Healthcare is vital to protect you and your family, ensuring a better quality of life. It helps prevent diseases and provides immediate medical assistance in dangerous situations, such as pregnancy and surgery. While securing health insurance can help in such cases, not everyone can afford it. Fortunately, the Philippine government founded PhilHealth (Philippine Health Insurance Corporation) to help Filipinos suffering from sickness or any condition that requires medical attention.
Whether employed or not, PhilHealth provides help to cover unexpected medical expenses and needs. It’s a public healthcare system owned by the Philippine government, aiming to ease the financial burden by providing health benefits and medical assistance to all Filipinos, regardless of their social or employment status. With PhilHealth, Filipinos of any age can ensure access to health insurance coverage and affordable healthcare. To learn more about PhilHealth, read on as we share what it is, its functions, benefits, and application procedure.
What is PhilHealth
PhilHealth, or the Philippine Health Insurance Corporation, is a social security organization providing all Filipinos with health insurance coverage. It’s owned and operated by the Philippine government and connected to the Department of Health (DOH), funded thru contributions, premiums, and taxes. Through PhilHealth, all Filipinos can ensure access to quality healthcare and receive treatment in hospitals despite not having much money.
Aside from that, PhilHealth provides financial assistance and easy access to affordable healthcare services for every Filipino, whether a child, senior citizen, or adult. The organization launched various services, such as health insurance for indigent Filipinos, a risk equalization fund, and expanded coverage for those with pre-existing conditions. For patients medically treated or confined in private hospitals, the organization will also help cover a percentage of the total medical expenses, including the doctor’s fee.
History
Around the 1960s, the MARIA Project was launched by the Philippine Medical Association, administering medical assistance to needy communities. During the time of former President Ferdinand Marcos, he passed the Philippine Medical Care Act. As years passed, the healthcare program improved. Established thru the National Health Insurance Act of 1995, PhilHealth shoulders the obligations of its predecessor, the Medicare Program.
In 2019, former President Rodrigo Duterte signed the Universal Health Care Act (UHC Act), ensuring all Filipinos and Overseas Filipino Workers (OFWs) have access to quality and affordable healthcare without financial burden. In addition, UHC Act prioritizes Filipinos who can’t afford medical services. As of 2021, PhilHealth has over 50 million members and over 42 million dependents who can access medical assistance.
PhilHealth Benefits & Services
To ensure Filipinos have access to a comprehensive set of healthcare insurance, PhilHealth provides the following benefits and services:
Inpatient Benefits
This benefit is a case rate/fixed amount PhilHealth will pay to an authorized Health Care Institution (HCI), which aims to cover medical expenses, such as diagnostic/therapeutic process, medicines, patient room, and professional fees. It’s accessible to members confined in hospitals and available at PhilHealth-accredited HCI. Before discharge, the case rate amount is deducted from the member’s total bill.
Outpatient Benefits
With Outpatient benefits, members will receive help in treatments and procedures that don’t require hospital confinement. It includes support for radiotherapy, surgeries, hemodialysis, and outpatient blood transfusion. It’s available at accredited primary care facilities, HCIs, and ambulatory surgical clinics (AASC).
Z Benefits
Z Benefits assist members and dependents suffering from extreme conditions that require hospitalization and high-cost treatments, such as but not limited to kidney transplants, certain orthopedic implants, and cancer (breast, cervical, prostate).
SDG-related Benefits
Under the United Nations Sustainable Development Goals (SDG), PhilHealth launched medical packages to help members diagnosed with or receiving treatment for the following:
- Animal Bite Treatment Package – P3,000
- Outpatient Anti-Tuberculosis Treatment via Directly-Observed Treatment Short-course (DOTS) package – P4,000
- Outpatient HIV-AIDS Package – P30,000 per annum (P7,500/quarter)
- Outpatient Malaria Package – P600
- Voluntary Surgical Contraception Procedures – P4,000
Maternity Benefits
Maternity benefits are also accessible to expectant mothers PhilHealth members, given their contributions are updated. Here are the following benefits PhilHealth offers to pregnant women members:
- Antenatal Care Package – refers to prenatal check-ups, including ultrasounds and laboratory tests.
- Normal Spontaneous Delivery Package – coverage provided to pregnant women members with normal, low-risk vaginal deliveries, such as postnatal check-ups three (3) to seven (7) days after delivery.
- Other Delivery Methods – PhilHealth also provides insurance coverage for breech extraction, Cesarean, vaginal delivery after C-section, and complex vaginal delivery with/without episiotomy or forceps.
- Newborn Care Package – provides coverage for newborn screening ang hearing tests, and essential newborn care, such as prompt skin-to-skin contact, weighing or drying the baby.
But note that the Maternity benefits packages only apply for the member’s first four normal deliveries. Therefore, PhilHealth will no longer provide insurance for the following childbirths. These packages are available at PhilHealth-accredited hospitals and non-hospital facilities.
Mental Health Services
As of writing, PhilHealth is currently working with DOH. So they can provide mental health services in their healthcare packages, especially for outpatients. You can visit this link for more details on PhilHealth benefits.
PhilHealth Online Services
With PhilHealth’s website, members can now check their contributions, update their personal data, and see claims and availments anytime and anywhere. Below are the online services PhilHealth members can use 24/7:
- Case Rate Research – members can check the details of PhilHealth benefit packages.
- Claims Eligibility Checking – a feature designed for providers, allowing them to determine if the member is eligible for certain benefits.
- Electronic Collection Reporting System – enables Organized Groups to register and receive billing.
- Electronic Group Enrollment System – enables employers to pay their premium contributions online.
- Health Care Institutions – a list of HCIs with their accreditation status
- Membership Portal – allows members to review their membership details accurately.
How to Become a PhilHealth Member
Types of PhilHealth Membership
Employed Filipino citizens are automatic members of PhilHealth since their employers should process their membership and pay their regular contributions. But anyone can apply for PhilHealth membership, including:
1. Formal Economy Members
Formal economy members refer to all government or private sector employees with offices in the Philippines. Also, seafarers fall under this category, given their agencies are in the country. The monthly contributions for these members start at 3%, and the employer and employee should each pay half of the premium.
2. Informal Economy Members
This membership category pertains to self-employed, unemployed, and informal workers, like construction workers or market vendors. Informal economy members should be naturalized Filipinos and foreigners residing in the country who voluntarily or individually pay their premiums. These members pay their full premium with monthly contributions starting at 3%.
3. Overseas Filipino Workers (OFWs)
As stated earlier, sea-based OFWs fall under the formal economy membership due to their employee-employer relationship. But other OFWs can pay their contributions every 3, 6, or 12 months.
4. Senior Citizens
Senior Citizens refers to Filipinos who are 60 years old and above. They don’t fall into any membership category since they’re considered automatic PhilHealth members according to the Universal Health Care Law of 2019. The national government will cover their annual premiums. You can register via PhilHealth Local Health Insurance Office (LHIO) or Office for the Senior Citizens Affairs (OSCA).
5. Qualified Dependents
This membership category refers to qualified dependents of a principal member, as they should cover their contributions. Qualified dependents can be the principal member’s legal spouse, children, or parents in the contributor’s PhilHealth Member Data Record (MDR).
6. Lifetime Members
Lifetime members pertain to those 60 years old and above who have paid at least 120 monthly premiums with the previous Medicare Program and PhilHealth. Once they turn 60, their PhilHealth membership is free.
7. Sponsored Members
Under this category, an individual is sponsored member if a sponsor, such as a private entity, government/private agency, or local government, pays their contributions. Also, this category includes low-income citizens who aren’t indigents, like unenrolled pregnant women, persons with disabilities (PWDs), nutrition scholars, barangay health workers, and volunteers.
8. Indigent Members
Indigent members refer to individuals without a source of income or inadequate household earnings according to the Department of Social Welfare and Development (DSWD) criteria. If identified as indigents, they’ll become registered PhilHealth members.
How to Apply for PhilHealth Membership
Via PhilHealth Office
For Newly Hired Employees (Formal Economy)
- Fill out two (2) copies of the PhilHealth Member Registration Form (PMRF).
- Submit the PMRF to your employer or company’s HR department.
- Then, wait for your Member Data Record and PhilHealth ID card from your employer.
For Self-Employed and Voluntary (Informal Economy)
- Visit the nearest PhilHealth branch or Local Health Insurance Offices (LHIO).
- Fill out two (2) copies of the PhilHealth Member Registration Form (PMRF).
- Submit the PMRF to PhilHealth or LHIO.
- Wait for the release of your Member Data Record and PhilHealth ID card.
- Then, use your PhilHealth ID number to pay the premium contribution.
Via Online Registration
Aside from that, PhilHealth has an Electronic Registration System where you can register for membership online at https://eregister.philhealth.gov.ph/. But it’s still under maintenance, so you can only register for membership on-site at the nearest PhilHealth office.
Summary
Considering not all have savings or health insurance, the coverage PhilHealth provides will surely benefit a lot of Filipinos. Although many don’t give importance to health insurance, it’s essential and should be a priority. As the Philippine government provides affordable health insurance coverage, all Filipinos are encouraged to apply for PhilHealth membership to protect themself, their family, and their future. That’s why if you don’t have insurance yet, whether a student, unemployed, or self-employed, head to the nearest PhilHealth office to apply for membership.
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