Vision

"Bawat Pilipino, Miyembro,

Bawat Miyembro, Protektado,
Kalusugan Natin, Segurado"

Mission
"Sulit na Benepisyo sa
Bawat Miyembro,
Dekalidad na Serbisyo para
sa Lahat"

Core Values
Inobasyon
Serbisyong Dekalidad
Lubos na Integridad
Angkop na Benepisyo
Panlipunang Pagkakabuklod at
Ganap na Pagkalinga

The goals of PhilHealth are as follows:

1) to provide health insurance coverage for all

Filipinos
2) to ensure affordable and quality health care
services
3) to manage its resources economically. If Filipinos
will support and enroll in PhilHealth, our country may
well be on its way to giving adequate healthcare to an
estimated 50 percent of Filipinos living with meager
incomes.

Registration Procedures

1. Fill-out thePhilHealth Member Registration Form (PMRF)

2. Submit PMRF to the nearest PhilHealth Office

3. Await Member Data Record (MDR) and PhilHealth ID
Card

4. Pay the necessary premium contribution using your

PhilHealth ID number.

PROGRAM SUMMARY

Type of Member

1. EMPLOYED or
MEMBERS in the
FORMAL ECONOMY

2. INDIVIDUALLY
PAYING, SELFEMPLOYED
orMEMBERS in the
INFORMAL

How much is the

Premium?

Eligibility for
Benefits

It ranges from200 to
875 pesos a month,
depending on the
monthly salary. The
employee pays 1/2 and
the employer pays the
other half.

Member should have

paid at least 3 months
of the six months prior
to treatment or
hospitalization.

2,400 pesos annually for

members earning
P25,000 and below
3,600 pesos annually for
members earning more
than P25,000

Before treatment or
hospitalization, the
member should have
paid at least 3 months
of the 6 months prior
to treatment or
confinement.

Type of Member

How much is the

Premium?

3. OVERSEAS
WORKERS
or OFWS

:2,400 pesosper year.

4. SPONSORED

: 2,400 pesos per year

Eligibility for
Benefits
Thedate of
hospitalization or
treatment is within the
Validity Dates written
on the Philhealth
payment receipt.
The date of treatment
or hospitalization is
within the Validity
Dates written on their
Sponsored Health Card
or Member Data
Record

Type of Member
5. INDIGENT

6. LIFETIME
7. SENIOR
CITIZENS

How much is the

Premium?
:2,400 pesosper
year.

NONE. ZERO. FREE.

NONE. ZERO. FREE.
Free lifetime coverage
(RA 10645)

Eligibility for
Benefits
The date of
treatment or
hospitalization
should be within the
Validity Dates
written on their
Family Health Card
or Member Data
Record.
Philhealth card
Bring your
Philhealth Lifetime
ID Card, or Senior
Citizens

 The hospital/clinic is an accredited hospital of Philhealth

Have paid at least 3 months premium within 6 months prior to
confinement or availment
The 45 days allowance for hospital room and board is not yet
consumed.
If you are sure of all listed above, secure the following forms and
documents before settling your hospital bill:
1. CF 1 or Claim Form 1 You may get this from your HR or
Philhealth offices
2. MDR or Member Data Record (2 copies) Usually, you can
get this from Philhealth offices. This form confirms that you are a
member of Philhealth with the list of approved qualified
dependents.
3. Schedule of Compensation - This is a proof that you and
your company have paid the minimun required contribution to
avail of the benefits.

DEPENDENTS

Legitimate spouse who is not a member

Child or children legitimate, legitimated,
acknowledge and illigitimate (as appearing in birth
certificate) adopted or stepchild or stepchildren below
21 yrs of age, unmarried and unemployed
Children who are 21 years old or above but suffering
from congenital disability, either physical or mental, or
any disability acquired that renders them totally
dependent on the member for support, as determined
by the Corporation;

Foster child as defined in Republic Act 10165

otherwise known as the Foster Care Act of 2012
Parents who are sixty years old or above, not
otherwise an enrolled member, whose monthly income
is below an amount to be determined by PhilHealth in
accordance with the guiding principles set forth in the
NHI Act of 2013; and,
Parents with permanent disability regardless of age as
determined by PhilHealth, that renders them totally
dependent on the member for subsistence.

TAKE NOTE:
Qualified dependents shall be
entitled to a separate coverage
of up to 45 days per calendar
year. However, the 45 days
allowance shall be shared
among them.

IMPORTANT:
Qualified dependents that must
be declared by the principal
member. Their names must be
listed under the principal members
Member Data Record (MDR) to
ensure
hassle-free
benefits
availment.

How to use Philhealth for Hospitalizatio

heck with your employer if you are a PhilHealth memb

All companies should register their
employees.
To verify, ask your Human Resources
Department or Compensation and Benefits
Department.
Check your payslip.

Ensure that your qualified dependents were

registered under your name
Your parents who are 60 years old and above,
legal spouse, children who are under 21 or above
21 and permanently disabled.
Make sure to attach official documents
confirming your relationship to them. (Birth
Certificate & Marriage Contract)

Required Documents for the automatic

deductions in the hospital bill.

Receipt of Premium payments. Employees only

need to submit the Certificate of Premium
Payments with OR numbers.
Your PhilHealth ID and a valid ID.

PMRF

A clear and updated

MDR or Member
Data Record (if
dependent, make sure
you are listed in the
MDR)

Original copy of CF1

or Claim Form 1
signed by your
employer of HR
Specialist

To avail PhilHealth benefits, the following

conditions must be met.

Payment of at least 3 months worth of

premiums within the immediate 6 months
of confinement. For pregnancies, availment
of the newborn care package, dialysis,
chemotherapy, radiotherapy and selected
surgical procedures, 9 months worth of
contributions in the last 12 months is
needed.

Confinement in an accredited hospital for 24

hours due to illness or disease requiring
hospitalization. Attending physician(s) must
also be PhilHealth accredited.
Claim is within the 45 days allowance for
room and board.

Claiming and Postclaims

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 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 itll
be a great help if you or
anyone declared as your
dependent requires
hospitalization.

How much is the Philhealth Contribution?

Philhealth contribution is computed at 2.5%

of an individuals salary rate, with the
maximum salary rate pegged at P35,000.00.
This means that individuals who receive a
salary of more than P35,000.00 will still be
deducted 2.5% of P35,000.00 every payday
for their Philhealth contribution, or the
amount of P875.00.

It is important to note, though, that this is not the

actual amount that employees pay because half of
the contribution is shouldered by the employer.
Meaning, individuals receiving P35,000.00 monthly
salary are only deducted P437.5 from their paythe
other P437.5 is shouldered by the employer.
Meanwhile, for employees who receive a salary of
P5,000 or lower every month, the employers must
shoulder the employees full Philhealth contribution.

Premium Contribution Table

Salary Bracket

Salary Range

Salary Base

Total Monthly
Premium

Employee Share*

Employer Share

8,999.99** and below

8,000.00

200.00

100.00

100.00

9,000.00 - 9,999.99

9,000.00

225.00

112.50

112.50

10,000.00 - 10,999.99

10,000.00

250.00

125.00

125.00

11,000.00 - 11,999.99

11,000.00

275.00

137.50

137.50

12,000.00 - 12,999.99

12,000.00

300.00

150.00

150.00

13,000.00 - 13,999.99

13,000.00

325.00

162.50

162.50

14,000.00 - 14,999.99

14,000.00

350.00

175.00

175.00

15,000.00 - 15,999.99

15,000.00

375.00

187.50

187.50

16,000.00 - 16,999.99

16,000.00

400.00

200.00

200.00

10

17,000.00 - 17,999.99

17,000.00

425.00

212.50

212.50

11

18,000.00 - 18,999.99

18,000.00

450.00

225.00

225.00

12

19,000.00 - 19,999.99

19,000.00

475.00

237.50

237.50

13

20,000.00 - 20,999.99

20,000.00

500.00

250.00

250.00

14

21,000.00 - 21,999.99

21,000.00

525.00

262.50

262.50

15

22,000.00 - 22,999.99

22,000.00

550.00

275.00

275.00

16

23,000.00 - 23,999.99

23,000.00

575.00

287.50

287.50

17

24,000.00 - 24,999.99

24,000.00

600.00

300.00

300.00

18

25,000.00 - 25,999.99

25,000.00

625.00

312.50

312.50

18

25,000.00 25,999.99

25,000.00

625.00

312.50

312.50

19

26,000.00 26,999.99

26,000.00

650.00

325.00

325.00

20

27,000.00 27,999.99

27,000.00

675.00

337.50

337.50

21

28,000.00 28,999.99

28,000.00

700.00

350.00

350.00

22

29,000.00 29,999.99

29,000.00

725.00

362.50

362.50

23

30,000.00 30,999.99

30,000.00

750.00

375.00

375.00

24

31,000.00 31,999.99

31,000.00

775.00

387.50

387.50

25

32,000.00 32,999.99

32,000.00

800.00

400.00

400.00

26

33,000.00 33,999.99

33,000.00

825.00

412.50

412.50

27

34,000.00 34,999.99

34,000.00

850.00

425.00

425.00

28

35,000.00 and up

35,000.00

875.00

437.50

437.50

How much will Philhealth deduct from your bill?

Philhealth Benefit packages

Name of Benefit Package

Case Rate (Php)

Maternity Care Package (MCP)

6,500.00

Normal Spontaneous Delivery (NSD) Package

6,500.00

TB-DOTS Package

4,000.00

SARS Package

50,000 - 100,000

Avian Influenza Package

50,000 - 100,000

New Born Care Package (NCP)

1,000.00

Bilateral Tubal Ligation (BTL) Package

4,000.00

Vasectomy Package

4,000.00

Malaria Package

600.00

Influenza A (H1N1) Package

75,000 - 100,000

NSD with BLT Package

10,500.00

Outpatient HIV / AIDS Treatment Package

30,000.00

8,000.00
Dengue I (dengue fever and DHF Grades I and II)*
Dengue II (dengue hermorrhagic fever grades III and
16,000.00
IV)*
Pneumonia I (moderate risk)*
15,000.00
Pneumonia II (high risk)*

32,000.00

Essential Hypertension*

9,000.00

28,000.00
Cerebral Infarction (CVA I)*
Cerebro - vascular Accident with Hemorrhage (CVA
38,000.00
II)*
6,000.00
Acute Gastroenteritis (AGE)*
Typhoid Fever*

14,000.00

Asthma*

9,000.00

Cesarian Section (CS)*

Dilatation and Curettage (D&C)*
Hysterectomy*
Mastectomy*
Appendectomy*
Cholecystectomy*
Herniorrhaphy*
Thyroidectomy*
Radiotherapy*
Hemodialysis*
Cataract Package*

19,000.00
11,000.00
30,000.00
22,000.00
24,000.00
31,000.00
21,000.00
31,000.00
3,000.00
4,000.00
16,000.00

UNCLAIMED
REFUND

Unclaimed Refund
A benefit payment that must be reimbursed
by the accredited hospital to the member
for a specific confinement period.

The refund results from either underdeduction or non-availment of benefits at

the point of service.

 Who are entitled to the refund?

How much is the refund?
How will I know if I have an
unclaimed refund?

How do I collect my refund?

Visit nearest Philhealth Regional Office or Local Health
Insurance Office in your locality. Bring at least 2 ID.
Fill out Request for Release of Unclaimed Refund Form.
Discuss the preferred mode of release of the said refund.
Go back to the Office youve been to on the scheduled date
of release of the refund.

 If member is not available, who may claim

the refund?
A. Photocopy of valid ID/ Passport of
member.
B. Valid ID card of representative
C. Authorization letter duly signed by the
member
D. Special power of Attorney

 If a member is deceased, who may claim

the refund?
A.Valid ID card of member
B.Death Certificate
C.Valid ID card of claimant
D.Birth Certificate
E.Marriage Contract
F. Waiver letter from surviving heir

 Why are some member names

missing in the list?

After I file for payment of my

refund, how long will it take before
I receive the refund?