Philhealth Benefits

Are you a Philhealth member?  Do you regularly check if your contributions are posted on your account?  What could be the reasons why a paying member may not be able to use his Philhealth benefits?

Regular remittance of premium contributions must be maintained in order for a Philhealth member to avail of the benefits seamlessly.  Philhealth does not accept retroactive payments such that, if the member missed paying a certain period, he may not be able to use his Philhealth benefits.

Below is a summary of Philhealth’s Eligibility Requirements, based on the paying member’s type of membership:

Sponsored Membership Date of hospitalization / availment must be within the effectivity period indicated in the member’s ID and MDR.
Individually Paying Members (IPM)
  1. There are certain confinement cases wherein three months’ worth of premium within the last six months (3/6) prior to confinement is acceptable.
  2. For pregnancy-related cases, dialysis, chemotherapy, radiotherapy, and other selected surgical procedures, the member must have paid nine months worth of premium within the last twelve months (9/12) prior to confinement.
Lifetime Member The member just has to show their Lifetime ID card; no need to pay premium anymore.
Employed Members Three months worth of premium within the last six months (3/6) prior to hospitalization.
Overseas Workers (OWP)
Date of hospitalization / availment must be within the coverage period specified in themember’s MDR.

How to maintain member’s eligibility?

The secret is simple: pay your premiums on time.  Any discrepancies or gaps in your premium contributions will definitely affect your eligibility to claim benefits.  Here are some tips to help you secure your Philhealth benefits:

a. Sponsored Members:

  • Member’s card must be kept updated all the time.  If card is about to or has expired already, Sponsored Member must proactively ask his Sponsor if his membership will still be renewed.
  • If Sponsor will no longer renew the Sponsored Member’s membership, the latter has the option to register as an Individually Paying Member.

b. Individually Paying Member (IPM)

  • He must make sure that each quarter of the year has been paid (and all payments are posted in his account).
  • You have the option to pay your premiums yearly (advance payments) for security and convenience.

c. Overseas Workers Program Member (OWP)

  • All premiums must be remitted and posted on member’s account before membership expires.
  • In cases when contract abroad has been terminated, inform Philhealth to process shifting of membership category from OWP to IPM (or other applicable categories).  Pay the corresponding premiums right away to avoid gaps in your contributions.

d. Employed Members

  • If you are an employed member and you will be taking a Leave Without Pay, you may pay your monthly contributions at any nearest Philhealth office under the IPM category.
  • Remember to bring a copy of your RF-1 issued by your employer (to attest to the fact that you are indeed on Leave without Pay status).
  • In case you resign or get separated from work, you have to shift your membership category to IPM.

Remember that Philhealth does not have a “grace period” for missing your monthly contributions.  Once a month is left unpaid, the member can no longer make a retroactive payment.  These gaps will impact your and your dependents’ benefit claims, so make sure your payments are properly posted and your account is consistently updated.

Source: https://www.scribd.com/doc/115987403/Phil-Health-FAQs