Published: October 9, 2020 | Updated: December 17, 2020 | Posted by: Moneymax | Government Services
Unexpected expenses, like a sudden hospitalization, can put a huge dent on your savings. Fortunately, there are PhilHealth benefits we can take advantage of. The Philippine Health Insurance Corporation or PhilHealth is a government agency mandated to financially help Filipinos with their medical needs. As of 2015, about 88% of the country’s population are contributing members of the agency[1]. Members and their qualified dependents can avail of PhilHealth benefits as long as they meet the eligibility criteria.
Keep on reading to know more about PhilHealth and the benefits you can get as a member.
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Established in 1995, PhilHealth aims to financially help Filipinos with their medical expenses. Contributions made by members and funding from both local and national governments enable PhilHealth to operate and aid its contributing members.
The government requires all employees to become PhilHealth members. Self-employed individuals (also called voluntary members) can also apply.
PhilHealth works like an insurance company, except that it is mandated by the government. The agency can help cover your medical bills or parts of it. However, there are eligibility requirements you must meet before you can enjoy PhilHealth benefits.
Read more: A Complete Guide to PhilHealth Voluntary Membership Registration
PhilHealth subsidizes your hospital bills based on the amount you have incurred. The agency typically pay parts of doctor’s professional fees, laboratory tests, and other medical costs.
If you are admitted to a hospital to receive care, you can get PhilHealth benefits. Part of your total bill will be shouldered by the agency, as long as the hospital where you were admitted is a PhilHealth partner.
If you need medical care but do not need to be admitted, you can still benefit from PhilHealth. The agency can cover part or the entire cost of your day surgery, hemodialysis, radiotherapy, and other primary care. Doctor consultation is also covered as PhilHealth benefits for outpatients.
Treatment for leukemia, prostate cancer, breast cancer, and cervical cancer is also covered by PhilHealth. However, the agency doesn’t cover the entire amount of the treatment and you have to go to a PhilHealth partner hospital to get Z benefits.
Animal bite, HIV-AIDs, outpatient anti-tuberculosis treatment are covered by PhilHealth’s SDG-related benefits. Just like its other cluster of benefits, PhilHealth should part of your treatment costs.
For a more complete list of PhilHealth benefits, click here.
Expats and foreign retirees in the Philippines, as well as Filipinos with dual citizenship, may now avail of PhilHealth benefits.
Foreigners and their qualified dependents can enjoy inpatient and outpatient benefits in any PhilHealth-accredited hospital or clinic in the Philippines. However, they cannot avail of the Z benefit packages and PhilHealth benefits for women who are about to give birth. They also cannot make reimbursement claims for hospital confinements abroad.
On the other hand, Filipinos with dual citizenship and their qualified dependents can have all PhilHealth benefits in accredited healthcare facilities nationwide and abroad. To qualify for benefits, they must pay at least three monthly PhilHealth contributions within six months before ailment.
Photo from philhealth.gov.ph
To apply as a PhilHealth member, you have to prepare these requirements first.
Read more: Simple Steps to Getting a PhilHealth ID
Your PhilHealth contribution depends on your monthly salary and your type of employment. Half of your monthly premium is paid by your employer, while the rest is deducted from your salary.
Here is the PhilHealth contribution table for members of the formal economy (kasambahay, sea-based OFWs, family drivers, etc.) and employees of public and private sectors:
Basic Monthly Salary | Premium Rate | Monthly Contribution |
---|---|---|
PHP 10,00 | 3.5% | PHP 300 |
PHP 10,00 to PHP 59,999 | 3% | PHP 300 to PHP 1,800 |
PHP 60,000 | 3% | PHP 1,800 |
Basic Monthly Salary | Premium Rate | Monthly Contribution |
---|---|---|
PHP 10,00 | 3% | PHP 350 |
PHP 10,00 to PHP 69,999 | 3% | PHP 350 to PHP 2,450 |
PHP 70,000 | 3% | PHP 2,450 |
Basic Monthly Salary | Premium Rate | Monthly Contribution |
---|---|---|
PHP 10,00 | 4% | PHP 400 |
PHP 10,00 to PHP 79,999 | 4% | PHP 400 to PHP 3,200 |
PHP 80,000 | 4% | PHP 3,200 |
Basic Monthly Salary | Premium Rate | Monthly Contribution |
---|---|---|
PHP 10,00 | 4.5% | PHP 450 |
PHP 10,00 to PHP 89,999 | 4.5% | PHP 450 to PHP 4,050 |
PHP 80,000 | 4% | PHP 3,200 |
Basic Monthly Salary | Premium Rate | Monthly Contribution |
---|---|---|
PHP 10,00 | 5% | PHP 500 |
PHP 10,00 to PHP 99,999 | 5% | PHP 500 to PHP 5,000 |
PHP 100,000 | 5% | PHP 5,000 |
If you are a voluntary PhilHealth member, your monthly premium depends on your monthly salary. However, the payment is done annually and in the full amount.
PhilHealth members who have at least three months of contribution within the immediate six months before their confinement are eligible for the benefits. Your qualified dependents can also take advantage of the abovementioned PhilHealth benefits.
To apply for such benefits, you need the following documents:
Submit the documents to your PhilHealth partner hospital before being discharged so that they can already deduct PhilHealth’s subsidy to your total medical bill.
Hospitalization can cost upwards of PHP 25,000, and paying out of pocket is your only option if you don’t have insurance. PhilHealth, or the Phillippine Health Insurance Corporation, provides PhilHealth benefits to all employed members.
As a member, you’re entitled to health and hospitalization subsidies for you or any dependents you have enrolled. As of 2014, hospitalized members need not directly file their claims.
Here’s how you can claim your PhilHealth benefits:
To be eligible to avail of your PhilHealth benefits when hospitalized, the following conditions must be met:
You’ll also need to submit the following documents before being discharged from the hospital for automatic deduction:
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.
The PhilHealth Claim Form 1 (CF1) is divided into two parts. Here’s an overview to guide you when answering the form:
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 hospital 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, as it’ll be a great help if you or anyone declared as your dependent requires hospitalization.
You can avail of PhilHealth benefits anytime of the year as long as you fulfill the contribution requirements and benefit eligibility criteria discussed above.
The agency covers part or all of your medical costs, but it depends on the medical case. For a list of medical rates covered by PhilHealth, click here.
The following are qualified dependents:
To avail of PhilHealth benefits, you must have at least three months of contribution within the immediate six months before your dependent is confined. Claiming of benefits and its requirements are the same.
Unfortunately, MRI is not covered by PhilHealth since it’s a diagnostic procedure.
Yes, CT scan can be covered by the agency.
PhilHealth members who are 24 to 36 weeks pregnant and at risk of premature birth are covered by PhilHealth. Additionally, premature newborns who are very small (500g to 2,499g fetal weight) at 24 weeks to less than 37 weeks (fetal age) are also covered by the agency.
Read more:
Yes, they can. Senior citizens can enroll by visiting the Office for the Senior Citizens Affairs or through a Local Health Insurance Office.
Senior citizen premiums are sourced from the proceed of the Sin Tax Law. This means they do not have to pay for monthly contributions.
The agency doesn’t shoulder part of the cost of the following:
Knowing the benefits you can get by being a PhilHealth member can help minimize your medical expenses. Your qualified dependents can also enjoy the same PhilHealth benefits you have. If you are a foreign or dual citizen, you can still get these benefits. Make sure to be on top of your contribution to avoid any inconvenience when claiming your benefits.
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