The Benchbook was developed by
PhilHealth with the assistance of various international health partners and several rounds of consultations
with health providers.
The previous and new quality standards are overseen by PhilHealth. The new quality standards focus on
patient rights, organizational ethics, patient care, leadership and management, human resource
management, information management, safe practice and environment and mechanisms of improving
performance. As of 2011, hospital accreditation is valid for up to 3 years. PhilHealth accreditation staff
physically check and verify compliance. PhilHealth has peer review committees mostly composed of
health care providers who review specific cases.
PhilHealth planned to implement quality-based purchasing but had not executed on this plan as of
December 2009.

Performance-based Payment
PhilHealth has been developing incentives focused on payment to health care professionals. Doctors are
usually independent practitioners who ‘practice’ in hospitals. Salaried government physicians are allowed
to also engage in private practice. Efforts to implement case payments essentially focus on bundling the
payment for the health facilities.
Among PhilHealth’s work in incentive-based payments is a scheme that has been piloted in 30 local
government hospitals since 2002 but has not spread. The scheme is called the Quality Improvement
Demonstration Study (QIDS). It utilizes clinical vignettes to measure quality of care. If a hospital meets a
set quality of care index score, physician payments are increased. Clinical vignettes focus on the illnesses
of children less than six years of age.
Another incentive scheme is increased payment for health professionals practicing in areas where there
is a lack of doctors.

Claims Processing
Claims processing and availment in accredited hospitals has been improved. Hospitals have installed the
ICHP Portal System. It is established to provide a link between accredited institutional health care
providers and Philhealth through online connections that shall ensure verification of eligibility
information.[10] Members do not need to fill out forms if member have updated premium contributions
and updated philhealth records, they will have to present their philhealth IDs. Claims are submitted to 17
regional claims processing centers. These centers initially review claims for eligibility. Review is input
manually with data encoded into the claims processing information system. Once the claim is approved
for payment, checks are prepared for the signature of regional heads. Electronic reimbursements are
planned but has yet to be implemented.

Monitoring and Evaluation

PhilHealth conducts its own monitoring and evaluation, though the law mandates that University of the
Philippines National Institutes of Health engages in monitoring of the scheme. Evaluations on the
PhilHealth program are ongoing.
The Department of Health (to which PhilHealth is an attached agency) monitors and analyses data,
including number and value of claims, number of accredited providers, number and value of premiums
paid, number of members, etc.

Fraud and Controversies

In 2013 fraudulent claims Juan Miguel of Regional 1 started fire with against the state-health insurer were
estimated at 4 billion pesos. However, the state failed to prosecute erring doctors, private and public
hospitals, and public officials. AFP Medical Center, St. Luke’s Hospital, Philippine Orthopedic
Hospital, University of Sto. Tomas Hospital, East Avenue Medical Center, Cardinal Santos Medical
Center, Medical City, National Kidney and Transplant Institute, General Santos Doctors Hospital (GSDH)
were investigated for health insurance fraud.[11] In Iloilo, eye-doctor claims for 2, 071 operations in 2006
amounting to PHP16 million in professional fees were also investigated. A hospital in Davao City also
noticed that a janitor, not a PhilHealth member, had been lying in bed to claim benefits as a PhilHealth-
accredited patient.[12] Also in 2006, PhilHealth revoked the accreditation of Sara Medical Clinic
in Midsayap for admitting ghost patients.[12] 2018, A lawmaker was shocked to find out that Philhealth
interim president Celestina Dela Serna spent one year living at a hotel worth P3,800 per night instead of
renting a condominium unit or apartment in Metro Manila. Negros Oriental Rep. Arnulfo Teves said he
and House Speaker Pantaleon Alvarez had the chance to talk to Dela Serna during an event at the House
of Representatives, and they were appalled at her extravagant lifestyle. “She admitted to staying in the
hotel for one year or more… More or less one year sa hotel siya nakatira charged to Philhealth and she
said she thought it was okay, that’s why she did it,” he said. Teves said Dela Serna told him and Alvarez
that she stayed at Legend Villas, where rooms are worth at least P3,800 a night. [13]

History
THE call to serve the rural indigents echoed since the early '60s when the Philippine Medical Association
introduced the MARIA Project which prioritized aid to communities in need of medical assistance. The
Project would then be considered a valuable precursor to the Medicare program, from which a medical
care plan for the entire Philippines was created. On August 4, 1969, Republic Act 6111 or the Philippine
Medical Care Act of 1969 was signed by President Ferdinand E. Marcos which was eventually
implemented in August 1971.
The Philippine Medical Care Commission (PMCC) was tasked to oversee the implementation of the
program which went for almost a quarter of a century.
In the 1990s, a vision for a better, more responsive government health care program was prompted by
the passage of several bills that had significant implications on health financing. The public's clamor for a
health insurance that is more comprehensive in terms of covered population and benefits led to the
development of House Bill 14225 and Senate Bill 01738 which became The National Health Insurance
Act of 1995 or Republic Act 7875, signed by President Fidel V. Ramos on February 14, 1995. The law
paved the way for the creation of the Philippine Health Insurance Corporation (PhilHealth), mandated to
provide social health insurance coverage to all Filipinos in 15 years' time.

Agency's Mandate and Functions

Mandate
The National Health Insurance Program was established to provide health insurance coverage and ensure
affordable, acceptable, available and accessible health care services for all citizens of the Philippines. It
shall serve as the means for the healthy to help pay for the care of the sick and for those who can afford
medical care to subsidize those who cannot. It shall initially consist of Programs I and II or Medicare and
be expanded progressively to constitute one universal health insurance program for the entire
population. The program shall include a sustainable system of funds constitution, collection, management
and disbursement for financing the availment of a basic minimum package and other supplementary
packages of health insurance benefits by a progressively expanding proportion of the population. The
program shall be limited to paying for the utilization of health services by covered beneficiaries. It shall
be prohibited from providing health care directly, from buying and dispensing drugs and pharmaceuticals,
from employing physicians and other professionals for the purpose of directly rendering care, and from
owning or investing in health care facilities. (Article III, Section 5 of RA 7875 as amended)

Powers And Functions

PhilHealth is a tax-exempt Government Corporation attached to the Department of Health for policy
coordination and guidance. (Article IV, Section 15 of RA 7875 as amended). It shall have the following
powers and functions (Article IV, Section 16 of RA 7875 as amended by RA 10606):
a) To administer the National Health Insurance Program;
b) To formulate and promulgate policies for the sound administration of the Program;
c) To supervise the provision of health benefits and to set standards, rules and regulations necessary to
ensure quality of care, appropriate utilization of services, fund viability, member satisfaction, and overall
accomplishment of Program objectives;
d) To formulate and implement guidelines on contributions and benefits; portability of benefits, cost
containment and quality assurance; and health care provider arrangements, payment, methods, and
referral systems;
e) To establish branch offices as mandated in Article V of this Act;
f) To receive and manage grants, donations, and other forms of assistance;
g) To sue and be sued in court;
h) To acquire property, real and personal, which may be necessary or expedient for the attainment of the
purposes of this Act;
i) To collect, deposit, invest, administer, and disburse the National Health Insurance Fund in accordance
with the provisions of this Act;
j) To negotiate and enter into contracts with health care institutions, professionals, and other persons,
juridical or natural, regarding the pricing, payment mechanisms, design and implementation of
administrative and operating systems and procedures, financing, and delivery of health services in behalf
of its members;
k) To authorize Local Health Insurance Offices to negotiate and enter into contracts in the name and on
behalf of the Corporation with any accredited government or private sector health provider organization,
including but not limited to health maintenance organizations, cooperatives and medical foundations, for
the provision of at least the minimum package of personal health services prescribed by the Corporation;
 l) To determine requirements and issue guidelines for the accreditation of health care providers for the
Program in accordance with this Act;
m) To visit, enter and inspect facilities of health care providers and employers during office hours, unless
there is reason to believe that inspection has to be done beyond office hours, and where applicable,
secure copies of their medical, financial, and other records and data pertinent to the claims, accreditation,
premium contribution, and that of their patients or employees, who are members of the Program;
n) To organize its office, fix the compensation of and appoint personnel as may be deemed necessary and
upon the recommendation of the president of the Corporation;
o) To submit to the President of the Philippines and to both Houses of Congress its Annual Report which
shall contain the status of the National Health Insurance Fund, its total disbursements, reserves, average
costing to beneficiaries, any request for additional appropriation, and other data pertinent to the
implementation of the Program and publish a synopsis of such report in two (2) newspapers of general
circulation;
p) To keep records of the operations of the Corporation and investments of the National Health Insurance
Fund;
q) To establish and maintain an electronic database of all its members and ensure its security to facilitate
efficient and effective services;
r) To invest in the acceleration of the Corporation’s information technology systems;
s) To conduct information campaign on the principles of the NHIP to the public and to accredited health
care providers. This campaign must include the current benefit packages provided by the Corporation,
the mechanisms to avail of the current benefit packages, the list of accredited and disaccredited health
care providers, and the list of offices/branches where members can pay or check the status of paid health
premiums;
t) To conduct post audit on the quality of services rendered by health care providers;
u) To establish an office, or where it is not feasible, designate a focal person in every Philippine Consular
Office in all countries where there are Filipino citizens. The office or the focal person shall, among others,
process, review and pay the claims of the overseas Filipino workers (OFWs);
v) Notwithstanding the provisions of any law to the contrary, to impose interest and/or surcharges of not
exceeding three percent (3%) per month, as may be fixed by the Corporation, in case of any delay in the
remittance of contributions which are due within the prescribed period by an employer, whether public
or private. Notwithstanding the provisions of any law to the contrary, the Corporation may also
compromise, waive or release, in whole or in part, such interest or surcharges imposed upon employers
regardless of the amount involved under such valid terms and conditions it may prescribe;
w) To endeavour to support the use of technology in the delivery of health care services especially in
farflung areas such as, but not limited to, telemedicine, electronic health record, and the establishment
of a comprehensive health database;
x) To monitor compliance by the regulatory agencies with the requirements of this Act and to carry out
necessary actions to enforce compliance;
y) To mandate the national agencies and LGUs to require proof of PhilHealth membership before doing
business with a private individual or group;
z) To accredit independent pharmacies and retail drug outlets; and
aa) To perform such other acts as it may deem appropriate for the attainment of the objectives of the
Corporation and for the proper enforcement of the provisions of this Act.
Affiliations
 International Social Security Association
 ASEAN Social Security Association
 Philippine Social Security Association

Vision, Mission, Core Values

Vision
"Bawat Filipino, Miyembro,
Bawat Miyembro, Protektado,
Kalusugan ng Lahat, Segurado"
Mission
"Benepisyong Pangkalusugang Sapat at De-kalidad para sa Lahat"
Core Values
Integridad
Inobasyon
 Agarang Serbisyo
Taos-Pusong Paglilingkod
Pagmamalasakit
Angkop na Benepisyo
Panlipunang Pagkakabuklod
Organizational Chart
Ex-Officio Members Representative/Alternate

Francisco T. Duque III, M.D., MSc. Lilibeth C. David, MD, MPH, MPM, CESO III
Secretary of Health Undersecretary
Chairperson
Lyndon L. Lee Suy, MD, MPH
Assistant Secretary

Atty. Charade B. Mercado-Grande

Assistant Secretary

BGen. Ricardo C. Morales, AFP (Ret) FICD

PhilHealth President and
Chief Executive Officer (CEO)
Vice-Chairperson

Rolando Joselito D. Bautista Joseline P. Niwane

DSWD Secretary Assistant Secretary
Member

Atty. Silvestre H. Bello III Atty. Jacinto V. Paras

DOLE Secretary Undersecretary
Member Atty. Federico V. Abuan
Assistant Secretary

Carlos G. Dominguez III Sharon P. Almanza

DOF Secretary Deputy Treasurer
Member Rosalia V. De Leon
Treasurer

Atty. Wendel E. Avisado Atty. Janet B. Abuel

DBM Acting Secretary Undersecretary
Member Carmencita P. Mahinay
Director
Atty. Ryan S. Lita
Director

Appointive Members

BGen. Ricardo C. Morales, AFP (Ret) FICD

Indirect Contributors Sector
Member

BGen. Marlene R. Padua, AFP (Ret.)

Health Care Providers Sector
Member
 Ex-Officio Members Representative/Alternate

Alejandro L. Cabading, CPA

Expert Panel
Member

Maria Graciela Garayblas-Gonzaga, M.D.

Expert Panel
Member

Elected Local Chief Executive

Member

Independent Director of the Monetary Board

Member

Filipino Overseas Workers Sector

Member

Formal Economy Sector

Member

Employers Sector
Member

Office of the Corporate Secretary

Atty. Jonathan P. Mangaoang

Corporate Secretary
REGIONAL OPERATIONS
Area 1 (North Luzon)
IBAY, JERRY F. Regional Vice-President PhilHealth Regional Office CAR

 • These benefits are paid to the accredited Health Care Institution (HCI) through All Case Rates

 • The case rate amount shall be deducted by the HCI from the member’s total bill, which shall include
professional fees of attending physicians, prior to discharge

 • The case rate amount is inclusive of hospital charges and professional fees of attending physician
 • Availment condition: Member must have six (6) months contributions preceding the three months
qualifying contributions within the 12-month period prior to the first day of confinement

 • Documents needed: copy of Member Data Record or PhilHealth Benefit Eligibility Form (PBEF) and duly
accomplished PhilHealth Claim Form 1

 • Where available: all accredited HCIs*

*Different case rate amounts for selected medical conditions are being implemented when done in
Primary Care facilities (PhilHealth Circular 14, s-2013)

 • Only admissible cases shall be reimbursed

1. Day Surgeries (Ambulatory Or Outpatient Surgeries) Are Services That Include Elective (Non-
Emergency) Surgical Procedures Ranging From Minor To Major Operations, Where Patients Are Safely
Sent Home Within The Same Day For Post-Operative Care
• Payments for these procedures are made to the accredited facility through All Case Rates
• the case rate amount shall be deducted by the HCI from the member’s total bill, which shall include
professional fees of attending physicians, prior to discharge
• The case rate amount is inclusive of hospital charges and professional fees of attending physician
• Availment condition: Member must have six (6) months contributions preceding the three months
qualifying contributions within the 12-month period prior to the first day of confinement
• Documents needed: copy of Member Data Record and duly accomplished PhilHealth Claim Form 1
• Where available: Accredited Ambulatory Surgical Clinics (ASCs)

2. Radiotherapy
• The case rate for radiotherapy using cobalt is P2,000 per session and P3,000 per session for linear
accelerator
• Includes radiation treatment delivery using cobalt and linear accelator
• Claims for multiple sessions may be filed using one (1) claim form for both inpatient and outpatient
radiation therapy
• May be availed of even as second case rate (full case rate amount)
• 45 days benefit limit: One session is equivalent to one day deduction from the 45 allowable days per
year
• If procedure is done during confinement, only the total number of confinement days shall be
deducted
• Exempted from Single Period of Confinement (SPC) rule (admissions and re-admissions due to same
illness or procedure within 90-calendar day period)
• Availment condition: Member must have six (6) months contributions preceding the three months
qualifying contributions within the 12-month period prior to the first day of confinement
• Where available: Accredited HCIs including Primary Care Facilities that are accredited for the said
service

3. Hemodialysis
• The Case Rate for hemodialysis is P2,600 per session
• Covers both inpatient and outpatient procedures including emergency dialysis procedures for acute
renal failure
• Claims for multiple sessions may be filed using one (1) claim form for both inpatient and outpatient
hemodialysis
• May be availed of even as second case rate (full case rate amount)
• 90 days benefit limit: One session is equivalent to one day deduction from the 90 allowable days per
year
 • If procedure is done during confinement, only the total number of confinement days shall be
deducted
• The procedure is exempted from Single Period of Confinement rule (admissions and re-admissions
due to same illness or procedure within 90-calendar day period)
• Availment condition: Member must have six (6) months contributions preceding the three months
qualifying contributions within the 12-month period prior to the first day of confinement
• Where available: All Accredited HCIs – this benefit is no longer restricted to hospitals and free standing
dialysis centers provided that the service is within their capability as provided for in the DOH license

4. Outpatient Blood Transfusion

• The case rate for outpatient blood transfusion is P3,640 (one or more units)
• Includes Drugs & Medicine, X-ray, Lab & Others, Operating Room
• Covers outpatient blood transfusion only
• One day of transfusion of any blood or blood product, regardless of the number of bags, is equivalent
to one session
• May be availed of as second case rate (full case rate amount)
• 45 days benefit limit: One session for each procedure is equivalent to one day deduction from the 45
allowable days per year Exempted from the SPC rule
• Where to avail: All Accredited HCIs

5. Primary Care Benefit (PCB)

Coverage
• Indigent
• Sponsored Members
• Overseas Workers Program (Land-based)
• Organized Groups/iGroups

Where to avail
• Accredited rural health units,
• Accredited health center
• Accredited government hospitals

Disease Conditions:
• Asthma
• Acute Gastroenteritis (AGE) with no or mild dehydration
• Upper Respiratory Tract Infection (URTI)
• Pneumonia (minimal and low risk)
• Urinary Tract Infection (UTI)

Benefit Inclusions:
• Preventive Services
1. 1. Consultation
2. 2. Visual inspection with acetic acid
3. 3. Regular BP measurements
4. 4. Breastfeeding program education
5. 5. Periodic clinical breast examinations
6. 6. Counseling for lifestyle modification
7. 7. Counseling for smoking cessation
8. 8. Body measurements
9. 9. Digital rectal examination
• Diagnostic Examinations (as recommended by the doctor)
1. 1. Complete blood count
2. 2. Urinalysis
3. 3. Fecalysis
4. 4. Sputum microscopy
5. 5. Fasting blood sugar
6. 6. Lipid Profile
7. 7. Chest x-ray
 • Drugs and Medicines
1. 1. Inhaled Corticosteroids (Fluticasone)
2. 2. Short acting beta 2 agonists/Inhalation solution or metered dose inhaler (Salbutamol)
3. 3. Oral or systemic corticosteroids (Prednisone)
4. 4. Oral Rehydration Salts (ORS)
5. 5. Amoxicillin
6. 6. Macrolide (Erythromycin)
7. 7. Beta Lactams with beta lactamase inhibitors (Cephalexin)
8. 8. 2nd generation cephalosporins (Cefuroxime)
9. 9. Oral fluoroquinolones (Ofloxacin)
10. 10. Co-trimoxazole
How to avail:
1. Assignment thru Local Health Insurance Offices (only for Indigent and Sponsored Members)
2. Visit the PCB provider where you are assigned/enlisted

Expanded Primary Care Benefit (EPCB)

Coverage
• Formal Economy (Employed)
• Lifetime Members
• Senior Citizen

Where to avail:
• Accredited EPCB Health Care Institution to include the following:
- OPD of Level 1, 2 and 3 government and private hospital
- Ambulatory Surgical Clinic
- Infirmaries
- Private medical outpatient clinics

Disease Conditions:
• Asthma
• Acute Gastroenteritis (AGE) with no or mild dehydration
• Upper Respiratory Tract Infection (URTI)
• Pneumonia (minimal and low risk)
• Urinary Tract Infection (UTI)
• Hypertension
• Diabetes Mellitus Type II
Benefit Inclusions:
• Health screening and assessment/consultation
• Essential Services (based on the life stage as indicated in the AO 2017-0012: Guidelines on the
Adoption of Baseline Primary Health Care Guarantees for All Filipinos )

Lifestage group Essential Services

0-12 months CBC
>1-4 years CBC
Fecalysis
Urinalysis
5-9 years old CBC
Fecalysis
Urinalysis
10-19 years old Paps smear (as applicable)
Urinalysis
Fecalysis
 Lifestage group Essential Services
CBC
Chest X-ray
20-60 years old (female) Paps smear( as applicable)
Chest X-ray
Lipid Profile
FBS (for follow up)
Oral Glucose Tolerance Test (for initial)
Sputum microscopy (as applicable e.g. Suspected TB)
ECG (for 30 y/o and up)
> 60 years old Pap smear (for female)
Chest X-ray
Lipid Profile
FBS (for follow up)
Oral Glucose Tolerance Test (for initial)
Sputum microscopy (as applicable e.g. Suspected TB)
ECG

• Drugs and Medicines

1. 1. Amoxicillin
2. 2. Co-Amoxiclav (Amoxicillin + Potassium Clavulanate)
3. 3. Cotrimoxazole (Sulfamethoxazole + Trimethoprim)
4. 4. Erythromycin
5. 5. Fluticasone + Salmeterol
6. 6. Ofloxacin
7. 7. Oral Rehydration Salts
8. 8. Prednisone
9. 9. Salbutamol (as Sulfate) + Ipratropium Bromide
10. 10. Salbutamol
11. 11. Paracetamol
12. 12. Simvastatin
13. 13. Gliclazide
14. 14. Metformin Hydrochloride
15. 15. Enalapril
16. 16. Metoprolol
17. 17. Amlodipine
18. 18. Hydrochlorothiazide + Losartan
Note/s:
 1. FREE (only for the member or 1 of his/her dependent)
• Initial Health screening and assessment
• Initial Essential Services

 2. FIXED CO-PAYMENT* (applicable for member and dependents)

• Initial and follow-up medicines
• Follow-up consultation
• Follow-up laboratory included in the list

 3. REGULAR FEE
• Initial health screening, assessment and essential services for beneficiaries not availing of the free
• Other laboratory services and prescribed medicines not included in the list
* The HCI shall apply the same fixed co-payment rules for other disease conditions not covered by the
expanded PCB that will require any of the laboratories and medicines included in the list of essential
services and drugs. (e.g. CBC for suspected dengue case, chest X-ray for suspected TB, antibiotics for
infected wounds, impetigo and other skin infections)
How to avail:
 1. Membership Data Record (MDR) Updating
2. Online assignment thru any of the following:
• Member Online Inquiry
• PhilHealth Call Center (02-4417442)*for further announcement
• Local Health Insurance Office (LHIO)
• PhilHealth Customer Assistance, Relations and Empowerment Staff (PCARES)
• Employer via Electronic Premium Remittance System (EPRS)

3. Acquire Authorization Transaction Code (ATC) through any of the following:

• Member Online Inquiry
• PhilHealth Call Center (02-4417442)*for further announcement
• Local Health Insurance Office (LHIO)
• PhilHealth Customer Assistance, Relations and Empowerment Staff (PCARES)
4. Visit the EPCB HCI where you are assigned

Benefit Package
and Selections criteria
Amount of Benefit
Acute a. Signed Member Empowerment (ME) Form;
Lymphocytic /
Lymphoblastic b. Age 1 to less than 10 years old;
Leukemia (standar
d risk) c. White blood cell count ‹50,000/µL;
P500,000
d. No CNS leukemia at diagnosis;

e. There should be no testicular involvement of male patient at diagnosis; and

f. WHO Classification: B or T lymphoblastic leukemia immunophenotype (mature B-cell ALL or B

Benefit Package
and Selections criteria
Amount of Benefit
Benefit Package
and Selections criteria
Amount of Benefit

Breast Cancer a. Signed ME Form

(stage 0 to IIIA)
P100,000 b. Clinical and TNM staging:
- Stage 0 TisN0M0
- Stage IA T1N0M0
- Stage IB T0,T1N1M0
- Stage IIB T2N1M0 or T3N0M0
- Stage IIIA T0, T1, T2N2M0 or T3N1N2M0
Benefit Package
and Selections criteria
Amount of Benefit
Benefit Package
and Selections criteria
Amount of Benefit
Benefit Package
and Selections criteria
Amount of Benefit

Prostate Cancer a. Signed ME Form;

(low to
intermediate risk) b. Male patients age up to 70 years old;
P100,000
c. Clinical stage (T1a-T2c), PSA level 10 to 20 ng/ml,
Tumor Grade (Gleason’s score of 2-7)
- Low risk: T1-T2a and Gleason score 2-6, and
PSA ‹10 ng/ml
- Intermediate risk: T2b to T2c, Gleason score of 7,
and PSA 10-20 ng/ml

d. Localized prostate cancer; and

e. No uncontrolled co-morbid conditions

Benefit Package
and Selections criteria
Amount of Benefit

End-stage renal a. Signed ME Form;

disease eligible
Benefit Package
and Selections criteria
Amount of Benefit
for requiring b. Age ›10 and ‹70 years;
kidney
transplantation (l c. Single organ transplant;
ow risk)
P600,000 d. Patient on chronic dialysis because of end stage renal disease or patient for pre-emptive kidn
i. The potential recipient should have an irreversible renal disease that has been progressive ov
ii. The recipient’s measured (nuclear scan) glomerular filtration rate, 24-hour urine creatinine c

e. Low immunologic risk defined as:

i. Past Panel Reactive Antibody (PRA) less than or equal to 20%
ii. Primary kidney transplant (no previous solid organ transplant)
iii. No donor specific antibody (DSA) in the potential recipient
iv. At least 1 HLA-DR match

f. Potential recipient has no previous history of cancer (except basal cell skin cancer), should be

g. Transplant candidate who is CMV-negative cannot receive an organ from a CMV-positive don

h. Absence of current severe illness (Congestive heart failure Class 3-4, liver cirrhosis (findings o

i. Absence of the following: hemi-paralysis because of stroke, leg amputation because of periph

j. Eligible patient for kidney transplant must have a certification from the social service of the h
Benefit Package
and Selections criteria
Amount of Benefit

Coronary Artery a. Signed ME Form

Bypass Graft
Surgery (standard b. Age 19-70 years
risk)
P550,000 c. Stable Coronary Artery Disease requiring ELECTIVE ISOLATED Coronary Artery Bypass Graft Su

d. Current Medical Status

i. Not in severe decompensated heart failure (NYFC IV)
ii. Not with severe angina (CCS Class III)
iii. No other cardiac/vascular procedures /interventions planned to be done with CABG during t

e. Past History:
i. No previous cardiac surgery such as CABG, valve surgery, etc.
ii. No previous transcutancous cardiac intervention such as coronary angioplasty or stenting
f. ONLINE EUROSCORE II and/or STS scoring predictive of low mortality risk (‹5%)
Benefit Package
and Selections criteria
Amount of Benefit
Benefit Package
and Selections criteria
Amount of Benefit

Surgery for a. Signed ME Form

Tetralogy of Fallot
in Children b. Age: 1 to 10 years + 364 days
P320,000
c. 2D-echocardiogram:
i. Pulmonary artery size
- McGoon’s index (Aorta/Pa ratio) ≥ 1.5
- Z score Pulmonary Valve Annulus : Acceptable if z score / BSA : ≥ 3 or better
- Z score peripheral PA’s : Acceptable if ≥ 2 or better
ii. Absence of major aortopulmonary collateral arteries (MAPCAs)

d. If cardiac catheterization / hemodynamic study available: PA size: adequate by Z score standa

e. No previous cardiac surgery (Blalock Taussig Shunt)

f. Functional Class I-II

g. No co-morbid factors, such as any of the ff:

i. Preoperative seizures
ii. Brain abscess
iii. Stroke events
iv. Bleeding disorders
v. Infective endocarditis
vi. Other congenital anomalies
Benefit Package
and Selections criteria
Amount of Benefit

Surgery for a. Signed ME Form

Ventricular Septal
Defect in Children b. Age: 1 to 5 years + 364 days
P250,000
c. 2D-echocardiography
i. Isolated VSD perimembranous, subaortic or subpulmonic
ii. No combined shunts such as atrial septal defect or patent ductus arteriosus or atrioventricula
iii. No other associated CHD’s : such as coarctation of the aorta, or moderate to severe aortic in
iv. Pulmonary artery pressure: ‹50 mmHg or at least 2/3 systolic blood pressure
v. QP QS: > 1.5:1

d. No previous cardiac surgery (PA Banding)

e. Functional Class I-II

f. No co-morbid factors, such as any of the ff:

i. Preoperative seizures
ii. Brain abscess
iii. Stroke events
iv. Bleeding disorders
v. Infective endocarditis

g. No chromosomal abnormalities and other associated congenital defects

Cervical Cancer: a. Signed ME Form;

Chemoradiation
with Cobalt and b. No previous chemotherapy
Brachytherapy
(low dose) or c. No previous radiotherapy
Primary surgery
for Stage IA1, IA2 d. No uncontrolled co-morbid conditions
– IIA1
P120,000 e. Treatment plan from gynecologic oncologist

Chemoradiation
Benefit Package
and Selections criteria
Amount of Benefit
with Linear
Accelerator and
Brachytherapy
(high dose)
P175,000

Z-MORPH a. Signed ME Form;

(Mobility,
Orthosis, b. No associated disabilities or co-morbidities, such as contractures, deformities, mental or beh
Rehabilitation,
Prosthesis Help) c. Community ambulation with or without cane, crutches or walker;
- first right and/or
left below the d. At least three (3) months post-amputation, if acquired; and
knee
P15,000 e. At least 15 years and 364 days of age, if congenital.

- both limbs
P30,000
Benefit Package
and Selections criteria
Amount of Benefit

Expanded Z-
MORPH

Selected a. Signed ME Form

Orthopedic
Implants b. Clinical Features
1. Implants for i. hip fracture
Hip
Arthroplasty 1. with avascular necrosis of the femoral head; OR
- Implants Hip 2. neglected fracture of the hip; OR
Prosthesis, 3. hip fracture with pre-existing cox-arthritis; OR
cemented* 4. displaced hip fracture
P103,400
ii. with avascular necrosis of the femoral head (FICAT Stage III and IV); OR
- Total Hip iii. hip dysplasia (CROWE I-IV); OR
Prosthesis, iv. severe osteoarthritis; OR
cementless** v. severe inflammatory joint disease (rheumatoid, gout, psoriatic, ankylosing spondylitis)
P169,400
c. Pre-injury status: ambulatory patients
- Partial Hip
Prosthesis, d. With no more than two co-morbid illnesses based on: Physical status classification based on
bipolar
P73,180 ASA I – normal healthy patient
ASA II – Patient with mild systematic disease; no functional limitation
*cemented: 66
years old and
Benefit Package
and Selections criteria
Amount of Benefit

above
** cementless:
65 years and
364 days old
and below
a. Signed ME Form

b. Any hip fracture not covered under the total hip package for femoral neck fracture
i. with no avascular necrosis of the femoral head; OR
ii. acute fracture of the hip; OR
iii. hip fracture with no pre-existing cox-arthritis; OR
iv. displaced hip fracture

c. Pre-injury status: ambulatory patients

2. Implants for
Hip Fixation d. With no more than two co-morbid illnesses based on: Physical status classification based on
- Multiple screw
fixation ASA I – normal healthy patient
(MSF)*** ASA II – Patient with mild systematic disease; no functional limitation
6.5mm
cannulated
cancellous
screws with
washer a. Signed ME Form
P61,500
b. CHS: stable fracture of the intertrochanteric area (AO Classification Type A1 fracture)
***59 years
and 364 days c. PFLP: unstable/comminuted pertrochanteric fracture (AO Classification Type A2 and A3 fract
old and below
(both displaced d. Pre-injury status: ambulatory patients
and undisplaced e. With no more than two co-morbid illnesses based on: Physical status classification based on
fracture); 60
years old and ASA I- normal healthy patient
above ASA II – Patient with mild systemic disease; no functional limitation
(undisplaced a. Signed ME Form
fracture)
b. Femoral shaft fracture
i. without malignant/metastatic pathologic fracture: AND
ii. with any complete fracture of the femur
Pre-injury status: ambulatory patients

3. Implants for c. Physical status classification based on ASA (low to moderate risk)
Pertrochanteric
Fracture ASA I – normal healthy patient
- Compression ASA II – Patient with mild systemic disease: no functional limitation
Hip Screw Set
(CHS)
P69,000

- Proximal
Femoral Locked
Benefit Package
and Selections criteria
Amount of Benefit

Plate (PFLP)
P71,000

4. Implants for
Femoral Shaft
Fracture
- Intramedullary
Nail with
Interlocking
Screws
P48,740

- Locked
Compression
Plate (LCP) –
Broad /
Metaphyseal /
Distal Femoral
LC
P50,740

“PD First” - for a. Signed ME Form (to be submitted annually together with the pre-authorization)
End-Stage Renal
Disease Requiring b. Patients must have a permanent Tenckhoff peritoneal dialysis catheter properly placed in the
Peritoneal
Dialysis c. Patients must have completed PD initiation in an accredited healthcare institution so that the
P270,000 per year
Clinical Criteria
i. Must be at least 10 years of age;

ii. Diagnosed to have end-stage renal disease requiring renal replacement therapy;

iii. No previous history of cancer other than a successfully and completely treated cutaneous sq

iv. HIV-negative;

v. No mental incapacity such that informed consent cannot be made or that would interfere wit

vi. For pediatric patients, aged 10 to 18 years and 364 days, informed consent from the parents

vii. Absence of current severe illness, including congestive heart failure Class IV, liver cirrhosis (f

viii. Absence of hemiparalysis and leg amputation because of peripheral vascular disease;

ix. No history of substance abuse for at least 3 months prior to start of chronic dialysis treatmen

x. Absence of any disease of the abdominal wall, such as injury or surgery, burns, hernia, extens
Benefit Package
and Selections criteria
Amount of Benefit
xi. Absence of any inflammatory bowel diseases (ex. Crohn’s disease, ulcerative colitis or diverti

xii. Absence of any intra-abdominal tumors or intestinal obstruction;

xiii. Absence of active serositis;

xiv. Absence of known or suspected allergy to PD solutions

Benefit Package
and Selections criteria
Amount of Benefit
Benefit Package
and Selections criteria
Amount of Benefit

Colon and Rectum 1. Signed Member Empowerment (ME) Form

Cancer For Colon Cancer
Colon Cancer a. Clinical and TNM Staging from stage I to III (Clinically T1-T4, N0-2, M0)
Stage I-II (low risk)
– P150,000 b. Pre-operative physical risk classification
Stage II (high risk) ASA I – normal health patient OR
– III – P300,00 ASA II – patient with mild systemic disease

Rectum Cancer c. ECOG Performance Status

Stage I (clinical
and pathologic) – d. Mandatory and other services (procedures, diagnostics, medicines & others)
P150,000
Pre-operative e. See Table 1 of Circular No. 028-2015
clinical stage I
but with post- For Rectum Cancer
operative a. Biopsy proven rectum cancer stages I to III (clinically T1-4, N0-2, M0)
pathologic
stage II-III b. No previous pelvic radiation
- using linear
accelerator as c. Pre-operative physical risk protection
mode of ASA I – normal health patient OR
radiotherapy) - ASA II – patient with mild systemic disease
P400,000
- using cobalt as d. ECOG Performance Status
mode of e. Mandatory and other services ( procedures, diagnostics, medicines & others)
radiotherapy - See Tables 6, 7, 8 of Circular No. 028-2015
P320,000

Clinical Stage II-III

- using linear
accelerator as
mode of
radiotherapy) -
P400,000
Benefit Package
and Selections criteria
Amount of Benefit
- using cobalt as
mode of
radiotherapy -
P320,000

PREMATURE and The following benefits shall be available for pregnant women who are in their 24 to 36 and 6/7
SMALL NEWBORN package.
Prevention of
Preterm Delivery

1.Prevention of
preterm delivery
with severe pre-
eclampsia/eclamp
sia - 3,000.00

2.Prevention of
preterm delivery,
with preterm pre-
labor rupture of
membrane
(pPROM) -
1,500.00

3. Prevention of
preterm delivery
without pre-
eclampsia/eclamp
sia or rupture of
membranes but
with labor or
vaginal bleeding
or multifetal
pregnancy -
600.00

4. With
coordinated
referral and
transfer from a
lower level of
facility - 4,000.00
Preterm and The following benefits shall be available for pregnant women who are in their 24 to 36 and 6/7
Small Newborns package.
(24 to < 32 weeks)

1. Essential
interventions for
Benefit Package
and Selections criteria
Amount of Benefit
24 to < 32 weeks -
35,000.00

2. Essential
intervention with
minor ventilator
support and
Kangaroo Care for
24 weeks to < 32
weeks - 85,000.00

3. Essential
interventions with
major ventilatory
support and
Kangaroo Care for
24 weeks to < 32
weeks -
135,000.00
Preterm and The following benefits shall be available for premature newborns who are visually small or very
Small Newborns
(32 to < 37 weeks)

1. Essential
interventions for
32weeks to < 37
weeks - 24,000.00

2. Essential
interventions with
mechanical
ventilation and
Kangaroo Care for
32 weeks to < 37
weeks - 71,000.00
Children with a. Chronological age must be zero to 17 years and 364 days old; and
Developmental
Disabilities b. A child presents with functional problems secondary to delays, regressions, or deviations in a

Assessment and
discharge
assessment ranges
from P3,626.00 –
P5,276.00

Rehabilitation
Therapy Sessions
P5,000.00 per set*

*Eligible children
with
developmental
disability can only
Benefit Package
and Selections criteria
Amount of Benefit
avail of a
maximum of nine
sets of therapies.
Each set of
therapies has a
maximum of 10
sessions

Children with a. General Criteria

Mobility
Impairment i. Age must be 0 to 17 years and 364 days old;

Requiring assistive ii. Absence of conditions that will compromise safety and functionality with the use of prost
devices ranges
from P13,110.00 – iii. On physical examination: no fresh or non-healing wound on body part of interest
P163,540.00
iv. At least three months-post-surgery, if acquired amputation
Requiring seating
device, basic and
intermediate b. With mobility impairment, presenting with any of the following:
wheelchair ranges
from P12,730.00 – i. Disorders resulting to mobility impairment:
P29,450.00
a.) Musculoskeletal conditions characterized with any of the following: limb loss (amputatio
Yearly services
and replacement i.) Gross motor function classification system (GMFCS) 1 and 2 for prosthesis and orthoses
of devices ranges
from P1,590.00 – ii.) GMFCS 3, 4, and 5 for seating device, wheelchair, prosthesis and orthosis (note: For seati
P13,690.00
iii.) Talipes equinovarus (clubfoot)

b.) Neuromuscular conditions characterized with any of the following: weakness or paralysis

i.) GMFCS 1 and 2 for prosthesis and orthosis, OR

ii.) GMFCS-3, 4, and 5 for seating device, wheelchair and orthosis

ii. Presence of cardiopulmonary, behavioral or cognitive conditions that impairs a child’s mo

Children With a. General Criteria

Visual Disabilities
1. Chronological age must be equal to 0 to 17 years and 364 days old;
Package code and
rates for initial 2. AND any of the following:
assessment and
intervention i. The child must have undergone a visual disabilities assessment from an ophthalmologist w

Initial assessment ii. Children needing an ocular prosthesis should fulfill the following criteria:
and intervention a. The child has enucleated eye
(i.e. rehabilitation b. Other clinical indications determined by ophthalmologists
and training) for
Category 1 Visual
impairment -
Benefit Package
and Selections criteria
Amount of Benefit
25,920.00 3. Must be eligible at the time of pre-authorization

Initial assessment
and intervention
(i.e. electronic
assistive device,
rehabilitation and
training) for
Categories 2, 3,
and 4 Visual
impairment -
31,920.00

Initial assessment
and intervention
(i.e. electronic
assistive device,
rehabilitation and
training) for
Category 5 Visual
impairment -
9,070.00

Optical Aid 1: Low

Power Distance,
Categories 1, 2, 3
and 4 visual
impairment
eyeglasses + low
power optical
device - 7,350.00

Optical Aid 2: High

power Distance,
Categories 1, 2, 3
and 4 visual
impairment
progressive
eyeglasses + high
optical device -
13,820.00

Optical Aid 3:
Colored Filter,
Categories 1, 2, 3
and 4 visual
impairment -
2,940.00

White cane,
Category 5 visual
impairment -
1,000.00
Benefit Package
and Selections criteria
Amount of Benefit
Description for
add-on* devices

*These add-on
assistive devices
are availed of on
top of the benefits
for initial
assessment and
intervention for
the Z Benefits for
visual disabilities.

Description for
yearly
diagnostics, after
the first year of
enrolment

Yearly Diagnostics
for Categories 1,
2, 3 and 4 -
3,220.00

Yearly follow up
consultation for
Category 5 -
780.00

Description for
other benefits

Electronic Aid
Replacement
done every 5
years - 6,000.00

Ocular Prosthesis,
per eye -
20,250.00

** Ocular
prosthesis may be
availed of
exclusively or with
any of the benefits
for visual
disabilities if the
child fulfills the
inclusion criteria
stated in Item
VII.1. c of
PhilHealth Circular
2018-0010
Benefit Package
and Selections criteria
Amount of Benefit
Children With Children presenting with the following are entitled to avail themselves of the benefit package:
Hearing
Impairment 1. Age must be equal to 0 to 17 years and 364 days old
Description for 2. A child must have undergone professional assessment and is deemed to have ALL of the foll
assessment and
hearing aid i. Presence of delay on auditory milestones and/or communication issues at home/school
provision of
children 0 to less ii. Sensorineural hearing loss presenting with either moderate or severe to profound hearing
than 3 years old a. Moderate hearing loss – three frequency (500 Hz, 1000Hz, 2000Hz) average threshold bet
at the time of b. Severe to profound hearing loss –three frequency (500Hz, 1000Hz, 2000Hz) average thres
approval of pre-
authorization iii. Absence of signs and symptoms of an active ear infection (e.g. otalgia, otorrhea, fever an

Assessment and
hearing aid
provision, with
moderate hearing
loss

Assessment:
Otoacoustic
Emission
Screening and
Auditory
Brainstem
Response (ABR)

Habilitation:
Hearing Aid fitting,
hearing aid device,
batteries good for
5 years, ear mold,
hearing aid
verification

Ear mold refitting

every six months
for five years

53,460.00

Assessment and
hearing aid
provision, with
severe to profound
hearing loss

Assessment:
Otoacoustic
Emission
Screening and
Auditory
Brainstem
Benefit Package
and Selections criteria
Amount of Benefit
Response (ABR)

Habilitation:
Hearing Aid fitting,
hearing aid device,
batteries good for
5 years, ear mold,
hearing aid
verification

67,100.00

Description for
assessment and
habilitation of
children 3 to less
than 6 years old
at the time of pre-
authorization

Assessment and
hearing aid
provision,
with moderate
hearing loss

Assessment: Age
Appropriate
Behavioral
Audiometry

Habilitation:
Hearing Aid fitting,
hearing aid device,
batteries good for
5 years, ear mold,
hearing aid
verification

Ear mold refitting

once a year for
five year

45,400.00

Assessment and
hearing aid
provision, with
severe to profound
hearing loss

Assessment: Age
Appropriate
Behavioral
Benefit Package
and Selections criteria
Amount of Benefit
Audiometry

Habilitation:
Hearing Aid fitting,
hearing aid device,
batteries good for
5 years, ear mold,
hearing aid
verification

Ear mold refitting

once a year for
five years

54,100.00

Description for
assessment and
habilitation of
children 6 to less
than 18 years old
at the time of
approval of pre-
authorization

Assessment and
habilitation,
with moderate
hearing loss

Assessment:
Diagnostic Pure
Tone Audiometry

Habilitation:
Hearing Aid fitting,
hearing aid device,
batteries good for
5 years, ear mold,
hearing aid
verification

Ear mold refitting

once a year for
three years

43,880.00

Description for
speech therapy
assessment and
sessions

Speech therapy
Benefit Package
and Selections criteria
Amount of Benefit
assessment and
sessions
for moderate
hearing loss

Include speech
evaluation, speech
therapy sessions
and counselling

22,100.00

Speech therapy
assessment and
sessions for severe
to profound
hearing loss

Include speech
evaluation, speech
therapy sessions
and counselling

63,420.00

Description for
hearing aid
replacement (The
rates mentioned
cover the hearing
aid, its
prescription,
fitting, and fitting
evaluation for one
ear only)

Replacement of
hearing aid
for moderate
hearing loss, 5 to
less than 18 years
old

Includes hearing
aid fitting, hearing
aid, batteries good
for five years , ear
mold and hearing
aid fitting
verification

43,670.00

Replacement of
Benefit Package
and Selections criteria
Amount of Benefit
hearing aid
for severe to
profound hearing
loss, 5 to less than
18 years old This is
only available to
those who have
been enrolled
prior to the age of
six years old and
availed of hearing
aid. This require a
new application
for pre-
authorization.
Includes hearing
aid fitting, hearing
aid batteries good
for five years, ear
mold and hearing
aid fitting
verification
48,670.00
As of March 31, 2019

Benefit Package and

Services included
Amount of Benefit
Outpatient Malaria Diagnostic malaria smears
Package and other laboratory
P600.00 procedures; drugs and
medicines & consultation
services, including patient
education & counseling.
Outpatient HIV-AIDS Drugs and medicines,
Package laboratory examinations,
P30,000.00 per year including Cluster Difference
(P7,500/quarter) 4 (CD4) level determination
test and test for monitoring
of anti-retro viral drugs
(ARV) toxicity and
professional fees of
providers
Outpatient Anti- Diagnostic exams,
Tuberculosis consultation services, drugs, Centers
Where available Conditions
Initial providers are Patients diagnosed with
the accredited malaria confirmed either
facilities for the through:
Outpatient benefit a. Microscopy-detection of
for the indigent malaria parasites in
members, i.e Rural Giemsa- stained blood
Health Units (RHUs) smear; or
b. Rapid Diagnostic Test
(RDT) in areas with no
access to microscopy
centers or during
outbreaks.
DOH-designated Cases confirmed by
treatment hubs STD/AIDS Central
Cooperative Laboratory
(SACCL) or Research
Institute for Tropical
Medicine (RITM).
Accredited TB-DOTS • TB cases that are
susceptible to 1st line anti-
Benefit Package and
Services included
Amount of Benefit
Treatment through health education and
Directly-Observed counseling during treatment
Treatment Short-
course (DOTS)
Package
P4,000
P2,500 – Intensive
phase
P1,500 –
Maintenance Phase
Voluntary Surgical Healthcare facility fee
Contraception component to cover all
Procedures applicable health facility
P4,000.00 charges inclusive of any of
the following:
• Room and Board
• Drugs and medicines used
during surgery or
confinement
• X-ray, laboratory and
other ancillary procedures
• Supplies used during
surgery or confinement
• Use of special rooms e.g.,
operating room, recovery
room
Where available Conditions
TB drugs
• Covers adult and children
under the following
registration groups:
• New
– Retreatment
• Relapse
• Treatment After Failure
• Treatment After Lost to
Follow-up
(Return After Default)
• Previous Treatment
Outcome Unknown
• Transfer-in
Accredited hospitals, Vasectomy including non-
ambulatory surgical scalpel vasectomy Ligation
clinics (ASCs) and or transection of fallopian
Primary care tube (s), abdominal or
facilities (For Non- vaginal approach
scalpel vasectomy
only)

Physician fee component to

cover any of the following:

• Family planning
counseling and client
assessment
• Intra-operative services
including provision of
anesthesia
Postoperative consultation
within 90 days from day of
surgery including dressing
changes, local incision care,
removal of sutures,
management of
complications that do not
require hospitalization
Animal Bite i. Rabies vaccine PhilHealth accredited This package shall cover
Treatment Package • Purified Vero Cell Rabies Animal Bite the following:
P3,000.00 Vaccine (PVRV) or Treatment Centers
• Purified Chick: Embryo a. The cost of providing
Vaccine (PCECV) Post-exposure Prophylaxis
Benefit Package and
Services included
Amount of Benefit
ii. Rabies Immune Globulin
(RIG)
• Human Rabies Immune
Globulin (HRIG) or
• Purified Equine Rabies
Immune Globulin (pERIG)
iii. Local wound care
iv. Tetanus toxoid and anti-
tetanus serum (ATS)
v. Antibiotics
vi. Supplies such as, but not
limited to, syringes, cotton,
alcohol and other
antiseptics
Where available Conditions
(PEP) services. The
following are identified as
reimbursable PEP service
items:
i. Rabies vaccine
• Purified Vero Cell Rabies
Vaccine (PVRV) or
• Purified Chick: Embryo
Vaccine (PCECV
ii. Rabies Immune Globulin
(RIG)
• Human Rabies Immune
Globulin (HR1G) or
• Purified Equine Rubies
Immune Globulin (pERIG)
iii. Local wound care
iv. Tetanus toxoid and anti-
tetanus serum (ATS)
v. Antibiotics
vi. Supplies such as, but
not limited to, syringes,
cotton, alcohol and other
antiseptics
b. Dog bites primarily.
However, persons bitten
by other domestic animals
(cats) and livestock (cows,
pigs, horses, goats) as well
as wild animals (bats,
monkeys) may be covered.
c. Category III Rabies
exposure
i. Trans dermal bite
(puncture wounds,
lacerations, avulsions) or
scratches/abrasions with
spontaneous bleeding
ii. Exposure to a rabies
patient through bites,
contamination of mucous
membranes (eyes,
oral/nasal mucosa,
genital/anal Mucous
membrane or open skin
lesions with body fluids
through splattering and
mouth-to-mouth
Resuscitation
iii. Handling of infected
carcass or ingestion of raw
infected meat iv. Category
II Rabies exposure
Benefit Package and
Services included Where available Conditions
Amount of Benefit
involving the head and
neck c. Patients with
repeat exposure

PhilHealth assumed the responsibility of administering the former Medicare program for government and
private sector employees from the Government Service Insurance System in October 1997, from the
Social Security System in April 1998, and from the Overseas Workers Welfare Administration in March
2005.

Here are the membership categories of Philhealth along with their premiums, enrollment date, and
minimum payment requirements to avail of health benefits:

Group Premiums Enrollment Payment

Formal Economy Employer and employee will each As of hire date 3 months
Members: Employees, pay half of the premium. The
business owners, contribution is 2.75% of the
household workers, employee’s income.
and family drivers.

Kasambahay (house Premium contributions of the As of hire date 3 months

helper) kasambahay shall be shouldered
solely by the household
employer. However, if the
kasambahay is receiving ₱5,000
monthly salary or above, the
kasambahay shall pay his/her
proportionate share.

Indigent (NHTS): Poor ₱2,400 annually National None

families selected by Government
the DSWD using the
National Household
Targeting System for
Poverty Reduction
(NHTS-PR or
Listahanan).

Sponsored Members: ₱2,400 annually Local None

Members whose Government
contributions are paid fully subsidizes
by a sponsor like the enrollment
local government, annually.
government agency or
private individual or
agency. It includes low
earning individuals
that are not
considered as
indigents like barangay
 Group Premiums Enrollment Payment

health workers,
nutrition scholars, etc.
Orphans, abandoned
kids, out-of-school-
youth, street children,
Person with
Disabilities (PWDs),
abused and pregnant
women under the
custody of the DSWD is
also registered here.

Lifetime Members: Free lifetime coverage Retirees and None

Members age 60 and Pensioners
above and retired
employees that
contributed not less
than 120 months in
Philhealth
contributions.

Senior Citizen: Under Non Paying (RA 10645), Free Age 60 years None
the Expanded Senior Lifetime coverage and up
Citizen Act (RA 10645),
all Filipinos age 60 and
above is already
covered by Philhealth.

Informal Economy ₱2,400 annually for members Enrollment date None

Members (or earning ₱25,000 and below
voluntary/individually ₱3,600 annually for members
paying): Includes earning more than ₱25,000
Overseas Filipino
Workers (OFWs), self-
earning individuals,
naturalized Filipinos
and foreigners living in
the Philippines.

OFW (Landbased) ₱2,400 annually Emigration date No subsidy.

Payment is on
emigration
date then
annually.

OFW (Seabased) Employer and employee will each As of hire date 3 months
pay half of the premium. The
contribution is 2.75% of the
employee’s income.
How Do You Register With PhilHealth?
Registration is easy under any membership categories. You just need to go to any PhilHealth office near
you and follow the following procedures:
Enrollment of Formal Economy Members
 Fill out two (2) copies of the PhilHealth Member Registration Form (PMRF)
 Submit PMRF to the HR Department of employer
 Await Member Data Record and PhilHealth ID card from employer
For Newly Hired Employees With PIN
 Report your PIN to your employer for them to indicate the same in their ER2
Premium Requirements
 Premium contributions are shared by the employee and the employer, the amount of which is
determined using the table of contributions. After deducting half of the premium requirement from your
monthly salary, total premiums are remitted by your employer to PhilHealth.
Enrollment of Indigent / Sponsored Members
Philhealth Members Sponsored by LGUs, National Government, congress and Indigents belonging to the
lowest 25% of the Philippine population can become Sponsored Members by submitting the usual
requirements to their sponsors or at any PhilHealth office.

How do Lifetime Members enroll to PhilHealth?

 Fill-out two (2) copies of the PhilHealth Member Registration Form (PMRF)
 Submit PMRF to the nearest PhilHealth Local Health Insurance Office (LHIO) together with the following
documents:
 Two (2) 1×1 latest ID picture,
 Two valid IDs; and
 Any of the following documents:

For SSS pensioners Photocopy of Death, Disability and Retirement (DDR) indicating the
date of retirement and effective date of pension

Photocopy of the Retiree/Pensioner Certification indicating the

effective date of retirement

For GSIS pensioners Photocopy of Service Record issued by the employer showing
rendered services of not less than 120 months

Photocopy of Certification/Retirement Gratuity from the employer

indicating services of not less than 120 months

Photocopy of retirement voucher issued by GSIS

For Uniformed Photocopy of General/Special or Bureau Order indicating effective

personnel of AFP, PNP, date of retirement
BJMP and BFP
Photocopy of Certification/Letter of Approval of Retirement from
the GSIS indicating services of not less than 120 months

Photocopy of Statement of Services issued by previous employer

showing service of not less than 120 months

GSIS Disability Photocopy of Death, Disability and Retirement (DDR) indicating the
Pensioner / SSS date of retirement and effective date of pension
Permanent Total
Disability Pensioner Photocopy of Disability Pensioner Certification issued by SSS/GSIS
before March 4, 1995 indicating effective date of pension or the period of coverage for
disabled pensioner.

SSS Survivorship Photocopy of Death, Disability and Retirement indicating the type
Pensioner before of survivorship in nature and the effective date of pension
March 4, 1995
Photocopy of Survivorship Pensioner Certification indicating the
effective date of pension
 Other individuals who Photocopy of official receipts of premium payments to PhilHealth
are not under the above
mentioned categories Any other documents indicating the months of premium payments
to PhilHealth

How do Senior Members enroll to PhilHealth?

 There are two options to enroll as a Senior Citizen member of PhilHealth.
Via Office for the Senior Citizens Affairs
Via PhilHealth Local Health Insurance Office (LHIO)
(OSCA)

Fill out two (2) copies of the PhilHealth Fill out two (2) copies of the PhilHealth Member
Member Registration Form (PMRF); Registration Form (PMRF);

Submit duly accomplished PMRF to the
OSCA in the city or municipality where the
elderly resides
Await Member Data Record and
Identification card issued by PhilHealth
through OSCA
Attach 1 x 1 photo taken within the last six months;
Present Senior Citizens’ Identification Card issued
by the OSCA in the city or municipality where the
elderly resides or a valid government issued ID.
Submit duly accomplished PMRF

Await Member Data Record and PhilHealth

Identification Card
 Premium Contributions
o The premium contributions of those who will be enrolled under the Senior Citizen category shall be
sourced from the proceeds of Republic Act No. 10351, commonly known as the Sin Tax Law.
 Benefits
o In hospitals with installed HCI Portal, Senior Citizens only need to present their senior citizen card, MDR
or any accepted proof of identity and age. The hospital shall print a PhilHealth Benefit Eligibility Form
(PBEF). A PBEF that says “YES” means that the patient is entitled to the benefits and shall serve as a basis
for automatic deduction.
o In case the hospital has no HCI portal installed, or the PBEF says “NO”, or the senior citizen was not able
to enroll before discharge, the following should be attached to the usual claim documents:
 Duly accomplished PhilHealth Member Registration Form (PMRF); and
 An acceptable proof of status as a senior citizen, including but not limited to the Senior Citizens’
Identification Card.
How do Informal Economy Members (Individually Paying Member) enroll to PhilHealth?
If you are currently unemployed or is self-employed, you can register as an Individually Paying Member.
This is also being referred as “voluntary member” by some. To become one, you must submit the
following requirements at the Philhealth office near you.
 Visit any of the Local Health Insurance Offices or PhilHealth Express outlets nationwide.
 Fill out (2) copies of the PhilHealth Member Registration Form (PMRF)
 Submit PMRF to the LHIO or PhilHealth Express
 Await Member Data Record (MDR) and PhilHealth ID Card
 Pay the necessary premium contribution using your PhilHealth ID number
Premium Requirements
 Individually Paying Members (IPMs) earning an average monthly income of ₱25,000 and below pay ₱200
monthly or ₱2,400 per year, while those earning above ₱25,000 pay ₱300 monthly or ₱3,600 per year.
Premium contributions may be paid monthly, quarterly, semi-annually or annually.
Schedule of payment:
Monthly Quarterly Semi-annual Annual

Pay until the last Pay until the last Pay until the last Pay until the last
working day of working day of working day of working day of
the month being the quarter being the first quarter the first quarter
 Monthly Quarterly Semi-annual Annual

paid for. paid for. of the semester of the year

Example:Month: Example:Period: being paid for. being paid for.
JanuaryDeadline January to Example:Period: Example:Period
: January 31 MarchDeadline: January to : January to
March 31 JuneDeadline: DecemberDeadl
March 31 ine: March 31
How do OFWs enroll to PhilHealth?
For OFWs (Overseas Filipino Workers), you can register and pay your contributions once you register at
the POEA as an OFW:
 If currently in the Philippines, visit the nearest PhilHealth Regional Office, Local Health Insurance Office,
PhilHealth Business Center or PhilHealth Express outlet in your locality.
 If currently overseas,
o Visit any branch of PhilHealth’s accredited collecting partners iRemit and Ventaja Corporation
o Access the Electronic Registration facility and follow the step-by-step procedure
o Download the PhilHealth Member Registration Form, fill it out and email to ofp@philhealth.gov.ph
How much do you need to contribute to PhilHealth?
According to Philhealth’s 2018 contribution table, members of the formal economy (kasambahay, family
drivers, seabased OFWs) and employees of both public and private sectors will have the following
monthly premium. The contribution will be shared by both the employer and employee
Premium Contribution Table 2018

Salary Salary Range Salary Base Total Employee Employer

Bracket Monthly Share Share
Premium

1 ₱9,999.99 and n/a ₱275.00 ₱125.00 ₱125.00

below

3 ₱10,000.00 – ₱10,000.00 ₱275.00 ₱125.00 ₱125.00

₱10,999.99

4 ₱11,000.00 – ₱11,000.00 ₱302.50 ₱137.50 ₱137.50

₱11,999.99

5 ₱12,000.00 – ₱12,000.00 ₱330.00 ₱150.00 ₱150.00

₱12,999.99

6 ₱13,000.00 – ₱13,000.00 ₱357.50 ₱162.50 ₱162.50

₱13,999.99

7 ₱14,000.00 – ₱14,000.00 ₱385.00 ₱175.00 ₱175.00

₱14,999.99

8 ₱15,000.00 – ₱15,000.00 ₱412.50 ₱187.50 ₱187.50

₱15,999.99

9 ₱16,000.00 – ₱16,000.00 ₱440.00 ₱200.00 ₱200.00

₱16,999.99
10 ₱17,000.00 – ₱17,000.00 ₱467.50 ₱212.50 ₱212.50
17,999.99

11 ₱18,000.00 – ₱18,000.00 ₱495.00 ₱225.00 ₱225.00

₱18,999.99

12 ₱19,000.00 – ₱19,000.00 ₱522.50 ₱237.50 ₱237.50

₱19,999.99

13 ₱20,000.00 – ₱20,000.00 ₱550.00 ₱250.00 ₱250.00

₱20,999.99

14 ₱21,000.00 – ₱21,000.00 ₱577.50 ₱262.50 ₱262.50

₱21,999.99

15 ₱22,000.00 – ₱22,000.00 ₱605.00 ₱275.00 ₱275.00

₱22,999.99

16 ₱23,000.00 – ₱23,000.00 ₱632.50 ₱287.50 ₱287.50

₱23,999.99

17 ₱24,000.00 – ₱24,000.00 ₱660.00 ₱300.00 ₱300.00

₱24,999.99

18 ₱25,000.00 – ₱25,000.00 ₱687.50 ₱312.50 ₱312.50

₱25,999.99

19 ₱26,000.00 – ₱26,000.00 ₱715.00 ₱325.00 ₱325.00

₱26,999.99

20 ₱27,000.00 – ₱27,000.00 ₱742.50 ₱337.50 ₱337.50

₱27,999.99

21 ₱28,000.00 – ₱28,000.00 ₱770.00 ₱350.00 ₱350.00

₱28,999.99

22 ₱29,000.00 – ₱29,000.00 ₱797.50 ₱362.50 ₱362.50

₱29,999.99

23 ₱30,000.00 – ₱30,000.00 ₱825.00 ₱375.00 ₱375.00

₱30,999.99

24 ₱31,000.00 – ₱31,000.00 ₱852.50 ₱387.50 ₱387.50

₱31,999.99

25 ₱32,000.00 – ₱32,000.00 ₱880.00 ₱400.00 ₱400.00

₱32,999.99
 26 ₱33,000.00 – ₱33,000.00 ₱907.50 ₱412.50 ₱412.50
₱33,999.99

27 ₱34,000.00 – ₱34,000.00 ₱935.00 ₱425.00 ₱425.00

₱34,999.99

28 ₱35,000.0 to ₱35,000.00 ₱962.50 ₱437.50 ₱437.50

₱39,999

29 ₱40,000 and up ₱40,000 ₱1,100 ₱550.00 ₱550.00

FWs or those under the Overseas Workers’ Program (OWP) shall pay ₱2,400.00 as their annual premium
contribution to PhilHealth. This is also applicable to land-based OFWs, whether documented or
undocumented. Payments may be made in two increments (₱1,200 every six months) or a one-time
payment of the full amount amounting to ₱2,400.

PhilHealth Contribution for Self-employed, Individually Paying Members:

 Members with monthly income of ₱25,000 and below shall pay ₱2,400 per year.
 Members with monthly income above ₱25,000 shall pay ₱3,600 per year.
 Sponsored Program Members: Whether fully or partially subsidized by the sponsor, members under this
category shall pay an annual premium of ₱2,400.

What are the benefits to PhilHealth?

To maximize your PhilHealth membership, it is important for you to know the benefits that you are
entitled to, as well as the requirements you need to procure to allow you and your beneficiaries to fully
enjoy your entitlements.
First thing to know are these basic items:
 You as a member and your qualified dependents are entitled to benefits for medical expenses for every
sickness or operation.
 Both, you as a member and your legal dependents, can get equal benefits.
 Every year, there is an allocated 45 days hospitalization allowance for the member and 45 days to be
divided to all qualified dependents. Hospitalization days in excess of 45 days will not be covered by
PhilHealth.
Secondly, these benefits can be used by you as a member and your qualified dependents, provided that:
 You, as a member, have updated contributions (except Lifetime and Senior Citizen Members) or valid
PhilHealth coverage (for Sponsored, Indigent, and OFWs).
 That the hospital or clinic that you went to is PhilHealth-accredited.
 And that the allocated 45 days in a year has not yet been consumed (except for other PhilHealth benefits
such as hemodialysis)

How much can you claim on PhilHealth?

The benefits will be paid by PhilHealth in terms of Case Rates whereas every illness or operation has price
allotment to be divided to the hospital and the doctor. This way, the member can already determine how
much will be covered by PhilHealth before hospitalization.
Check the PhilHealth website to find out what the equivalent value of benefits for covered illnesses and
operations under the All Case Rates (ACR) program of PhilHealth.

How can you claim your PhilHealth benefits?

Step 1: Conditions
To be eligible to the PhilHealth benefits when hospitalized, the following conditions must be met:
 Payment of at least 3 months’ worth of premiums within the immediate 6 months of confinement. For
pregnancies, the new born care package, dialysis, chemotherapy, radiotherapy and selected surgical
procedures, 9 months’ worth of contributions in the last 12 months is needed.
 Confinement in an accredited hospital for 24 hours due to illness or disease requiring hospitalization.
Attending physician(s) must also be PhilHealth accredited.
 Claim is within the 45 days allowance for room and board.
Step 2: Required documents
You’ll also need to submit the following documents before being discharged from the hospital for
automatic deduction:
 A clear, updated copy of your Member Data Record (MDR). If you are dependent, make sure that you are
listed in the MDR.
 An original copy of PhilHealth Claim Form 1, which you can get at PhilHealth, the hospital or your
employer. Submit the original copy signed by your employer.
 Receipt of premium payments. Employees only need to submit the Certificate of Premium Payments with
OR numbers.
 Your PhilHealth ID and a valid ID.
Ask the hospital regarding their PhilHealth submission rules. If you can’t submit the claim form personally,
have an authorization letter and a valid ID ready for your representative.
Step 3: Claiming and post-claims
 As direct filing is no longer needed, submission of the documents to the hospital before the end of your
stay means automatic deduction of your benefits from your total bill.
 Once your benefits have been automatically deducted, PhilHealth will send a benefit payment notice to
the address declared in your MDR. This details the actual payments made by PhilHealth relative to your
claim or confinement.
Keeping your PhilHealth up-to-date is important, remember that updated premiums is key to enjoy your
entitlements. It is also essential for you to keep your updated premium payment receipts safe and within
easy reach for emergencies. You will definitely need them in asking the hospital billing section to deduct
your benefits from your total charges.