What is PhilHealth?

Mission and Vision Foundation Day Members Proof of registration Premium Rate Benefits Advantage Disadvantage

What is PhilHealth?

The Philippine Health Insurance Corporation (PhilHealth) is a GovernmentOwned and Controlled Corporation that was established to administer the National Health Insurance Program nationwide.

Mission To ensure adequate financial access of every Filipino to quality health care services through the effective and efficient administration of the National Health Insurance Program.

Vision To provide adequate and affordable social health insurance coverage for all Filipinos.

When was PhilHealth Created?

In the 1990s, came the development of House Bill 14225 and Senate Bill 01738 which became The National Health Insurance Act of 1995 or Republic Act 7875, signed by President Fidel V. Ramos on February 14, 1995.

When was PhilHealth Created?

PhilHealth was established Febuary 14, 1995 and assumed the responsibility of administering the former Medicare program for government and private sector employees from the Government Service Insurance System in October 1997,

When was PhilHealth Created?

The law paved the way for the creation of the Philippine Health Insurance Corporation (PhilHealth), mandated to provide social health insurance coverage to all Filipinos more than 15 years' time.

When was PhilHealth Created?

from the Social Security System in April 1998, and from the Overseas Workers Welfare Administration in March 2005.

Who can be members of PhilHealth?

All Filipino citizens are mandated to enrol into the National Health Insurance Program.

What is my proof that I am already a registered member?

After registering, each member should receive the following important documents: 1. PhilHealth ID contains the members PIN (PhilHealth Identification Number), name, picture, and signature. Remember that each member should have only one PIN. 2. Member Data Record (MDR) contains the members name, address and legal dependents listed in the PhilHealth database.

How much is the premium contribution rate?

Overseas Employed Sponsored Workers NHTS-PR LGU
How Much? Jan-June 2012

Individually Paying Member (IPM)

Professionals Low Income

P1200/year Up to 3% of P2400 July-Dec 2012 P1200/year monthly basic salary P2400/year 2013 (w/ P50,000 cap) Who remits? Member Employer National

P1200/year for P300 2-year lock-in Monthy period P2400/year

LGU Member
Quarterly Semi-annually Annually

P200 Monthly

Member
Monthly Quarterly Semi-annualy Annually

When? Annually Monthly Annual

Annual/ Biannual

PhilHealth Benefits: Inpatient coverage:

PhilHealth provides subsidy for room and board, drugs and medicines, laboratories, operating room and professional fees for confinements of not less than 24 hours.

PhilHealth Benefits: Inpatient coverage:

Rate ceilings/maximum allowances for inpatient coverage:

PhilHealth Benefits: Inpatient coverage:

Rate ceilings/maximum allowances for inpatient coverage:

PhilHealth Benefits: Outpatient coverage:

Day surgeries, dialysis and cancer treatment procedures such as chemotheraphy and radiotheraphy in accredited hospitals and free-standing clinics.

PhilHealth Benefits: Special benefit packages:

Enhanced Outpatient Benefit Package Coverage for Up to the Fourth Normal Delivery Newborn Care Package TB treatment through DOTS SARS and Avian Influenza Package Influenza A (H1N1) Package

Exclusions/Non-Compensables
The following shall not be covered except when, after actuarial studies, PhilHealth recommends their inclusion subject to approval of its Board of Directors: Fifth and subsequent normal obstetrical deliveries Non-prescription drugs and devices Alcohol abuse or dependency treatment Cosmetic surgery Optometric services Other cost-ineffective procedures as defined by PhilHealth

Advantages:

Equity and access

Targets services for poor and vulnerable populations (open to all) Attentive to geographic disparities

Advantages:

Prevention

Philhealth prevents diseases through early detection and doctor recommended lifestyle changes. This prevention not only keeps citizens healthier, but it also saves money on the expense of the health care that would otherwise be required to deal with the problem when it arises.

Disadvantages:

Management

General dependence on political and legislated direction Restrictive range of discretionary authority, less flexibility, less innovation

Disadvantages:

Customer orientation
Limited attention to customer convenience and comfort Indirect accountability for customer satisfaction

Disadvantages:

Flexibility

Slow to respond to changing market conditions because of political and budgetary commitments to ongoing programs