Tag Archive: Philhealth Contribution


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 - 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/

Chips And Nibblers (1)

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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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Philhealth MDR

Yesterday we shared the step-by-step process on how to create an online Philhealth account.  Now that you have one, you are free to enjoy the convenience of monitoring your and your employer’s contributions online.  Much more, you may now download and print a copy of your Member Data Record (MDR) whenever you need it.

The MDR is required when claiming hospitalization benefits for you or your declared dependents.  If you do not have an online Philhealth account, you will have to wait in line at a Philhealth branch or satellite office in order to get a copy.  Imagine the utmost convenience of simply logging in to your account and printing the needed document, all because you have an online Philhealth account!

To help you save time in studying the process on how to download a copy of your MDR, we are sharing the following visual guide.  Bookmark this and share in your network!

Step 1: Log on to your Philhealth online account from the Philhealth website www.philhealth.gov.ph

1. Philhealth Login

Step 2: You will be asked to answer your Challenge Question.  You supplied the answer to this question when you created your online account.  Supply the correct answer in order to access your account.

2. Philhealth Challenge Question

Step 3: After you have entered the correct answer to the challenge question, you will be taken to the homepage of your online account.  From here, you have access to your profile, premium contributions, password resets, and MDR Printing.  Click on MDR Printing to get a copy of your MDR.

3. Philhealth Member Information

Step 4: After clicking the MDR Printing link, a new tab will launch on your browser.  You have the option to print the document straight from the browser or save it on your computer for future reference.  Make sure that all pertinent details on your MDR are accurate and clear:

4. Philhealth MDR (1)

Try it now to see if you are able to login successfully to your account and that your MDR has all the correct information.

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

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Philhealth Online

An online account with Philhealth allows you to monitor your monthly contributions and gives you an access to print your Member Data Record (MDR) anywhere you are.  Normally, a Philhealth member who does not have an online account will have to wait in line at a Philhealth branch or satellite office in order to obtain a copy of his MDR.  The MDR is required when a member’s dependent is confined in a hospital.

Here is how you can conveniently create an online account and never have to wait in line again when you need a copy of your MDR:

Step 1: Log on to the Philhealth website (www.philhealth.gov.ph) and click on the “Register” link.  You can find this on the right side of the screen, below the Login button.

Philhealth3

 

Step 2: You will be taken to the registration page.  Supply all required information as shown below:

Philhealth1

Philhealth2

Step 3: Wait for a small pop-up window that will confirm that your registration is successful.  Once you see this, you must log on to your email to complete the activation of your account.

Philhealth4

Step 4: Once logged on to your email, click on the link provided to complete the activation of your account.  Meantime, keep the PIN and password sent by Philhealth to your email.  This will serve as your access to your online account.

Philhealth5

Now that you have an online Philhealth account, you may check your contributions anytime and print your MDR whenever you need it.  No more waiting in line!

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

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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

How Much Will Philhealth

It is a good thing to be a member of Philhealth as it assures you of assistance in paying your hospital bills.  Their recent update on the guaranteed membership of Senior Citizens added to the insurance’s value to Filipinos.  Patients recovering from their illnesses can sleep soundly knowing that they can count on ready assistance from Philhealth.

To help us understand better how far Philhealth will go to support us in our hospital expenses, here is a “price list” of Philhealth’s participation on certain medical and surgical cases.  It is best to consult with your doctor or hospital as well to be sure of the fees that will be charged to your account.

Medical Cases (in Php)

  1. Dengue I (Dengue fever, DHF grades I & II) – 8,000
  2. Dengue II (DHF grades III & IV) – 16,000
  3. Pneumonia I (moderate risk) – 15,000
  4. Pneumonia II (high risk) – 32,000
  5. Essential Hypertension – 9,000
  6. Cerebral Infarction (CVA-I) – 28,000
  7. Cerebral Hemorrhage (CVA-II) – 38,000
  8. Acute Gastroenteritis (AGE) – 6,000
  9. Asthma – 9,000
  10. Typhoid Fever – 14,000
  11. Newborn Care Package in Hospitals and Lying in Clinics – 1,750

Surgical Cases (in Php)

  1. Radiotherapy – 3,000
  2. Hemodialysis – 4,000
  3. Maternity Care Package (MCP) – 8,000
  4. NSD Package in Level I Hospitals – 8,000
  5. NSD Package in Levels 2 to 4 Hospitals – 6,500
  6. Caesarean Section – 19,000
  7. Appendectomy – 24,000
  8. Cholecystectomy – 31,000
  9. Dilatation and Curettage – 11,000
  10. Thyroidectomy – 31,000
  11. Herniorrhaphy – 21,000
  12. Mastectomy – 22,000
  13. Hysterectomy – 30,000
  14. Cataract Surgery – 16,000

Source: http://www.pinoy-ofw.com/directory/question/how-much-is-the-amount-covered-by-philhealth-for-surgical-and-medical-cases

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