Tag Archive: Philhealth Benefits


07 - 27

Matagal na akong hindi nakapag hulog sa aking SSS / Philhealth account; ngayon, may sakit ako at maco-confine.  Pwede ko bang habulin ang mga nalibanan kong buwan para makapag claim pa din ako ng benefits?

This is a common question we receive from followers.  Apparently, a lot of Filipinos think that paying their monthly contributions for government-mandated insurances is optional.

It isn’t.  We all need to activate our SSS and Philhealth memberships and diligently remit our monthly contributions to ensure that we are protected and covered by benefits.

We summarized SSS and Philhealth’s requirements and needed premium payments before a member can claim his benefits from these government agencies.  We aim to encourage everyone to update and maintain their monthly contributions to ensure hassle-free benefits claim anytime emergency strikes.

Read on.

Philhealth

  • Member must have paid at least three months’ premium contributions within the immediate six-month period prior to the first day of confinement to avail of benefits.
  • Philhealth does not accept retroactive payments for unpaid months.
  • Contributions made on admission date, during the confinement period, or after the member or dependent is discharged from the health care institution will not be counted as qualifying contributions.

What are the requirements for eligibility and when is a member eligible to claim?

Sponsored Members Date of hospitalization/availment must be within the effectivity period indicated in the member’s ID and MDR.
Individually Paying Members 1. There are certain confinement cases wherein three months worth of premium within the last sixmonths (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.

Lifetime Member The member just has to show their Lifetime ID Card; no need to pay premiums anymore.  This now includes Senior Citizens; in which case, all they need to show is their SC IDs.
Employed Members Three months worth of premium within the last six months (3/6) prior to hospitalization.
Overseas Workers Date of hospitalization/availment must be within the coverage period specified in the member’s MDR.

 

SSS

A. Maternity Benefits

The maternity benefit is offered only to female SSS members.  A member is qualified to avail of this benefit if:

  1. She has paid at least three monthly contributions within the 12-month period immediately preceding the semester of her childbirth or miscarriage.
  2. She has given the required notification of her pregnancy to SSS through her employer if employed; or submitted the maternity notification directly to the SSS if separated from employment, a voluntary or self-employed member.
  3. SSS does not accept retroactive payments for unpaid months.

The maternity benefit shall be paid only for the first four (4) deliveries or miscarriages.

B. Sickness Benefits

The sickness benefit is a daily cash allowance paid for the number of days a member is unable to work due to sickness or injury.

A member is qualified to avail of this benefit if:

  1. He is unable to work due to sickness or injury and confined either in a hospital or at home for at least four days;
  2. He has paid at least three months of contributions within the 12-month period immediately before the semester of sickness or injury;
  3. He has used up all current company sick leaves with pay; and
  4. He has notified the ER, or directly the SSS, if separated from employment, VM or SE regarding his sickness or injury.

C. Retirement

The retirement benefit is a cash benefit paid either in monthly pension or as lump sum to a member who can no longer work due to old age.

A member is qualified to avail of this benefit if:

  1. Member must have paid at least 120 monthly contributions prior to the semester of retirement and is any of the following, whichever is applicable:
    • At least 60 years old and separated from employment or has ceased to be an SE/OFW/Household Helper (optional retirement);
    • At least 65 years old whether still employed/SE, working as OFW/Household Helper or not (technical retirement);
    • At least 55 years old and separated from employment or has ceased to be an SE, if an “underground mineworker” (optional retirement);
    • At least 60 years old whether still employed/SE or not, if an “underground mineworker” (technical retirement); or
    • A total disability pensioner who has recovered from disability and is at least 60 years old (or at least 55 years old, if an underground mineworker).
  2. A former retiree-pensioner whose monthly pension was suspended due to re-employment / self-employment and is now separated from employment or has ceased to be an SE.
  3. A member who is 60 years old and above, but not yet 65, with 120 contributions or more may continue paying as VM up to 65 years old to avail of the higher amount of benefit.

If you have questions regarding benefit claims from Philhealth and SSS, send us a message and we will do our best to find the answers for you.

 

Sources:

www.sss.gov.ph

www.philhealth.gov.ph

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07 - 10

The fourth and final installment of our series on Philhealth benefits will focus on orthopedic surgeries, renal diseases, and other types of cancer.  When availing of these benefits, it is best to see a Philhealth representative at the hospital where you are confined or call their Action Center number at 02-447-7442.

Read on.

Benefit Package and Amount Selections Criteria
Z MORPH (Mobility, Orthosis, Rehabilitation, Prosthesis Help)

–          First right and / or left below the knee P15,000.00

–          Both limbs P30,000.00

a. Signed ME Form;

b. No associated disabilities or co-morbidities, such as contractures, deformities, mental, and behavioral incapacity, quadriparesis, cardiopulmonary disease;

c. Community ambulation with or without cane, crutches, or walker;

d. At least three months post-amputation, if acquired; and

e. At least 15 years and 364 days of age, if congenital.

Selected Orthopedic Implants

1. Implants for Hip Arthroplasty

a.  Implants hip prosthesis, cemented P103,400.

b. Total hip prosthesis, cementless P169,400.

c. Partial hip prosthesis, bipolar P73,180.

a. Signed ME Form;

b. Should pass Philhealth’s prescribed Clinical Features.

c. Pre-injury status: ambulatory patients.

d. With no more than two co-morbid illnesses based on physical status classification based on ASA.

2. Implants for Hip Fixation

a. Multiple screw fixation (MSF) – P61,500

a. Signed ME Form

b. Any hip fracture not covered under the total hip package for femoral neck fracture.

c. Pre-injury status: ambulatory patients.

d. With no more than two co-morbid illnesses based on: Physical status classification based on ASA (low to moderate risk).

3. Implants for Pertrochanteric Fracture

a. Compression Hip Screw Set (CHS) – P69,000

b. Proximal Femoral Locked Plate (PFLP) – P71,000

a. Signed ME form;

b. CHS: stable fracture of the intertrochanteric area.

c. PFLP: unstable/comminuted pertrochanteric fracture .

d. Pre-injury status: ambulatory patients.

e. With no more than two co-morbid illnesses based on: Physical status classification based on ASA (low to moderate risk).

4. Implants for Femoral Shaft Fracture

a. Intramedullary Nail with Interlocking Screws – P48,740.

b. Locked Compression Plate (LCP) – Broad/Metaphyseal/Distal Femoral LC – P50,740.

a. Signed ME Form

b. Should pass Philhealth’s requirements for Femora Shaft Fracture and physical status classification based on ASA.

“PD First” – for End-stage Renal Disease Requiring Peritoneal Dialysis – P270,000 per year. a. Signed ME Form (to be submitted annually together with the pre-authorization)

b. Patients must have a permanent Tenckhoff peritoneal dialysis catheter properly placed in the abdominal cavity;

c. Patients must have completed PD initiation in an accredited healthcare institution so that the patient is no longer uremic, with stable vital signs and adequately trained (patient himself/herself or a caregiver) to perform PD at home using manual exchanges;

d. Must pass Philhealth’s clinical criteria (including age of patient, history of cancer, etc.)

Colon and Rectum Cancer

a. Colon Cancer

– Stage I – II (low risk) – P150,000

– Stage II (high risk) – III – P300,000

b. Rectum Cancer

– Stage I (clinical and pathologic) – P150,000

– Pre-operative clinical stage I but with post-operative pathologic stage II – III

– Using linear accelerator as mode of radiotherapy P400,000.

– Using cobalt as mode of radiotherapy P320,000

– Clinical Stage II – III

-Using linear accelerator as mode of radiotherapy P400,000.

-Using cobalt as mode of radiotherapy P320,000.

It pays to be well-informed especially with government benefits such as financial assistance when a family member is sick and needs to be hospitalized.  Always make sure that you are transacting with a Philhealth-accredited health institution and medical practitioners.

If you have questions about Philhealth benefits, send us a message and we will do our best to find the answers for you.

Source: https://www.philhealth.gov.ph/benefits/

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07 - 07

Z Benefit Packages were created by the government to help address patients’ needs of some cancer cases and other illnesses that require longer hospital confinement and special treatment procedures.  These are available through Philhealth and may be availed by contributing members and their qualified dependents.

In the third installment of our blog series on Philhealth benefits, we are going to feature the partial list of illnesses categorized as “Z” cases and the corresponding amount of Philhealth benefits for each:

Benefit Package and Amount of Benefit Selections Criteria
Acute Lymphocytic / Lymphoblastic Leukemia (standard risk)

Php 210,000.00

a. Signed Member Empowerment (ME) Form;

b. Age 1 to less than 10 years old;

c. White blood cell count <50,000/µL;

d. No CNS leukemia diagnosis

Breast Cancer (Stage 0 to IIIA)

Php 100,000.00

a. Signed ME form

b. Follow Philhealth’s prescribed clinical and TNM staging.

Prostate Cancer (low to maintenance risk)

Php 100,000.00

a. Signed ME Form;

b. Male patients age up to 70 years old;

c. Follow Philhealth’s prescribed clinical stage.

d. Localized prostate cancer; and

e. No uncontrolled co-morbid conditions.

End-state renal disease eligible for requiring kidney transplantation (low risk)

Php 600,000.00

a. Signed ME Form;

b. Age >10 and <70 years old;

Single organ transplant

c. Follow prescribed conditions for kidney transplant for recipient.

d. Certification from social service of the hospital that they can maintain anti-rejection medicines for the next three years.

Coronary Artery Bypass Graft Surgery (standard risk)

Php 550,000.00

a. Signed ME Form

b. Age 19 to 70 years

c. Should pass current medical status and past history as prescribed by Philhealth.

Surgery for Tetralogy of Fallot in Children

Php 320,000.00

a. Signed ME Form

b. Age: 1 to 10 years + 364 days

c. Should pass 2D Echo and Functional Class specifications prescribed by Philhealth.

Surgery for Ventricular Septal Defect in Children

Php 250,000.00

a. Signed ME Form

b. Age: 1 to 5 years + 364 days

c. Must pass 2D Echo results as prescribed by Philhealth.

d. No previous cardiac surgery.

e. Must pass pulmonary artery pressure as prescribed by Philhealth.

Cervical Cancer:

a. Chemoradiation with Cobalt and Brachytherapy (low dose).

Php 120,000.00

 

b. Chemoradiation with Linear Accelerator and Brachytherapy (high dose)

Php 175,000.00

a. Signed ME Form

b. No previous chemotherapy

c. No previous radiotherapy

d. No uncontrolled co-morbid conditions

e. Treatment plan from gynecologic oncologist

On Monday, we will feature Z benefits dealing with fractures, orthopedic implants, and rehabilitation, so stay tuned.

If you have questions about Philhealth benefits, send us a message and we will do our best to search for the best answers for you.

Have a great weekend!

Source: https://www.philhealth.gov.ph/benefits/

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07 - 06 (1)

Outpatient benefits are applied on hospital visits that are less than 24 hours and without the need for confinement.  Today’s article will focus on such benefits afforded by Philhealth to its contributing members and their dependents.

This is the second part of our feature blog series on Philhealth benefits.

Outpatient Benefits

1. Day Surgeries (Ambulatory or Outpatient Surgeries) – these include elective surgical procedures (non-emergency) ranging from minor to major operations, where patients are safely sent home within the same day for post-operative care.

  • Payments for these procedures are made to the accredited facility through All Case Rates.
  • The case rate amount shall be deducted by the HCI from the member’s total bill, which shall include professional fees of attending physicians, prior to discharge.
  • The case rate amount is inclusive of hospital charges and professional fees of attending physician.
  • Availment condition: Member must have at least three months’ premium contributions within the immediate six months prior to the month of availment.
  • Documents needed: copy of Member Data Record (MDR) and duly accomplished Philhealth Claim Form 1.
  • This is available in all accredited ambulatory surgical clinics (ASC).

2. Radiotherapy

  • Case Rate: P2,000 for radiotherapy using cobalt and P3,000 for linear accelerator (case rate per session).
  • 45 days benefit limit: one session is equivalent to one day deduction from the 45 allowable days per year.
  • Availment condition: Member must have at least three months’ premium contributions within the immediate six months prior to the month of availment.
  • This is available at Accredited HCIs including Primary Care Facilities that are accredited for the said service.

3. Hemodialysis

  • Case Rate: P2,600 per session.
  • 90 days benefit limit: One session is equivalent to one day deduction from the 90 allowable days per year.
  • Availment condition: Member must have at least three months’ premium contributions within the immediate six months prior to the month of availment.
  • This is available at all accredited HCIs.

4. Outpatient Blood Transfusion

  • Case rate: P3,640 (one or more units).
  • Includes drugs and medicines, X-ray, laboratory, operating room.
  • 45 days benefit limit: One session for each procedure is equivalent to one day deduction from the 45 allowable days per year exempted from the SPC rule.
  • Available at all accredited HCIs.

5. Primary Care Benefits

  • Preventive Services
    • Consultation
    • Visual inspection with acetic acid
    • Regular BP measurements
    • Breastfeeding program education
    • Periodic clinical breast examination
    • Counseling for lifestyle modification
    • Counseling for lifestyle modification
    • Counseling for smoking cessation
    • Body measurements
    • Digital rectal examination
  • Diagnostic Examinations
    • Complete blood count
    • Urinalysis
    • Fecalysis
    • Sputum microscopy
    • Fasting blood sugar
    • Lipid profile
    • Chest x-ray
  • Drugs and Medicines
    • Asthma including nebulisation services
    • Acute Gastroenteritis (AGE) with no or mild dehydration
    • Upper Respiratory Tract Infection (URTI) / Pneumonia (minimal and low risk)
    • Urinary Tract Infection (UTI)

Tomorrow we are going to feature Philhealth’s coverage for Z Benefit packages.  These cases include cancer patients, kidney transplantation, Artery Bypass, and the like.

Stay tuned.

Source: https://www.philhealth.gov.ph/benefits/

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07 - 05

The rainy season has officially begun in our country!  And along with the unpredictable changes in weather (warm and sunny in the morning, cold and wet in the afternoon) come different types of bacteria and viruses that cause infections and ailments among kids and adults.  Visiting your doctor’s clinic, or worse, the Emergency Room, could be inevitable during these wet season.

Good thing we have Philhealth to help us cover the unexpected expenses of getting medical treatment!

This week, we will dedicate a blog series on the different benefits that we can avail as Philhealth members, starting off with INPATIENT BENEFITS.  Share this with your friends and family!

Read on!

Inpatient Benefits

  • These benefits are paid to the accredited Health Care Institution (HCI) through All Case Rates.
  • The case rate amount shall be deducted by the HCI from the member’s total bill, which shall include professional fees of attending physicians, prior to discharge.
  • The case rate amount is inclusive of hospital charges and professional fees of attending physician.
  • Availment condition: Member must have at least three (3) months’ premium contributions within the immediate six months prior to the month of availment.
  • Documents needed are:
    • Copy of Member Data Record or
    • Philhealth Benefit Eligibility Form (PBEF)
    • Duly accomplished Philhealth Claim Form 1
  • These benefits can be obtained at all accredited HCIs.  Different case rate amounts for selected medical conditions are being implemented when done in Primary Care facilities.
  • Only admissible cases shall be reimbursed.

Tomorrow we will feature the Outpatient Benefits offered by Philhealth to contributing members.  Meantime, you may send us your questions about Philhealth coverage and we will try our best to look for the answers for you.

See you tomorrow!

Source: https://www.philhealth.gov.ph/benefits/

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01-10-1

For our information and guidance, the Philippine Health Insurance Corporation or PhilHealth, has released their new contribution schedule for employed and self-employed members, OFWs, and Sponsored Program Members for 2017.  Below is the table of contributions and other important announcements from PhilHealth.

philhealth-contribution-2017

Philhealth Contribution Table for OFWs:

OFWs or those under the Overseas Workers’ Program (OWP) shall pay Php 2,400.00 as their annual premium contribution to PhilHealth.  This is also applicable to land-based OFWs, whether documented or undocumented.  Payments may be made in two increments (Php 1,200 every six months) or the full amount of Php 2,400.

PhilHealth Contribution Table for Self-employed, Individually Paying Member:

  1. Members with monthly income of Php25,000 and below shall pay Php2,400 per year.
  2. Members with monthly income above Php25,000 shall pay Php3,600 per year.

Sponsored Program Members:

Whether fully or partially subsidized by the sponsor, members under this category shall pay an annual premium of Php2,400.

Source: https://www.philhealth.gov.ph/

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11-14

We have been receiving a lot of questions about Philhealth contributions and membership renewals so we decided to run a research on these topics.  Below are just some of the questions we researched on; all answers were lifted from the Philhealth website and memorandum circulars available online:

  1. If I don’t get hospitalized in a year, can I refund my unused Philhealth contributions?
  2. Does Philhealth accept retroactive contribution payments?
  3. Do I need to pay more than one Philhealth contribution if I have multiple jobs?
  4. Are my Philhealth privileges transferable to my dependents after I pass away?
  5. Are employed Senior Citizens still mandated to make Philhealth contributions?

Read on:

  1. Can a member who has not used his Philhealth benefits for an entire year refund his Philhealth contributions?

The answer is no.  Philhealth members’ premiums are pooled to become a single fund which is then used to pay for the benefits of sick members.  It being a social health insurance program, whatever funds are not “used” by a member, are kept in the premiums pool.

2. Can a member, who has ceased making regular Philhealth contributions, still use his benefits?  If not, can he pay his missed contributions in lump sum and immediately become eligible for Philhealth benefits once again?

A member should have paid at least three months premium contributions within the immediate six-month period before his medical confinement and Philhealth benefits claim.  If the member is an Individually Paying member, he must have paid at least nine months’ contributions within the last 12 months in order to enjoy the following Philhealth benefits:

  • Pregnancy-related cases
  • Dialysis (except those undergoing emergency dialysis service during confinement)
  • Chemotherapy
  • Cataract Extension
  • Radiotherapy
  • Selected surgical procedures

Only active members (updated contributions payments) will be afforded Philhealth benefits.

Retroactive payments are only allowed if the member can show proof of sufficient regularity of premium contributions or payment of nine consecutive months or three consecutive quarters within the last 12 months prior to the missed quarter.  Should the member be able to execute the said proofs, he shall be given a grace period of one month immediately after the missed quarter to pay retroactively including the current calendar quarter.

Newly enrolled members (with less than 12 months totaled from date of enrollment), retroactive payment for the missed quarter including the current calendar quarter shall also be allowed within the month immediately following the missed period.

This privilege is granted only once every 12 months.

3. If an employed member who was separated from service last October 2011 wants to continue his membership as an Individually Paying Member in March 2012, can he retroactively pay the premiums for November to December 2011 and first quarter 2012, in March 2012?

Yes; the said member shall be given a grace period of one calendar quarter immediately after the unpaid quarterly period to retroactively settle his obligation.

4. Do I need to pay more than one Philhealth contribution if I have multiple jobs?

According to RA 7875 (Section 18-20 of IRR), employers are mandated to enroll their employees, deduct from their salaries the required premium contribution, and remit the same, together with the corresponding employer share, to Philhealth.  This means that Philhealth members who have more than one employment should consequently be deducted of their corresponding employee share by each and every employer with which they are currently employed.

5. Are my Philhealth privileges transferable to my dependents after I pass away?

No; a deceased member’s privileges are automatically terminated as well.  Only the dependents of a Sponsored Member are allowed to use the unexpired portion of the member’s contributions.

6. I already have a lifetime member card, but my current employer still continues to pay for my premiums.  Can these premium contributions be credited to my son/daughter’s membership when I retire?

As mentioned in item number 4, employers are mandated to pay the Philhealth contributions of their employees, including those within the Senior Citizen bracket.  The payments made are non-transferable  and cannot be credited to the Senior Citizen’s dependents after the member retires.

Sources: www.philhealth.gov.ph (Philhealth FAQs)

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09-19

Sea-based Overseas Filipino Workers (OFW) are also encouraged to become Philhealth members or continue their Philhealth contributions even while they are working abroad.  Here are the frequently asked questions of sea-based OFWs regarding Philhealth membership, contributions, and how they can avail of services and benefits.

Q: How do I register as a sea-based OFW Philhealth member?

A: You need to fill out and submit a Philhealth Member Registraton Form to the Human Resource Department of your Manning Agency.  You may also download a copy of the form here (hyperlink PDF copy).

Q: How do I update my personal information?

A: Secure a copy of the Philhealth Member Registration Form (PMRF) (hyperlink PDF copy) and submit accomplished copy to the nearest Philhealth office or email to ofp@philhealth.gov.ph.  Include supporting documents.  Make sure that you signed the PMRF as proof that all submitted information are true and correct.

Q: Can I still continue paying my Philhealth contributions even after my contract has already expired?

A: Yes.  All sea-based OFWs are encouraged to continue paying their Philhealth contributions. This ensures continuous Philhealth coverage of the member and his listed dependents.

After expiration of job contract, the member only needs to update his membership category at Philhealth from Formal Economy to Informal Economy member.  He needs to do this every time his contract expires.  Premium contribution as an Informal Economy member is PHP 600.00 per quarter.

Q: What do I need to submit to avail of the benefits?

A: For confinement in the Philippines, bring the following:

  • Duly accomplished copy of the Philhealth Claim Form 1 (CF 1). If the OFW member is currently on-board a vessel or job contract has not expired yet, the second part of the CF 1 must be signed by the Manning Agency. You may secure a copy of the CF 1 from the hospital.
  • Copy of MDR.
  • Proof of contributions (if not stated in the MDR).

For confinement abroad, submit the following to any Philhealth office in the Philippines within 180 days after member has been discharged from the hospital:

  • Statement of account in English.
  • Copy of medical certificate in English, with clear description of diagnosis, confinement period, and procedures given to the patient.
  • Official receipt of patient’s hospital and physician fees.

Next week, we will feature Philhealth information for Pinoys residing permanently abroad as immigrants and those with dual citizenship.

Source: www.philhealth.gov.ph

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09-15-1

Philhealth membership is open to all Filipinos in the country and those working abroad.  Recently, automatic membership has been granted to Pinoy senior citizens, a move that delighted our parents.  Lolos and Lolas as they no longer need to pay their Philhealth contributions but are assured of Philhealth assistance when they need medical care.

This article shall focus on all the information that Pinoys need regarding Philhealth membership while they are working abroad as land-based OFWs.  Share this to your family and friends who are Philhealth members or want to become Philhealth members but are residing outside the Philippines.

Q: I forgot my Philhealth number, where can I verify?

A: You can send an email to ofp@philhealth.gov.ph, include the following information:

  • Last Name
  • First Name
  • Middle Name
  • Birthday

A Philhealth representative will reply to your email with your Philhealth number.

Q: I used to be a Voluntary Member of Philhealth.  I am an OFW now.  What are the documentary requirements I need to submit in order to update my membership category?

A: You need to accomplish a PMRF form and submit this to any Philhealth office with the following documentary attachments:

  • Valid Overseas Employment Certificate (OEC)
  • Valid E-Receipt
  • Valid working visa/re-entry permit
  • Valid job employment contract
  • Valid company ID issued by employer abroad
  • Certificate of Employment for applicable period from employer abroad
  • Cash remittance receipt from member abroad at least 2 months prior to the date of renewal/payment
  • Valid ID/Certificate issued to OFWs in the host country
  • Any other equivalent proof, subject to the approval of the authorized officer.

Q: My foreign employer has granted me an insurance abroad, do I still need to pay for my Philhealth contributions?

A: Yes because Philhealth is mandatory among OFWs.  Through your contributions, you can still avail of Philhealth benefits abroad and also cover your qualified dependents in the Philippines.

Q: Can I still pay my contributions for the months I missed?

A: Yes, Philhealth gives OFWs a 30-day grace period to settle unpaid contributions from the expiry date.

Q: When can I use my Philhealth benefits?

A: If your contributions are updated, you may use your Philhealth benefits within the validity coverage stated in your MDR.

Q: What numbers do I call if I have questions regarding my Philhealth OFW membership?

A: You may call the following numbers:

  • Corporate Action Center: (63) 2 – 4417442
  • OFW Mobile Phone: +63 917 5129149

You may also send an email to: actioncenter@philhealth.gov.ph and ofp@philhealth.gov.ph

Next week, we will post facts for Sea-based OFWs and Filipinos residing abroad.

Source: www.philhealth.gov.ph

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09-07

Private insurance firms allow policy holders to freely choose who among his family members – by consanguinity or affinity – to declare as his dependent or beneficiary.  This may not be true with the Philippine Health Insurance Corporation or Philhealth as they follow stricter rules in identifying who among the member’s family may be declared as his dependent.

Below are two prevalent questions raised by Philhealth members who would like to make their spouses and live-in partners as their Philhelath dependents.  These information were lifted from the Philhealth’s website:

How can a member declare his spouse whose membership is inactive as a dependent?

The inactive member-spouse must submit the following at any Philhealth Office:

  1. 2 copies of duly accomplished Philhealth Member Registration Form.
  2. Clear copy of PSA Marriage Certificate with registry number (please bring original copy for validation).
  3. Request letter to be declared as legal dependent signed by the inactive/unemployed spouse.

After processing, Philhealth will issue a new (updated) Member Data Record which indicates the name of the spouse (inactive) as legal dependent of the active member.

Can my live-in partner be declared as my legal dependent?  How about our children?

While the live-in partner cannot be declared as a legal dependent (one of the supporting documents required is the marriage certificate), your children can still qualify as dependents.

Simply update your MDR and submit the necessary supporting documents (i.e. PSA Birth Certificates) of your children.

How is updating of membership records done?

Ideally, members should update their MDR when:

  1. They have to shift membership categories (e.g. individually paying to employed);
  2. They get married;
  3. New dependents shall be declared;
  4. Incorrect information in old MDR need to be corrected.

To update your MDR, simply submit an updated PMRF to the nearest Philhealth Office, along with the necessary supporting documents (PSA Marriage Certificate, PSA Birth Certificates, etc.).  You can have copies of your marriage and birth certificates delivered to you by ordering online at www.psahelpline.ph.

For further questions, you may call the Philhealth customer service hotline at (02) 441 7442 or visit their website at www.philhealth.gov.ph.

Source: www.philhealth.gov.ph

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