WELCOME

PARTICIPANTS!
 PhilHealth Orientation
I. Orientation Proper
 National Health Insurance Program

 Membership & Contribution

 Benefits
II. Open Forum
PhilHealth
(Philippine Health Insurance Corporation)

 Administrator of the NHIP

 Social Health Insurance (Draws
inspiration from the concept of
Social Solidarity or ‘bayanihan’)
 Government-Owned & Controlled
Corporation (GOCC)
 Offshoot of Medicare
PhilHealth Vision and Mission

VISION

Bawat Filipino, MIYEMBRO

Bawat Miyembro, PROTEKTADO.
Kalusugan ng Lahat, SEGURADO

MISSION

Benepisyong Pangkalusugang Sapat

At De-kalidad para sa Lahat
Membership classification
I. Formal Economy
 Government employees
 Private employees
 All other workers rendering services, whether in
government or private offices
 Owners of micro enterprises
 Owners of small, medium and large enterprises
 Household helpers
 Family Drivers
II. Informal Economy

 Migrant workers (Land based)

 Informal sector (Market Vendor, Pedicab/tricycle
drivers, etc…)
 Self-Earning individuals (Doctors, Dentist,
Lawyers, etc…)
 Filipinos with dual citizenship
 Naturalized Filipino citizens
 Citizens of other countries and / or residing in the
Philippines
 Organized Groups (Cooperatives…)
III. Sponsored Program
 Sponsored by private or government such as local
government unit (LGU)
 By means test rule of the DSWD

 Orphans, abandoned minors, out-of-school youths,

street children, PWDs, battered women under DSWD
custody

 Women about to give birth (as determined by

DSWD), Barangay health workers, nutrition scholars,
etc.
IV. Indigent Program
NHTS-PR or National Household
Targeting System-Poverty Reduction

 Identified by the DSWD through a means test

 Subsidized by the National Government

V. Lifetime Membership Program

Qualifications:
 Not an active member
 Aged 60 years old and above
 accumulated at least 120
months contributions
Requirements:
 PMRF
 Copy of 2 valid ID’s
 2 pcs. 1x1 photo
 Proof of 120 months contributions
VI. Senior Citizen Program

Qualifications:
 Filipino Citizens
 Aged 60 years old and above
 Not currently covered by any
membership category of Philhealth
Requirements:
 PMRF
 Senior citizens ID or valid
government issued ID
PhilHealth Membership Registration Form
 PhilHealth Number Cards

MEMBERSHIP IDENTIFICATION

-01-237456120-3
-
PHILHEALTH NUMBER

JUAN A. DELA CRUZ

Formal, Informal Economy & Senior Citizen
NAME

SIGNATURE
SOUTH SUPERBAYANI, AYALA
-
ALABANG, MOUNTAIN CITY
ADDRESS

LIFETIME
LIFETIME
MEMBER
MEMBER

Lifetime Membership Program

Indigents & Sponsored Program

(with validity date)
 Legal Dependents

Legal Spouse
Who is not yet a member

Children
• 20 years old and below
Parents - unmarried & unemployed
• 60 years old and above - legitimate, illegitimate,
• Parents with permanent legitimated
disability, regardless of - adopted, stepchildren
age, thus fully dependent - foster child
on member • 21 years old and above
with total disability
(congenital/acquired)
 Premium Contributions

MEMBERSHIP CATEGORY PREMIUM

CONTRIBUTIONS
1. Formal Economy Refer to PC 24, s-2017
2. Informal Economy Php2,400/year;
(self-earning individuals) Php3,600/year
3. Sponsored Program 2,400/year *
4. Indigent Program 2,400/year *
5. Senior Citizen Program 2,400/year *
6. Lifetime Member Program NO CONTRIBUTIONS

Legend (*)- Subsidized by the government

Premium Contributions (Employed)

Legend (*)- Minimum of Php 10,000 monthly salary bracket and in accordance
with Premium Schedule issued by Philhealth (i.e., PC 24, s- 2017)
Principal Member
+ All Qualified
Dependents

For the price

of one!
PAYMENT CENTERS
PHILHEALTH
LOCAL HEALTH INSURANCE OFFICES

ACCREDITED COLLECTING BANKS

CIS BAYAD CENTERS

MLHUILLIER PAWNSHOPS

POST OFFICES

SM RETAIL, INC.

LBC EXPRESS, INC.

 BENEFIT
AVAILMENT
General Rules on PhilHealth Benefits

HOSPITAL ACCREDITED

AT LEAST 24 HOUR CONFINEMENT

45 DAYS MEMBER
45 DAYS DEPENDENTS
For one calendar year
 Entitlements to PhilHealth Benefits
Members and their dependents are entitled to avail
of the benefits if:
Employed, Self-employed, Paid at least 9 months premium
Professionals, Sea-Based contributions within immediate 12
OFWs, Voluntary months prior to the first day of
confinement

Land-based OFWs Within validity period of premium

payments

Sponsored/Indigent Within validity period of membership

Senior Citizens Automatic PhilHealth coverage

(not gainfully employed)

Lifetime Lifetime coverage

CASE PAYMENTS
A. Medical Cases B. Surgical Cases
Dengue 1 P10,000 Radiotherapy P 3,000
Dengue 2 P16,000 Cesarean Section P19,000
Pneumonia 1 P15,000 Appendectomy P24,000
Pneumonia 2 P32,000 Cholesystectomy P31,000
Essential HPN P 9,000 Dilatation & P11,000
Curettage
CVA 1 P28,000
Thyroidectomy P31,000
CVA 2 P38,000
Herniorrhapy P21,000
Acute Gastro P 6,000
Enteritis (AGE) Mastectomy P 22,000
Typhoid Fever P10,000 Hsyterectomy P30,000

Cataract Extraction P16,000

(1 day interval)
Special Benefit Packages
Case Rates
1. Normal Spontaneous Delivery Package P 6,500
2. Maternity Care Package P 8,000
3. Newborn Care Package/Enhanced NCP P 1,750/P2,950
4. Voluntary Surgical Contraception P 4,000
5. Tuberculosis Treatment thru DOTS P 4,000
6. Animal Bite Treatment Package P 3,000
7. Outpatient Malaria Package P 600

8. Outpatient HIV/AIDS Treatment (OHAT) Package P7,500/quarter

Latest Updates
Coverage for:

Women About to Give Birth

Senior Citizens

All senior citizens shall be covered

by the national health insurance
program of PhilHealth
Latest Updates
Benefits for:

Hemodialysis – Php 2,600/session

Hemodialysis Sessions Per Year

45 days
45 days 90 days
How to avail the benefits:
For confinements within the country

FOR AUTOMATIC DEDUCTION

(SUBMIT TO BILLING SECTION OF HOSPITAL)
1. Properly Filled-out Claim Signature Form
2. Copy of MDR
3. Proof of premium payment (for informal
economy)

NO DIRECT
FILING
How to avail or file for reimbursement:
For confinements Abroad
DIRECT REIMBURSEMENT ONLY

1. Properly Filled-out Claim Form 1/CSF

2. Copy of MDR
3. Proof of premium payment/contributions
4. Statement of Account with Itemized Charges and/or Official
Receipts
5. Medical Certificate/Abstract with Final Diagnosis, period of
confinement & services rendered (with English Translation)

180 days
PhilHealth Claim Forms
How to avail the benefits:
For confinements within the country
Latest Updates
“PhilHealth ACR Search” Mobile Application
BENEFITS PAYMENT NOTICE

BPN
 written notice sent to
members who availed
themselves of the
benefits
 shows the details of
the benefits computed
(i.e. benefits received by
the member, hospital,
doctors)
PhilHealth NCR BRANCHES
NCR-SOUTH NCR-NORTH NCR-CENTRAL
1. LHIO PASIG 1. LHIO MANILA 1. LHIO QUEZON CITY
G/F Iriz One Bldg., Meralco Ave., 1810 JARS Bldg. Corporate 145, Mother
Pasig JPLaurelSt., San Miguel,
Ignacia St.,Quezon City
2. LHIO MAKATI Sampaloc, Manila
2. LHIO CALOOCAN 2. LHIO RIZAL
ITC Bldg., 337 Sen. Gil Puyat
5th/F Victory Central Fibertex Bldg., Don
Ave., Makati City
Mall, Caloocan City Mariano Subd. Cor Ortigas
3. LHIO LAS PIÑAS 3.LHIO MANDALUYONG Ext, Cainta, Rizal
471 Alabang-Zapote Rd., 3/F, 500 Shaw Zentrum
Almanza Uno, Las Piñas Mall, Shaw Blvd., 3. LHIO FAIRVIEW
Mandaluyong City Our Workshop Sales(OWS)
4. BUSINESS CENTER-BGC 4.POEA – POEA Bldg., Building, Lot 19 Block 237
7TH F/ SM Aura Tower, Ortigas Ave.Mandaluyong City
Neopolitan 4, Britanny
BGC Taguig City 5. LHIO Valenzuela Subd. Barangay Pasong
5. LHIO PARAÑAQUE 6/F Puregold, Paso De Putik, Quezon City
G/F HRDC Bldg. Km 16, South SuperHiway Blas Rd., Valenzuela
cor Severenia Industrial Estate, West
Service Rd., Brgy. Marcelo, Paranaque
City
Philhealth Communication Channels
WEBSITE
www.philhealth.gov.ph
EMAIL ADDRESS
actioncenter@philhealth.gov.ph
TWITTER ACCOUNT
Teamphilhealth
FACEBOOK ACCOUNT
www.facebook.com/Philhealth
YOU TUBE ACCOUNT
www.youtube.com/teamphilhealth
SMS HOTLINE NUMBER
0917-898-7442
Concept of Social Health Insurance

Social Solidarity or “Bayanihan”, where:

• The rich subsidizes the poor

• The young subsidizes the old
• The healthy subsidizes the sickly
THANK YOU!!!