One of the busiest offices among the various government agencies, the Philippine Health Insurance Corporation (PhilHealth), is a government-owned and controlled corporation (GOCC) meant to provide health insurance coverage and ensure affordable, acceptable, and accessible healthcare services for all Filipino citizens.
Also Read: What is DOLE? Department of Labor and Employment Philippines
PhilHealth is also known as the Philippines’ National Health Insurance Program—a program established to 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 is a universal social security institution meant to ensure that all Filipinos, regardless of status, have access to quality health care. To learn more about how you too can enjoy these benefits from PhilHealth, then keep reading this guide.
What is PhilHealth
PhilHealth, otherwise known as the Philippine Health Insurance Corporation (PHIC), is the government-run version of a national health insurance program in the Philippines. It is funded mostly through taxes, premiums, and other contributions, and is meant to offer programs and services related to health and hospitalization so that all Filipinos can enjoy equal access to quality health care.
PhilHealth History
PhilHealth started out as a simple MARIA Project—a project introduced by the Philippine Medical Association in the early ’60s in an attempt to offer aid and medical assistance to communities in need. In 1969, the Republic Act 6111 (Philippine Medical Care Act of 1969) was signed into law, creating the Philippine Medical Care Commission (PMCC)—a commission tasked to oversee and implement a medical care plan for the entire Philippines.
In the ’90s, the public called for a better, more responsive government health care program, leading to the development and passage of several bills including House Bill 14225 and Senate Bill 01738 which later became The National Health Insurance Act of 1995 (Republic Act 7875). This law paved the way for the creation of the Philippine Health Insurance Corporation (PhilHealth)—an agency mandated to provide social health insurance coverage to all Filipinos within 15 years’ time.
In October 1997, PhilHealth assumed the administration of the former Medicare program for government and private sector employees from the Government Service Insurance System (GSIS). It did the same for employees who are members of the Social Security System in April 1998 and from the Overseas Workers Welfare Administration in March 2005.
Mandate
PhilHealth was established to offer affordable and accessible health insurance coverage for all Filipinos. Originally consist of Programs I and II or Medicare, PhilHealth has since expanded into becoming the universal health insurance program for all. Under the program, PhilHealth will become a system of funds—from the constitution to the collection, management, and disbursement of financial assistance for the basic minimum and other supplementary packages of health services. The agency offers programs that pay for utilization of services, but not for providing health care directly, buying and dispensing drugs and pharmaceuticals, employing physicians and other professionals for the purpose of directly rendering care, and owning or investing in health care facilities.
PhilHealth Powers and Functions
PhilHealth is a tax-exempt GOCC attached to the DOH for policy coordination and guidance. It was mandated by law to have the following powers and functions:
- To establish branch offices for the administration, collection, deposit, investment, administration, and disbursement of the National Health Insurance Fund of the National Health Insurance Program;
- To formulate and promulgate policies for the sound administration and guidelines for contributions and benefits, cost containment and quality assurance; and health care provider arrangements for the Program;
- To supervise, manage, and regulate the provision and appropriation of health benefits, including grants, donations, and other forms of assistance;
- To negotiate and sign 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;
- To authorize Local Health Insurance Offices (LHIO) to negotiate and enter into contracts in the name and on behalf of PhilHealth with any accredited government or private sector health provider organization;
- To determine requirements and issue guidelines for the accreditation of health care providers for the Program in accordance with this Act;
- To visit, enter, and inspect facilities of health care providers and employers and 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;
- To audit, report, and submit such report to the President of the Philippines and to both Houses of Congress regarding the status, activities, and implementation of the National Health Insurance Fund, and publish a synopsis in two (2) newspapers of general circulation;
- To keep records and establish an online database of the members, operations, and investments of the National Health Insurance Fund and its services;
- To establish an office, designate a focal person, and invest in the acceleration of PhilHealth’s healthcare and information campaign, delivery, and technology systems, particularly in far-flung areas;
- To monitor compliance and mandate the national agencies and LGUs to to require proof of PhilHealth membership before doing business with a private individual or group,independent pharmacies and retail drug outlets;
- To impose interest and/or surcharges of not exceeding three percent (3%) per month in case of delay in remittance of contributions regardless of the amount involved;
PhilHealth Vision, Mission, and Core Values
Vision
The agency operates with the goal of being the agency to provide all Filipinos, particularly the PhilHealth members, with the protection of subsidized health care service.
“Bawat Filipino, Miyembro, Bawat Miyembro, Protektado, Kalusugan ng Lahat, Segurado”
Mission
The agency’s objective is and will always be to offer quality healthcare services for all.
“Benepisyong Pangkalusugang Sapat at De-kalidad para sa Lahat”
Core Values
The agency lives by the the following core values:
- Integrity
- Innovation
- Immediate Service
- Heartfelt Service
- Concern
- Rightful Service
- Community Ties
PhilHealth Benefits for Members
As an agency, one of the main objectives of PhilHealth is to ensure that all Filipinos have access to quality health care. To achieve this, they offer a number of comprehensive health care services—from the very basic primary care to even the most catastrophic packages—to the members and their beneficiaries. These also include provision for health insurance coverage of indigent Filipinos, expansion of the coverage of pre-existing conditions, and establishment of a risk equalization fund.
Some of these benefits include:
Inpatient Benefits
Inpatient benefits refer to the benefits deducted to the total bill of the members whose medical conditions are treated in accredited Health Care Institution (HCI). The case rate amount is inclusive of hospital charges as well as the professional fees of attending physicians.
Outpatient Benefits
Outpatient benefits for PhilHealth members include payment for the following procedures:
- Day Surgeries (Ambulatory Or Outpatient Surgeries) including 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.
- Multiple radiotherapy procedures amounting to Php2,000.00 per session (for cobalt radiotherapy) and Php3,000.00 (for linear accelerator) for a maximum of 45-day benefit limit.
- Multiple sessions of hemodialysis procedures amounting to Php2,600.00 for both inpatient and outpatient procedures, including emergency dialysis procedures for acute renal failure within a maximum of 90-day benefit limit.
- Outpatient blood transfusion for a 45-day limit amounting to Php3,640.00 per case rate for up to second case rate or equivalent to one day or one session of transfusion of any blood or blood product, regardless of the number of bags transfused.
Z Benefits
Under PhilHealth’s Z Benefits, members are entitled to the following support:
- Up to Php500,000.00 for those diagnosed with Acute Lymphocytic or Lymphoblastic Leukemia, except for those with mature B-cell ALL or Burkitt leukemia
- Php100,000.00 for those with stage 0 to IIIA Breast Cancer
- Up to Php100,000.00 for those diagnosed with low to intermediate risk Prostate Cancer, provided that the kember does not have uncontrolled co-morbid conditions
- Up to Php600,000.00 for those with low risk end-stage renal disease eligible for kidney transplantation, provided that they satisfy the following conditions:
- Has an irreversible renal disease that has been progressive for over 6 – 12 months
- Has a measured (nuclear scan) glomerular filtration rate, 24-hour urine creatinine clearance or calculated glomerular filtration rate of
- less than 20 ml/min/1.73m2 in diabetics
- less than 15 ml/min / 1.73m2 in patients with non-diabetic renal disease
- Has past Panel Reactive Antibody (PRA) of less than or equal to 20%
- Has not had any previous solid organ transplant
- Does not have any donor-specific antibody (DSA)
- Has at least 1 HLA-DR match
- Has no previous history of cancer (except basal cell skin cancer)
- Is HIV negative
- Is Hepatitis B surface antigen negative
- Is Hepatitis C antibody negative
- Does not have any of the following:
- Congestive heart failure Class 3-4
- Liver cirrhosis (findings of small liver with coarse granular/heterogenous echo pattern with signs of portal hypertension)
- Chronic lung disease requiring oxygen, etc)
- Hemi-paralysis because of stroke
- Leg amputation because of peripheral vascular disease or diabetes
- History of mental retardation such that informed consent cannot be made
- History of substance abuse for at least 6 months prior to the start of transplant work-up.
- Can maintain anti-rejection medicines for the next three (3) years.
Sustainable Development Goal (SDG) Related
PhilHealth members are also qualified to enjoy these benefits:
- For patients diagnosed with malaria: Up to Php600.00 to pay for Outpatient Malaria Package, including:
- Diagnostic malaria smears and other laboratory procedures;
- Drugs and medicines
- Consultation services
- Patient education & counseling
- For HIV-AIDS patients confirmed by STD/AIDS Central Cooperative Laboratory (SACCL) or Research Institute for Tropical Medicine (RITM): Up to Php30,000.00 per year or Php7,500.00 per quarter for Outpatient HIV-AIDS Package
- For adults and children with TB cases that are susceptible to 1st line anti-TB drugs: Php4,000.00 to be spent for Directly-Observed Treatment Short-course (DOTS) Package, Php2,500.00 (Intensive phase), Php1,500.00 (Maintenance Phase) of Outpatient Anti-Tuberculosis Treatment through P4,000
- For vasectomy procedures including non-scalpel vasectomy ligation or transection of fallopian tube (s), abdominal or vaginal approach: Up to Php4,000.00 for voluntary Surgical Contraception Procedures
- Up to Php3,000.00 for Animal Bite Treatment Package to cover for Post-exposure Prophylaxis (PEP) services which includes the following:
- Rabies vaccine
- Rabies Immune Globulin (RIG)
- Local wound care
- Tetanus toxoid and anti-tetanus serum (ATS)
- Antibiotics
- Supplies such as, but not limited to, syringes, cotton, alcohol and other antiseptics
PhilHealth Services Online
Some services available on the PhilHealth website include:
Member Registration Portal
This portal allows PhilHealth members to register and login to their PhilHealth account to check on the accuracy of their membership details on the site database.
Electronic Group Enrollment System
Through this service platform, employers, agencies, or other organized groups get the facilities they need to complete employee registration and billing.
Case Rates Search
Through this service, members can get information on PhilHealth’s benefit packages.
Claims Eligibility Checking
This service allows healthcare service providers to ascertain the benefit eligibility of members.
Electronic Premium Remittance System
Through this, employers can remit their premium contributions online.
Electronic Collection Reporting System
This platform enables PhilHealth-accredited collecting agents to submit their daily RF2 reports online.
Health Care Institutions Database
This database shows the complete list of all PhilHealth-accredited HCIs along with their accreditation status.
PhilHealth Registration Procedures
If you are not a member yet and it is your first time securing a PhilHealth Number, there are three different ways of doing so:
Through Online Registration
- Visit the PhilHealth online registration facility.
- Click Proceed and tick the check box to agree to the Terms and Conditions.
- Click Accept.
- Key in your personal information, contact details, dependents, your membership category, and PhilHealth Employer Number or PEN (which employed members can obtain from their employer/HR department) in the online registration form.
- Upload the PhilHealth registration requirements and wait for the email with the PhilHealth verification link.
- Click the verification link and complete the registration process.
- You should receive another email with your PhilHealth transaction number. Note that this is not your official PhilHealth number. You will receive your PhilHealth number in a separate email after one (1) to three (3) weeks.
- Once you’ve received your PhilHealth number, you can already start paying for your contributions to become eligible for PhilHealth benefits.
Through Registration via Email Request
If the online registration facility is not available, you may also register for a PhilHealth number by making an email request. To do it, you may follow these steps:
- Download the PhilHealth Member Registration Form (PMRF) from downloadable forms on the official PhilHealth website.
- Simply select downloads from the main menu.
- Choose Forms.
- Under Membership, click the download link for the PMRF.
- Print out the form and manually fill it out with your personal information. Note that PhilHealth won’t accept electronically signed forms.
- Scan the duly accomplished form and send it in PDF or JPEG format together with a scanned copy or photo of your valid ID.
- Use this as the email subject line: Register<space>Name<space>City/Province, Region
- Wait for PhilHealth to reply with your new PhilHealth number.
Through Manual Registration
For local employees and sea-based OFWs
- Fill out two copies of the PhilHealth Member Registration Form (PMRF).
- Submit the completed forms to the HR department of your company or manning agency.
- Once your application has been processed, you will be issued your Member Data Record (MDR) and PhilHealth ID, both of which will contain your PhilHealth number.
For employers
- Visit the nearest PhilHealth branch and submit the requirements for employee registration.
- Once your application has been processed, you’ll be issued your PhilHealth Employer Number (PEN) as well as the MDR/s and PhilHealth number/s of your employee/s.
For sponsored members
- If you and your family are listed as NHTS (National Household Targeting System for Poverty Reduction), visit your city or municipal DSWD office to get a certification.
- Submit this certificate to the nearest PhilHealth branch along with your valid ID.
- Once submitted, you will be enrolled as an indigent member of PhilHealth.
- Once enrolled, you may view your PhilHealth number through the MDR or the PhilHealth ID that will be given to you.
- Note that if your family is not listed as NHTS, you may still visit the barangay office to request for the sponsored PhilHealth membership. If you are qualified, you’ll be enrolled under the Sponsored Program and issued a PhilHealth ID containing your PhilHealth number.
For voluntary members
- Prepare the PhilHealth registration requirement including the PhilHealth Member Registration Form (PMRF) and valid ID.
- After completing the PhilHealth registration requirements, submit them to any of the following offices:
- PhilHealth Regional Office (PRO)
- Local Health Insurance Office (LHIO)
- PhilHealth Express outlet in select malls,
- iRemit branch in the host country (if you’re an OFW)
- Ventaja branch in your host county (if you’re an OFW),
- Office for Senior Citizens Affairs (OSCA) (if you’re a senior citizen)
- PRA Head Office (if you’re a foreign retiree)
- Pay your PhilHealth contribution.
- Submit the Official Receipt.
- Once registration is successful, you’ll be issued your MDR and PhilHealth ID containing your PhilHealth number.
Video: How to Create a PhilHealth Account
For a quick guide on how to get a PhilHealth account online, you may follow along while you watch this video from Youtube:
Frequently Asked Questions (FAQs)
Here are some common questions and answer about PhilHealth:
1. What if I am no longer paying PhilHealth? Can I still avail of the PhilHealth benefits?
Yes. PhilHealth allows retroactive contribution payment if these two conditions are met:
- You must have paid nine consecutive monthly payments before the unpaid months.
- Pay the underpaid months back in full within one month or prior to hospitalization.
If these options don’t apply, and you were separated from your previous employer, you may check about how to update your paid PhilHealth membership so you can become a sponsored PhilHealth member.
2. Is it possible to use my husband’s PhilHealth for maternity leave?
Yes. If you have legal documents to present, then as husband’s legal dependents, you and your child are eligible for PhilHealth benefits, maternity benefits included.
3. How can I update my PhilHealth if I am now married?
Simply update your status by following these steps:
- Download the Member Registration Form for PhilHealth or (PMRF).
- Accomplish the PMRF as needed.
- Send the completed PMRF to the nearest PhilHealth office.
- Wait for the amended Member Data Record (MDR) to be printed.
4. Can I retrieve or verify my PhilHealth number if it gets lost or forgotten?
Yes. In fact, there are many ways to do so. Here are some of them along with the procedures for doing so.
Via the PhilHealth Corporate Action Center Hotline
- Prepare your TIN or SSS number and call (02) 8441-7442 if you’re calling from a landline outside Metro Manila. If you are calling from Metro Manila, simply dial 8441-7442. On the other hand, those who are calling from a mobile phone can dial 2-8441-7442.
- When your call gets through, simply tell the agent that you need to know your existing PhilHealth number.
- Provide your full name, birthdate, and TIN/SSS number to verify your identity and once your identity is verified, the agent will give you your PhilHealth number.
Note: This is probably the best and easiest way to retrieve your PhilHealth number. You may contact the PhilHealth call center hotline anytime from Mondays to Fridays, 8am to 5pm.
Via PhilHealth’s Corporate Action Center callback channel
Aside from calling the hotline above, you can also reach out to PhilHealth’s Corporate Action Center through its callback channel.
- Type PHIC callback PIN VERIF<space>Your mobile number or Metro Manila landline<space>Details of your concern (e.g., PHIC callback 09889898899 I want to know my PhilHealth number).
- Send it to 0921-630-0009.
- Wait for a PhilHealth representative to call you back within 48 hours (available only during office hours, and weekdays).
Via Your PhilHealth ID or Company ID
You may also find your PhilHealth number on the topmost portion of the PhilHealth ID issued to you. If you don’t have an ID yet, you might find your PhilHealth number on your company ID, along with your tax identification (TIN), SSS, and Pag-IBIG numbers.
Through Your Employer/HR Department
The HR department of your company, whether it is a private corporation or a government office, will always have a record of all the employees’ information, which includes the PhilHealth numbers. You may simply contact or visit the HR of your present or past employer to request for your PhilHealth number.
Via Email Inquiry
The PhilHealth number online inquiry service is available to all members.
- Simply email a request with your complete name and birthdate.
- Attach an image of your valid ID, along with your personal information so PhilHealth can confirm your identity.
- Wait for the emailed response from PhilHealth.
5. Does PhilHealth accept walk-in membership applications?
Yes. If you do not have an Internet connection, if you can’t apply online for any reason, or if you have not received your PIN even after sending your registration application via email, you may opt to apply for PhilHealth membership manually, by visiting any of the following offices:
- PhilHealth Regional Office (PRO)
- Local Health Insurance Office (LHIO)
- PhilHealth Express outlet in select malls,
- iRemit branch in the host country (if you’re an OFW)
- Ventaja branch in your host county (if you’re an OFW),
- Office for Senior Citizens Affairs (OSCA) (if you’re a senior citizen)
- PRA Head Office (if you’re a foreign retiree)
Do take note that the process will depend on the type of membership you are availing of.
Summary
Getting sick or hospitalized isn’t always something that you can prepare for. Unfortunately, it almost always affects not only yours but also your family. More than the emotional strain caused by getting hospitalized for any reason, the financial effect isn’t something that can be ignored. It is for this very reason that the Philippine government set up the Philippine Health Insurance Corporation (PhilHealth)—a government office that offers mandatory health insurance coverage to all Filipinos so they may have access to affordable, acceptable, available, and accessible health care and financial support in times of need.
Contact Information
In case you have inquiries about PhilHealth and all the benefits attached to it, you may reach out to:
Philippine Health Insurance Corporation (PhilHealth) Main Office
Office Address: Citystate Centre, 709 Shaw Boulevard, Pasig City, Metro Manila, Philippines
E-mail address: actioncenter@philhealth.gov.ph / ofp@philhealth.gov.ph.
Telephone Number: (02) 637-9999 / +63 2 8441 7442
Website: http://www.philhealth.gov.ph
Facebook Page: https://www.facebook.com/PhilHealthOfficial
Callback Channel: 0917-898-7442 (PHIC)
Text “PHICcallback [space] Mobile No. or Metro Manila landline [space]
details of your concern” and we will call you during office hours, weekdays only.
(Callback requests will expire after 72 hours.)
Call Center Hotline: 84417442 (PHIC)
