THE NATIONAL HEALTH INSURANCE PROGRAM

Under Republic Act 11223 or the Universal Health Care Act, every Filipino citizen are automatic members of the National Health insurance Program (NHIP) which is administered by PhilHealth. The UHC Law also prescribes that all Filipinos are granted with immediate eligibility to PhilHealth benefits.

All are encouraged to register themselves into the program to get their unique PhilHealth Identification Number (PIN). More than a requirement before one is hired for a job, the PIN is one’s proof of membership and is needed when availing of healthcare benefits such as hospitalization, outpatient procedures, and primary care benefits later on.

WHO CAN BE A MEMBER?

Membership in PhilHealth is simplified into two (2) types: Direct and Indirect contributors. Direct contributors are those who have the capacity to pay premiums, while Indirect contributors are those whose premiums are paid for by the national government. Both type of members has the privilege to extend their PhilHealth coverage to their qualified dependents that include:

• Legal spouse/s who is/are not an active member;
• Unmarried and unemployed legitimate, illegitimate children, legally adopted or stepchildren below twenty-one (21) years of age;
• Foster children as defined in RA 10165 (Foster Care Act of 2012); and
• Parents who are sixty (60) years old and above, not otherwise an enrolled member.

Direct Contributors

• Employees with formal employment
• Kasambahays
• Self-earning individuals; Professional practitioners
• Overseas Filipino Workers
• Filipinos living abroad and those with dual citizenship
• Lifetime members
• All Filipinos aged 21 years and above with capacity to pay

Indirect Contributors

• Indigents identified by the DSWD
• Beneficiaries of Pantawid Pamilyang Pilipino Program
• Senior citizens
• Persons with disability
• Sangguniang Kabataan officials
• Previously identified at point-of-service / sponsored by LGUs
• Filipinos aged 21 years old and above without capacity to pay premiums

HOW TO BE A MEMBER?

A. Direct Contributors

Registration procedures

For Newly Hired and Existing Employees without PIN yet

• Fill out two (2) copies of the PhilHealth Member Registration Form (PMRF) https://www.philhealth.gov.ph/downloads/membership/pmrf_012020.pdf
• Submit the PMRF to the company’s HR Department
• Await Member Data Record (MDR) and PhilHealth ID card from employer

For Newly Hired Employees with PIN

• Submit your PIN to your employer for them to report the same in PhilHealth.

For New Members Seeking Employment

• Fill out two (2) copies of the PhilHealth Member Registration Form (PMRF)
• Secure Certification from the Barangay stating that member is seeking employment
• Attach any proof of identity
• Submit the documents to any PhilHealth Office or available channels of PhilHealth for registration

For self-earning Individuals; Professional Practitioners; All Filipino aged 21 years and above with capacity to pay 

• Visit any of the Local Health Insurance Offices (LHIO) or PhilHealth Express outlets
• Fill out (2) copies of the PhilHealth Member Registration Form (PMRF)
• Submit PMRF
• Await MDR and PhilHealth ID Card
• Pay the necessary premium contribution

NOTE: Unemployed minors (below 21 years old) can still be declared as legal dependent by a parent-member

B. Indirect Contributors

Enrolment of Indirect Contributors to PhilHealth is usually facilitated by the concerned agencies.

PREMIUM CONTRIBUTION TABLE (for direct contributors)

WHAT ARE YOUR BENEFITS?

• Inpatient Benefits

These benefits are deducted from the total bill prior to discharge using the case rates, a pre-determined fixed amount set by PhilHealth. https://www.philhealth.gov.ph/services/acr/

• Outpatient Benefits

Day surgeries, radiotherapy, hemodialysis, outpatient blood transfusion and KonSulTa package.

• Z Benefits

Any illness as a primary condition that is life or limb-threatening and requires prolonged hospitalization, extremely expensive therapies or other care that would deplete one’s financial resources, unless covered by special health insurance policies. Some of the Z Benefits Packages are:

🗸 End-stage renal disease eligible for requiring kidney transplantation(low risk) – P600,000
🗸 Coronary Artery Bypass Graft Surgery(standard risk) – P550,000
🗸 Acute Lymphocytic / Lymphoblastic Leukemia(standard risk) – P500,000

• SDG-Related Benefits

Outpatient Malaria Package, Outpatient HIV-AIDS Treatment Package, Outpatient Anti-Tuberculosis Treatment through DOTS Package, Voluntary Surgical Contraception Procedure, Animal Bite Treatment Package

Visit www.philhealth.gov.ph for more information.