Guide to PhilHealth in the Philippines
Since times immemorial, health and material wealth are inseparable eternal concerns for the human race.e. If you are unhealthy, you can’t work, and it will lead you to poverty. Malnutrition and poor hygiene are by-products of poverty. It again triggers another cycle of health issues and poverty.
Thanks to the technological developments in the medical field, we live much longer than our forefathers, albeit at higher spending. Sadly, only a very few countries provide universal health insurance coverage for their citizens. For the rest, an individual has to bear the expenses of his healthcare.For many, this out of the pocket spending on skyrocketing healthcare expenses is “a cure worse than the disease.”
Like many of the poor souls in developing countries, healthcare expenses had been a nightmare for Filipinos. But in the year 1995, The Philippine Health Insurance Corporation (PhilHealth) was created to implement universal health coverage for its citizens, including those working outside the country.
Since then, PhilHealth has been the good Samaritan for the Filipinos to secure the proper treatment without straining their financial well being.
What is PhilHealth?
The Philippine Health Insurance Corporation or PhilHealth is a government-owned and controlled corporation (GOCC) that works under the Health Department to establish a National Health Insurance Program. The primary goal of PhilHealth is to make quality healthcare accessible and affordable for every Filipino. Anyone with Filipino citizenship can become a member of the PhilHealth scheme and keep it active with a monthly contribution. The different set of membership schemes allows everyone, irrespective of their financial, social, gender, or age status, to be part of the system. One can choose his membership scheme according to his capabilities. For the less privileged, the government takes care of their contributions.
Some of the significant features of PhilHealth are:
1. A PhilHealth Member and his legal dependents have equal benefits for all their medical expenses.
2. The scheme offers subsidies for your total health care expenses such as outpatient care, inpatient services, surgeries, professional fees, medicines, room and board, diagnostic processes, deliveries, etc.
3. In traditional health insurance schemes, the ceiling is for the amount. In PhilHealth, a member and his dependents can get PhilHealth benefits for up to 45 days of hospitalization care in a year.
4. PhilHealth benefits work based on case rates. Here every illness or its procedure costs are predetermined, including the doctor’s fees and hospital expenses. So a patient will have a clear picture of the PhilHealth benefits much prior to his hospitalization.
5. Patients have the freedom to choose the health care provider. You can seek service from public or PhilHealth accredited private hospitals. In such cases, the applicant needs to pay the additional hospital expenses, if it exceeds the PhilHealth benefits.
6. It covers day procedures such as radiotherapy, hemodialysis, and outpatient blood transfusion as well.
7. The Primary Care Benefit scheme provides better management of existing illness and early detection of diseases through regular monitoring and medications.
The eligibility to claim a PhilHealth allowance:
1. The applicant should be an active PhilHealth member with at least three months’ worth of premiums within the immediate six months of confinement.
2. For some healthcare expenses such as pregnancies, newborn care packages, dialysis, chemotherapy, radiotherapy, and selected surgical procedures, nine months of contributions in the last 12 month is essential.
3. The attending physician must be PhilHealth accredited.
4. The applicant should submit the claim within 45 days of obtaining room and board.
The essential documents for a successful claim processing are:
1. Member Data Record Form (MDR) – that includes your name either as the member or dependent.
2. PhilHealth claim form 1 (original copy) – the employer’s signature is a must for employees.
3. Certificate of payments (with OR numbers) – if you are an employee, the Certificate of Premium payments with OR number will be sufficient.
4. PhilHealth ID and another valid ID. How to get a PhilHealth ID, you can find on the PhilHealth official website.
If you can’t make a personal representation during the process, there is an option to authorize someone for the same.
Usually, submission of the required documents at the hospital before your discharge would be sufficient for the automatic deduction of your PhilHealth benefits from your total bill.
Why do You Need PhilHealth?
The primary reason for enrolling in PhilHealth is the treatment costs. A medical emergency has no other options than getting the treatment, whatever be the costs. In the absence of PhilHealth benefits, you need to pay the entire amount. It can create irrevocable damage to your financial stability. Unlike in the past, lifestyle diseases such as hypertension, diabetics, cardio-vascular diseases, or cancer are the primary reasons for death today. Even though they can be problematic, if untreated, we can manage them and improve the quality of life with regular monitoring.
With its Primary Care Benefit scheme, PhilHealth takes care of such chronic diseases’ routine management efficiently. It avoids loss of workdays and prevents the disease’s manifestation, leading to loss of limbs or even death.
Pregnancy and childbirth are the auspicious moments of everyone’s life. PhilHealth Maternity Care Packages shoulder a considerable portion of your financial liabilities and allow you to enjoy the bliss of parenthood without any distractions.
How to Apply for PhilHealth Online?
PhilHealth benefits are restricted only for the members. Perhaps you are interested in the question, what is the formal economy in PhilHealth? For the formal economy employees, the employer takes care of their PhilHealth membership and its monthly contributions. Other categories of PhilHealth memberships such as Self-Employed, Informal Sector Workers, Overseas Filipino Workers (OFWs), Sponsored Members, Indigent Members, Lifetime, and Senior Citizens need voluntary membership registration.
One can register for a suitable membership either through a nearby PhilHealth Office or using PhilHealth online services as given below:
Step 1: Access the registration in PhilHealth site and select “Register” under the “Membership” category.
Step 2: Read and accept the PhilHealth Electronic Registration Terms and Conditions.
Step 3: Fill the online PhilHealth application with the relevant data.
Step 4: Upload supportive documents to the portal.
Step 6: Review and confirm the details.
Step 7: Wait for the confirmation mail with your PhilHealth ID Number.
Below are some of the common terminologies you may encounter with every reference to PhilHealth.
What is my PhilHealth number?
The PhilHealth Identification Number (PIN) is a 12-digit number that is issued to each PhilHealth member. It is unique for each participant. The PhilHealth number is required in all PhilHealth operations. So when you get it, be sure to copy and write it down in case of emergency.
What is PEN in PhilHealth?
The law stipulates that all private and public employers have to register with PhilHealth to ensure their PhilHealth coverage. Every such employer will have a unique PhilHealth Employer Number (PEN). So, what is the role of PEN in PhilHealth application? The PEN will be the organization’s identification number for all PhilHealth activities. The employer has to display the PhilHealth Certificate Registration in the workplace. Similarly, any changes in the employees, business details, or organization structure needs to update in the PhilHealth register.
What is MDR in PhilHealth?
PhilHealth MDR, Philippine Health Insurance Corporation Member Data Record, carries vital information about the member such as PhilHealth Identification Number (PIN), membership details, address, and the list of dependents.
The cardholder has to ensure that MDR contains all his dependent details to avoid the chances of denial of Phil-Health benefits.
What is ePCB PhilHealth?
Earlier, the Primary Care Benefit (PCB), a package covering preventive care and diagnostic services, was accessible only to a specific category of members.
The new Expanded PCB enables all members and their dependents to have free health screening and assessment, free diagnostic services, and discounts on specific medicines.
What is ER2 PhilHealth?
The employer has to file the ER2 form for each recruit to ensure PhilHealth Coverage to them. For employees with an existing PhilHealth Membership, essential details such as PhilHealth Number need to be mentioned in the ER2 form.
Suppose the employee is unsure about his PhilHealth number. In that case, he can get it from his previous employer, PhilHealth branches, or by texting or sending emails to the department.
What is CSF PhilHealth?
A scanned image of the Claim Signature Form (CSF) is mandatory to settle a PhilHealth benefit claim. All providers have to use a uniform standard CSF for claim settlement processes.
What is CF1 PhilHealth?
Claim Form 1 (CF1) is used to ascertain the member’s eligibility for the PhilHealth benefits. The first part of the form covers member/patient’s details. The second part covers the employer’s details and contribution details.
How Can I Get a PhilHealth ID?
Active membership with regular contributions will make one eligible for PhilHealth benefits. But availing of the services would be quite complicated unless you have a PhilHealth ID card. This portable ID card ensures every provider in the Philippines that you are eligible for PhilHealth benefits.
The PhilHealth ID cards are not issued automatically for all members. You have to apply separately for the PhilHealth ID card. Both formal and informal sector members are eligible for the PhilHealth Cards. Any PhilHealth member can obtain a PhilHealth ID card by approaching the nearby PhilHealth office and completing the formalities. You can find detailed ID requirements on the PhilHealth official website.
Is PhilHealth ID a Valid ID?
There are two types of PhilHealth ID cards:
• Regular PhilHealth ID;
• PhilHealth Insurance ID Card.
The regular PhilHealth ID card is just a paper printed ID document that will help you get your Phil-health claims. The PhilHealth Insurance ID Card is a digitized ID issued to employed members and active members. It means the card is available only to the members of the formal economy definition of PhilHeath, and it adds some legitimacy for it. Hence these cards are accepted as a valid ID form for some category of operations and organizations.
Still, PhilHealth ID cards are not yet fully established as a valid ID card for all purposes. For instance, the state-licensed and legit lenders like Robocash do not accept PhilHealth ID as a valid ID card for their loans.
Robocash is quite popular among the Filipinos due to their fully automated lending system that works 24/7. Any Filipino within the age group of 21-70 years old with a mobile connection can secure a loan of up to PHP 25,000 from Robocash. They have a loan approval rate of 95%, and the loan decision hardly takes more than 20 minutes.Apply now
Sickness can strike anyone at any time, and PhilHealth can be your great solace at that time. But sometimes, the expenses can go beyond your benefits, and you may need to mop up resources to manage the contingency. Such vulnerable situations can force people to make impulsive decisions and may end up with expensive loans. Proper finance management backed by PhilHealth and a legit lender like Robocash can help you tide over such situations without the risk of any debts.