2018
Covered Members and Dependents
as of December 31, 2018
Sector Members Dependents Beneficiaries
Members in the Formal 15,989,829 15,002,702 30,992,531
Economy Private 13,659,502 11,222,664 24,882,166
Government 2,257,851 3,726,782 5,984,633
Household Help/Kasambahay 71,152 51,478 122,630
Enterprise Owner & Family Drivers 1,324 1,778 3,102
Members in the 11,778,458 12,254,864 24,033,321
Informal Economy Migrant Worker
Informal Sector
337,426
1,829,026
524,541
2,882,224
861,967
4,711,249
98%
Self-Earning Individual 346,019 506,837 852,856 of 2018
Organized Group and Others 23,470 29,661 53,131 projected
Group Enrollment 28,533 28,617 57,150 population
Othersa 539 509 1,047
Point of Service (POS) Eligibleb 9,213,446 8,282,476 17,495,921
Indigents 15,718,882 18,743,293 34,462,175
Sponsored Members 1,519,424 1,864,239 3,383,663
Lifetime Members 1,278,549 927,707 2,206,256
Senior Citizens 7,531,326 1,879,707 9,411,033
TOTAL 53,816,468 50,672,512 104,488,979
Note: - Indigent count of members and dependents was based on DSWD Listahanan database and are subject for further validation.
- 2018 Projected Population is 106,345,533 estimated from the August 2015 PopCen by PSA with a 1.72 Growth Rate.
a) Members and dependents under Filipino w/ Dual Citizenship, Naturalized Filipino Citizen, Citizen of Other Countries
Working/Residing/Studying in the Philippines, PRA Foreign Retirees.
b) Members and dependent under the Informal Economy w/o 9/12 contributions who are entitled to the POS mechanism.
Covered Members (by Sector)
as of December 31, 2018
Lifetime
2%
Senior Citizens
Sponsored
3% 14%
Formal
Economy
30%
Indigents
29% Informal Economy
22%
Accreditation
as of December 31, 2018
Gov't
Private 34%
66%
Sector
Category Total
Private Government
Level 1 473 334 807
Level 2 291 46 337
Level 3 64 51 115
Infirmary 342 327 669
Total 1,170 758 1,928
% to Total 61% 39% 100%
Benefit Payment
January 1 to December 31, 2018
% to Total
Benefit Payment
Sector Benefit
(in million pesos) Payment
140,000 %
Increase./(Decrease)
121,041
120,000 Lifetime Members
106,416
33%
100,000 Senior Citizen 18%
80,000 Sponsored
(25)%
60,000 Indigent
40,000
Informal Economy 62%
20,000 1%
Formal Economy
6%
-
2017 2018
Source : Financial Statement
Claims Processing
(Number of Claims Paid Per Sector)
January 1 to December 31, 2018
Percent Distribution
Total Amount of Total No. of
Sector Claims Paid Claims Paid
to Total No. of
Claims
Number of claims paid were extracted from Power BI Dashboard based on check date processed 2/1/2019.
Claims Processing
Top 10 Procedures by RVS Codes
January 1 to December 31, 2018
% to Total No.
RVS Total Amount of Total No. of
Rank Illness Description of Procedure
Code Claims Paid Claims Paid
Claims Paid
not NBB
18%
No Balance
Billing
82%
Note: Level of NBB Compliance by PROs based on Exit Survey Results from January 1 to December 31,2018
Support Value
January 1 to December 31, 2018
Preliminary estimates using AVPC for claims paid January 1 to December 31, 2018 P 9,652 over P 23,165 the average cost of confinement
based from the 2017 NDHS by PSA with annual inflation rate.