Are You Aware of These Updates to PhilHealth Benefits?

January 22, 2018 | Posted by: Venus Zoleta | Government Services

January 22, 2018

philhealth benefits
Occasionally, PhilHealth makes some changes to its coverage policies, benefits packages, and membership requirements. It’s important to keep yourself updated on these changes, so you can plan your budget accordingly and maximize your PhilHealth benefits.

Here are some of the latest updates to PhilHealth benefits, contributions, and coverage that you might not know about.

1. Higher PhilHealth Contributions

Starting January 2018, the PhilHealth premium contributions will slightly increase for all government and private-sector employees, sea-based overseas Filipino workers, household helpers, and other formal economy members.

The new PhilHealth contribution rate will be 2.75%, which is 0.25% higher than the previous 2.50% rate.
PhilHealth also adjusted the lowest and highest monthly salary brackets. The lowest bracket (previously at PHP 8,999.99) is now at PHP 10,000, while the highest bracket (previously at PHP 35,000) is now at PHP 40,000.

The employee and the employer will still equally share the monthly PhilHealth contribution. For kasambahays earning less than PHP 5,000, the employer will be the one to pay the premium contributions. Kasambahays with a higher monthly salary will have to pay their share.

These changes mean that the monthly premium contribution of workers with a monthly basic pay of PHP 10,000 and below will increase from PHP 250 to PHP 275. Half of the amount (PHP 137.50) will be deducted from the employee’s salary, and the other half will be paid by the employer.

For workers receiving a monthly basic salary of PHP 40,000 and above, the premium will increase from PHP 1,000 to PHP 1,100 (PHP 550 employee share and employer share).

Below is the PhilHealth contribution table that summarizes the computation of monthly premiums:

Updated PhilHealth Premium Contributions
Monthly basic salaryMonthly premiumEmployee shareEmployer share
PHP 10,000.00 and belowPHP 275.00PHP 137.50PHP 137.50
PHP 10,000.01 to PHP 39,999.99PHP 275.02 to PHP 1,099.99PHP 137.51 to PHP 549.99PHP 137.51 to PHP 549.99
PHP 40,000.00 and abovePHP 1,100.00PHP 550.00PHP 550.00

2. Lifting of Length-of-Stay Requirement for Pneumonia, Acute Gastroenteritis, and UTI Patients

philhealth benefits

Instagram photo by @nutypreeeyang_03

If you (or your dependent) are admitted due to pneumonia, acute gastroenteritis, or urinary tract infection (UTI), PhilHealth will reimburse your confinement fees regardless of how long you have stayed at the hospital.

This is based on PhilHealth’s latest circular that removes the length-of-stay requirement for reimbursing claims for those three common diseases.

Prior to that, PhilHealth did not reimburse confinement expenses of patients who failed to meet the minimum length-of-stay requirement. Pneumonia patients confined for less than 4 days were not covered. For acute gastroenteritis and UTI patients, they could file reimbursement claims if they were admitted for at least 3 days and 96 hours, respectively.

3. PhilHealth Coverage Extended to Foreigners and Dual Citizens

philhealth benefits
Expats and foreign retirees in the Philippines, as well as Filipinos with dual citizenship, may now avail of PhilHealth benefits.

PhilHealth coverage for foreigners and dual citizens

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, Pinoys 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 3 monthly PhilHealth contributions within 6 months before availment.

PhilHealth requirements for membership

For foreign retirees:

For foreigners living or working in the Philippines:

  • Valid Alien Certificate of Registration Identity Card (ACR I-Card) issued by the Bureau of Immigration
  • Valid working permit
  • Accomplished PMRF for Foreign Nationals that must be submitted to any Local Health Insurance Office

For Filipinos with dual citizenship:

  • Accomplished PMRF
  • Certificate of Re-acquisition/Retention of Philippine Citizenship (CRPC)
  • Identification Certificate (IC) issued by the Philippine Embassy or Philippine Consulate abroad or by the Bureau of Immigration

Annual PhilHealth premium contributions

  • Foreign retirees: PHP 15,000
  • Expats: PHP 17,000
  • Dual citizens: PHP 3,600

4. Z Benefits for Premature and Small Newborns

philhealth benefits
Apart from maternity benefits for pregnant women and newborns, PhilHealth also provides benefit packages for premature babies and pregnant mothers who are at risk of premature delivery.

Who are covered?

  • PhilHealth members who are 24 to 36 and 6/7 weeks pregnant and at risk of premature birth
  • Premature newborns who are very small (500g to 2,499g fetal weight) at 24 weeks to less than 37 weeks (fetal age)

Z benefit packages and rates

  • Prevention of premature delivery: ranging from PHP 600 to PHP 4,000
  • Benefit packages for premature newborns with fetal age of 24 weeks to less than 32 weeks: ranging from PHP 35,000 to PHP 135,000
  • Benefit packages for premature newborns with fetal age of 32 weeks to less than 37 weeks: ranging from PHP 24,000 to PHP 71,000

The health care facility shall file the reimbursement claim on behalf of the mother or baby within 30 calendar days upon discharge. PhilHealth does not accept Z benefit claims filed directly by members.

Final Thoughts

To further improve its services, PhilHealth updates its policies and benefits packages from time to time. As a Filipino or foreigner living in the Philippines, it pays to stay up-to-date to maximize your PhilHealth benefits.

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