Category: Philhealth News and Facts


Dec 03

December is Firecrackers Injury Prevention Month as announced by PhilHealth in their Facebook page. I think it is a timely and relevant campaign as Christmas and New Year are but a few weeks away and we all know that the Pinoy holidays are never complete if we do not light a few fireworks.  Because of this, hospitals and clinics are also bracing themselves for the onslaught of wounded patients due to firecracker burning.

The PhilHealth case rate packages include burns that require hospital confinement.  For your proper information and guidance below are the rates and conditions when availing this type of benefit:

  • Burn A Rate: Php 8,500
  • Burn B Rate: Php 10,600
  • Confined at: Level 1, 2, and 3 hospitals
  • Conditions when availing:
    • The victim must be a listed qualified dependent or is an active PhilHealth member himself and has complete qualifying contributions;
    • Has not used up his 45-day regular benefit limit;
    • Is admitted at a PhilHealth-accredited facility for no less than 24 hours;
    • Is attended to by a PhilHealth accredited doctor.

How do you determine if the wound is Burn A rate or Burn B?

Burn A category are first degree burns in the areas of the head and neck, shoulders and upper limbs.   Burn B category are second and third degree burns involving multiple regions and affecting 20% to 50% of body surface.

For the complete list of cases for A and B burns, click this link: https://www.philhealth.gov.ph/circulars/2017/annexes/0019/AnnexA-MedicalCaseRates.pdf

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Stay safe this holiday season, whether from sickness brought about by the changing weather or injuries from the many merry-making and parties you will be attending in the days to come.  Always make sure that your PhilHealth contributions are updated and accurate to avoid problems with your hospital bills, especially during the holidays when government offices are closed.

Source: www.philhealth.gov.ph

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Nov 5

PhilHealth members no longer need to guess how much of their hospital bills will be shouldered by PhilHealth.  With the Case Rate Search app, you can begin exploring the different medical cases and corresponding rates that are covered by PhilHealth and take the guesswork out of the entire billing process.

Before the app was made available, PhilHealth members would have to wait for the hospital’s billing department to facilitate their accounts before they can get a view of PhilHealth’s participation in their hospital bill.  This is a concern for most members and has even become a reason for others to refuse confinement.  When patients are unaware of how much of their bill PhilHealth will be paying, they become concerned with their expenses and decide against having themselves admitted for proper treatment and observation.

Although PhilHealth’s participation is not applied on the patient’s bill until the attending physician has given a final diagnosis, it is still best to have an advance view of the possible deductions that the patient can look forward to.  This serves as a guideline for the patient and his family, assuring them that they will not have to shoulder all of the medical expenses on their own.

To download the app, make sure your Android phone or tablet is connected to the internet.  Launch the Play Store app and search for the ‘PhilHealth ACR’ mobile application.  Tap on the ‘download’ button and wait until the app is successfully installed in your device.  Non-android users can access the search engine at the PhilHealth’s website at www.philhealth.gov.ph.  Downloading and use of the app is free of charge.

Tell us about your experience when using the PhilHealth Case Rate Search app!

 

Source: www.philhealth.gov.ph

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Sept 06

Sa October 1, 2018, ang lahat ng PhilHealth members ay dapat nakakumpleto ng hindi bababa sa 9 months na contributions sa loob ng 12 months BEFORE or BAGO ang hospital confinement, upang magamit ang kanilang mga benepisyo.  Ito ang 9/12 rule na papalit sa 3/6 (3 months paid contributions within the last 6 months prior to confinement) rule na kasalukuyang sinusunod ng mga members at mga hospitals.

Paano ang pagbilang ng 9 months sa 9/12 rule?

Kung ang date of confinement mo ay October 2, 2018 (isang araw matapos mag effect ang 9/12 rule), bumilang ka ng 12 months pabalik, kasama ang buwan ng confinement (October).

  • 12 months: October 2018 to November 2017
  • Kailangang bayad ang contributions ng 9 na buwan between October 2018 to November 2017,
  • Hindi kailangang consecutive o sunod-sunod na buwan ang bayad; basta’t nakabuo ng at least 9 months na premium payments, eligible ang miyembro sa PhilHealth benefits.

Para sa lahat ng types ng PhilHealth members ba ang 9/12 rule?

Ito ay applicable sa lahat ng uri ng members MALIBAN SA MGA SUMUSUNOD:

  • Members na may Validity Dates ang PhilHealth cards tulad ng mga Sponsored Members, Land-based OFWs, at Indigent Members.

Magkano ang monthly PhilHealth contributions ng mga Individual Payors?

Mananatili sa Php 200 per month ang required monthly contribution (para sa P2,400 annually) at Php 300 per month (para sa Php 3,600 annually).

Ang mga employed, seafarers, at kasambahay members lamang ang nag increase ang monthly premium payments.

Tandaan:

Hindi tatanggapin ng PhilHealth ang same day settlement o ang mga miyembro na nag bayad ng kanilang contribution (para mabuo ang 9 months) sa mismong araw ng confinement.  Ibig sabihin, kahit nagbayad ka ng umaga ng October 2, 2018 at ikaw ma-admit sa hospital ng gabi ng parehong araw, hindi ico-consider ng PhilHealth na nakatupad ka sa 9/12 rule.  Kaya’t importanteng regular na nakakapag bayad ng contributions buwan-buwan para laging siguradong eligible ka, ano man ang mangyari.

Ang 9/12 rule ay mag-uumpisa sa October 1, 2018.

Source: www.philhealth.gov.ph

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Aug 22

Even Filipinos who work abroad, whether land-based or sea-based, must be covered by the Philippine Health Insurance Corporation or PhilHealth.

Here is a quick guide that can help OFWs stay updated on their membership:

How to register for membership:

  1. If currently in the Philippines:
  • Visit the nearest PhilHealth Regional Office, Local Health Insurance Office, PhilHealth Business Center, or PhilHealth Express outlet in your area.
  1. If currently overseas:
  • Visit any branch of the PhilHealth accredited collecting partners, iRemit, and Ventaja Corporation.
  • Access the Electronic Registration facility and follow the step-by-step procedure.
  • Download the PhilHealth Member Registration Form, fill out, and email to ofp@philhealth.gov.ph

Checking one’s Member Data Record:

To verify if your PhilHealth Member Data Record contains updated information about your membership profile and your list of qualified dependents, click on the Member Inquiry icon under the Online Services section, follow the log-in procedures and check on the accuracy of your member data.

Updating the Member Data Record

  1. Download the PhilHealth Member Registration Form.
  2. Click FOR UPDATING on the upper right-hand side of the form.
  3. Indicate the necessary revisions.
  4. Email the accomplished form to ofp@philhealth.gov.ph
  5. Await via email a copy of your updated Member Data Record.

Premium Contribution Rates

  1. For land-based OFW:
  • Based on the amount prescribed by the PhilHealth.
  • Minimum current rate is Php 2,400 per year.
  • This can be paid in advance for two years to five years, or depending on the duration of the employment contract with the overseas employer.
  1. For sea-based OFW:
    • The premium contribution rate is salary-based following the premium schedule for the Formal Economy.

Where to pay premium contributions:

  • Premium payments can be made overseas through any PhilHealth accredited collecting agents and tie-ups.
  • Payments may also be made at any accredited collecting partners in the Philippines or through PhilHealth Counter at the Philippine Overseas Employment Administration (Ortigas Ave., Mandaluyong City).

Notes for Filipino Seafarers

PhilHealth coverage need not end when your contract with manning agency ends.  If vacationing in the Philippines while waiting for contract renewal, sea-based OFW members should pay their premium contributions to ensure benefits availment should the need arises.

Source: www.philhealth.gov.ph

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June 19 (1)

It is that time of the year when dengue mosquitoes seem to be more active in hunting their prey.  Young and old alike can fall victim to these pesky insects that carry the deadly dengue virus.  It is no secret why emergency rooms are never without a patient exhibiting the early signs of dengue fever.

Does PhilHealth cover dengue fever cases?

Yes.  That is why it is important that you keep your PhilHealth account updated because you never know when serious illnesses might attack.

PhilHealth’s coverage for dengue fever is based on the severity of the patient’s case.  There are simple cases of dengue and there are those that are listed as severe.  PhilHealth coverage will always be based on the attending physician’s final diagnosis.  Below is the list of case rates for dengue fever:

DESCRIPTION

CASE RATE PROFESSIONAL FEE

HEALTH CARE INSTITUTION FEE

Dengue without warning signs: Dengue fever (DF) Dengue hemorrhagic fever Grades 1 and 2; Dengue hemorrhagic fever without warning signs. 10,000.00 3,000.00 7,000.00
Dengue with warning signs; Dengue hemorrhagic fever with warning signs. 10,000.00 3,000.00 7,000.00
Severe Dengue; Severe Dengue Fever; Severe Dengue hemorrhagic fever. 16,000.00 4,800.00 11,200.00

To avoid inconvenience and delays in your claims, make sure that your PhilHealth contributions are updated every month.  You never know when diseases may strike and your only assurance of financial assistance during times of emergency is a flawless record with PhilHealth.

Keep your homes and yards dengue-free and make sure that your children are protected against mosquito bites while they are in school or at play.

If you have questions about PhilHealth, send us an email and we will do our best to find the answers for you.

Source: www.philhealth.gov.ph

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May 28

One of the leading causes of death in the Philippines remains to be uncontrolled hypertension leading to heart disease and stroke.  In 2017, it was reported that 25% of Pinoy adults have high blood pressure caused by either their lifestyle or inherited the condition from their parents and elders.  The climate and high fat, high sodium diet in the Philippines do very little to help Filipinos avoid the burden of hypertension.

The good news is that hypertension is a manageable disease and the patient is likely to keep its complications at bay with low-cost preventive measures like exercise and diet changes.  Regular visits to one’s physician and easy access to an emergency room can help arrest any adverse effects of an elevated blood pressure as well.

It is good to know that hypertension is covered by the PhilHealth and is available to all bona fide members and their dependents.  Below are some important things you need to remember when claiming your PhilHealth benefits for cases of hypertension:

  1. PhilHealth will cover up to Php 9,000.00 for hypertension cases, where:
  • 30% is for professional fees (Php 2,700.00);
  • 70% for room and board, drugs, supplies, ancillary tests, laboratory, and other procedures (Php 6,300.00).
  1. Benefits for hypertension cases are covered by the No Balance Billing (NBB) policy.
  • Hospitals should be able to provide the complete and quality service for hypertensive Philhealth member patients.
  • The member patient should no longer make out-of-pocket payments for his room, board, medicines, supplies, laboratory, X-ray procedures, and professional fees.
  1. Member patients can claim from PhilHealth only if they are admitted to the hospital (not outpatient cases or emergency room only).
  2. The benefits of hypertension cases are covered by the Single Period of Confinement (SPC) rule. This means that only one claim for hypertension benefits can be applied every 90 days.

A hypertensive person’s blood pressure can shoot up anytime.  It is best to always be armed with your PhilHealth benefits to help ease the burden of hospital expenses.  Of course, the best way to keep yourself from the hassles of hospital confinement and expenses is to exert extra efforts in making sure that you lead a healthy lifestyle:

  • Grab every opportunity to walk instead of riding your car, a cab, or even the elevator.
  • Drink plenty of water.
  • Avoid salty food and those that are high in cholesterol.
  • Get enough sleep.
  • Free your mind of negative thoughts.

Have a hypertensive-free summer, folks!

 

Source: www.philhealth.gov.ph

 

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May 15

Pinoys have yet to fully accept the values and benefits of being insured.  Whether it is a life or medical insurance, every working Filipino must be protected from the inevitable.  When unfortunate situations arise – a family member gets sick, a child meets an accident – it is best to be prepared.

If you are employed by the government or by a private firm, it is most likely that you are granted a medical insurance sponsored by your employer.  This is a good thing to have, especially if it is extended to your family.  However, this is only applicable while you are salaried by your employer.  The moment you quit your job (or it quits you!), you lose the privilege and will be left on your own to manage when you or someone in your family gets sick.

That is why it is important that you have yourself enlisted as a member of the PhilHealth, if you haven’t yet.  The PhilHealth voluntary membership is open to anyone who does not have a fixed employment, not a senior citizen, not an indigent member, or sponsored member of the PhilHealth.

Who are qualified to become voluntary PhilHealth members?

  1. OFWs – documented or undocumented Filipino workers abroad.
  2. Self-employed professionals – self-earning individuals such as entrepreneurs, lawyers, doctors, and freelancers whose income is generated from their profession or business.
  3. Informal sector workers – people working in the informal economy, including jeepney and tricycle drivers, street and market vendors, and small construction workers.
  4. Dual citizens – Filipinos who also hodl citizenship in another country.
  5. Naturalized Filipino citizens – foreigners who have become Filipino citizens through naturalization.
  6. Expats – foreign workers who live in the Philippines with valid working permits or Alien Certificate of Registration.

What documentary requirements do you need to prepare when applying?

You only need a duly accomplished PhilHealth Member Registration Form (PMRF) and submit this to the nearest Local Health Insurance Office or PhilHealth Express outlet.

You will then be issued a Member Data Record or MDR and an ID card after your application has been reviewed.  Your PhilHealth ID number will serve as your lifetime PhilHealth number and must be used as reference when you pay your contributions to the cashier.

Online application is also available!

  1. Go to the PhilHealth Electronic Registration System.
  2. Click on “Proceed”.
  3. Read the Terms and Conditions, tick the small box below, and click “Accept”.
  4. On the PhilHealth online registration form, enter the required information.
  5. Upload your document in jpeg, pdf, gif, or png format.  (optional)
  6. Enter the provided Captcha code, tick the small box below, and click “Submit Registration”.

Access your email for the instructions on how to complete the rest of your application.  Take note of your transaction number as this will serve as your reference number to your registration.

How much should be my contribution?

Members earning PHP 25,000 or below every month must pay a quarterly contribution of PHP 600 (or PHP 200 per month / PHP 2,400 per year).

Members earning over PHP 25,000 must pay PHP 900 for the quarter (or PHP 300 per month / PHP 3,600 per year).

It costs so little to become a bona fide PhilHealth member, but the assurance of knowing that you are covered by the PhilHealth when emergencies strike will far outweigh the price you think you are paying now.

Visit the nearest PhilHealth office now and have yourself signed up as a member.

Reference: http://www.philhealth.gov.ph

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May 03 - 1

In a previous article, we featured the guidelines on how you can be sure that you are eligible to claim your PhilHealth benefits after you have been confined and treated in a hospital.  There are cases, however, when even a qualified PhilHealth member is not able to fully enjoy his privileges in spite of showing sufficient proof that he or she must be afforded his PhilHealth benefits.  Sadly though, the causes of these issues are often due to the medical facility’s negligence and refusal to abide by the policies set by PhilHealth for its affiliated clinics and hospitals.

To help you maximize your PhilHealth benefits, here are four important tips you need to know when applying your privileges as a PhilHealth member:

  • PhilHealth does not refund benefits directly to members.

This means that the hospital or clinic must deduct the amount of PhilHealth’s participation in your treatment, from your total hospital bill.  The benefits may not be converted to cash that the hospital “pays” to the patient.

  • The PhilHealth benefit must be applied AFTER other tax deductions, including the Senior Citizen discount.

The Senior Citizen discount and Value-added Tax (VAT) are different from PhilHealth benefits.  If the patient is a Senior Citizen, the SC and VAT must first be deducted from his total hospital bill, before his PhilHealth benefits are applied.

This computation is applicable only if the No Balance Billing was not applied to the patient’s case.

  • 3 Must-have documents when claiming your PhilHealth benefits:
    • PhilHealth Claim Form 1 (CF1)
    • Member Data Record (MDR)
    • Contributions Record
  • PhilHealth members with complete documents must not be made to pay the hospital bill in full.

Some health institutions make the patient pay the full hospital bill with the promise of refunding them their PhilHealth benefits after they have received the funds from PhilHealth.

This is not how PhilHealth benefits are disbursed to members.

Should the hospital demand that you pay the bill in full, even after you have satisfied all requirements for the application of your PhilHealth benefits, report them right away to PhilHealth.  Most hospitals have PhilHealth helpdesks in its premises; you may also call the PhilHealth call center at 02-441-7442.

Reference: www.philhealth.gov.ph

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I recently visited a money remittance center in Baguio City and claimed some cash that was sent to me by a relative.  I used my PhilHealth Insurance ID as proof of my identity.  When the teller called my name, I approached her window and claimed my cash.  But before she handed my ID back to me, she asked, “Bakit ganyan ang PhilHealth ID mo?”

I was taken aback and gave her a quizzical look.  She probably sensed my confusion because she immediately showed me her PhilHealth ID and said, “Kasi yung sa amin itong luma pa.  Papano ka nakakuha ng magandang PhilHealth ID?”  This time, she was already smiling.

I said that my ID is the insurance card version that I got from PhilHealth when they conducted an onsite application at our office.

Apparently, not all PhilHealth members are aware that they can get the new PhilHealth Insurance Card version of their PhilHealth IDs.  And how.  So today, we are going to share with you how you can apply for this sleek card, even if PhilHealth does not hold an online application event in your office.

How to get a PhilHealth ID?

First things first: you have to be a member of the PhilHealth before you can apply for either the paper ID or the plastic ID card.  Once you are enrolled as a member, you will be assigned a lifetime PhilHealth number which will be asked of you every time you avail of benefits and privileges.  You do not have to have an ID in order to be granted your PhilHealth benefits, you just need to have a membership number.

If you are already a registered PhilHealth member, here’s how you can get the PhilHealth regular ID card:

  1. Download PhilHealth’s registration form from their website (PMRF).
  2. Submit the PMRF to the nearest Local Health Insurance Office together with the following documents:
  • Two 1×1 latest ID picture;
  • Two valid IDs; and
  • Any of the following documents:
    • For SSS pensioners
      • Photocopy of Death, Disability, and Retirement (DDR) indicating the date of retirement and effectivity date of pension.
      • Photocopy of the Retiree/Pensioner Certification indicating the effectivity date of retirement.
    • For GSIS pensioners
      • Photocopy of Certification/Letter of Approval of Retirement indicating the effectivity date of retirement.
      • Photocopy of Service Road issued by the employer showing rendered services of not less than 120 months.
      • Photocopy of Certificate/Retirement Gratuity from the employer indicating services of not less than 120 months.
      • Photocopy of retirement voucher issued by GSIS.
    • For Uniformed personnel of AFP, PNP, BJMP, and BFP
      • Photocopy of General/Special or Bureau Order indicating effectivity date of retirement.
      • Photocopy of Certification/Letter of Approval of Retirement from the GSIS indicating services of not less than 120 months.
      • Photocopy of Statement of Services issued by previous employer showing service of not less than 120 months.
    • GSIS Disability Pensioner/SSS Permanent Total Disability Pensioner before March 4, 1995.
      • Photocopy of Death, Disability and Retirement (DDR) indicating the date of retirement and effectivity date of pension.
      • Photocopy of Disability Pensioner Certification issued by SSS/GSIS indicating effectivity date of pension or the period of coverage for a disabled pensioner.
    • SSS Survivorship Pensioner before March 4, 1995.
      • Photocopy of Death, Disability, and Retirement indicating the type of survivorship in nature and the effectivity date of pension.
      • Photocopy of Survivorship Pensioner Certification indicating the effectivity date of pension.
    • Other individuals who are not under the above-mentioned categories.
      • Photocopy of official receipts of premium payments to PhilHealth.
      • Any other documents indicating the months of premium payments to PhilHealth.
  1. Await Member Data Record (MDR) and PhilHealth ID Card.

PhilHealth Insurance Card

After you have accomplished the process above, you just need to do a few things to get the PhilHealth insurance card.

  1. Download PhilHealth’s registration form from their website (PMRF).
  2. Submit PMRF to the nearest LHIO or any of their SM Mall branches together with the following documents:
  • Two (2) 1×1 latest ID picture,
  • Two (2) valid IDs;
  • Photocopy of official receipts of premium payments to PhilHealth or any other documents indicating the months of premium payments to PhilHealth.
  • Two (2) valid IDs of your dependent (if you wish to include them).
  1. Declare your dependents to apply for maximum benefits (if applicable).

4. Pay P90 for the ID; P358 additional if you wish to include your dependents.

If you have questions about securing your very own PhilHealth ID, send us a message and we will do our best to find the answers for you.

Reference:

http://www.philhealth.gov.ph

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Mar 14 (1)

The Philippine Health Insurance Corporation is responsible for implementing universal health coverage for Filipinos.  Every Pinoy must be listed as a member of the PhilHealth and make regular contributions to secure his claims in the event that he gets sick or gets into a medical emergency.  In the same manner, PhilHealth, being a social insurance program, provides a means for the healthy to pay for the care and wellness of the sick and those who cannot readily afford medical procedures and assistance.

As soon as an individual reaches the age of 21, whether employed or still studying, he or she must already be enrolled and provided with a PhilHealth number.

How does one become a PhilHealth member?  Here are the steps, procedures, and requirements to get a PhilHealth number and begin making contributions to the agency.

Requirements for: UNEMPLOYED MEMBERS (Individually Paying Member)

Submit the following to the nearest PhilHealth office in your area.  Foreigners residing in the Philippines may also enroll in the PhilHealth under this membership category.

  1. Duly filled out PhilHealth Membership Form (PMRF).  You may download a copy of the form here: https://www.philhealth.gov.ph/downloads/membership/pmrf_revised.pdf
  2. Photocopy of PSA birth certificate or any valid government-issued ID.  Bring an original copy of your birth certificate for verification.
  3. Photocopy of supporting documents for your beneficiaries.
  4. Two latest 1×1 ID pictures.
  5. Photocopy of Alien Certificate of Registration (ACR) issued by the Bureau of Immigration (for foreigners only).

Your PhilHealth number will be issued to you on the same day.  Your PhilHealth membership is a lifetime membership and will not change even if you change membership status (in case you become employed or later on, as a Senior Citizen).

Requirements for: EMPLOYED MEMBERS

  1. Duly filled out PhilHealth Membership Form (PMRF), making sure you include your employed status.
  2. Photocopy of PSA birth certificate or any valid government-issued ID.  Bring an original copy of your birth certificate for verification.
  3. Photocopy of supporting documents for your beneficiaries.

Requirements for: OFWs

OFWs may register and pay their contributions once they are registered at the POEA.

  1. Duly accomplished PMRF
  2. Supporting documents of beneficiaries
  3. Any proof of being an active OFW

 

How to get your PhilHealth ID?

There are actually two types of PhilHealth IDs.

  • The paper ID that can be used when claiming inpatient or outpatient hospital benefits. This can be claimed without charge at any PhilHealth Local Health Insurance Office (LHIO).
  • The PhilHealth Insurance ID Card – a digitized ID card issued to members in the Formal Economy and Informal Sector.  This is issued on a voluntary basis at a cost of P90.00.  It is a duly recognized valid government-issued ID.

Both IDs may be applied for at any PhilHealth office.

The following perks are made available to holders of the digitized ID card:

  • 15% discount on generic drugs on Watson’s, Rose Pharmacy, South Star Drug, and The Generics Pharmacy.
  • 20% to 80% discount on flu vaccines on PQ Health Shield and GSK.
  • Free eye exam from Vivian Sarabia optical.
  • 20% discount on regular items in Vivian Sarabia Optical.
  • 10% discount on drug testing services at JNW Drug Testing sites.

Being a PhilHealth member and having any of the two types of IDs above are the most effective ways to claim your health assistance benefits at private and public hospitals.  Always update your contributions to ensure that you are able to claim your benefits in full, when and where you need to.

Reference: www.philhealth.gov.ph

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