Tag Archive: Philhealth


3 Mar 21.jpg

Now that we have the list of documents and IDs that can be presented when registering for a National ID, we shall be sharing the areas of registration centers where citizens and resident aliens can submit their application.  The following list was lifted from the Implementing Rules and Regulations of the RA 11055 or the Philippine Identification System Act.

Section 8. Registration

  1. Registration Centers

Every citizen or resident alien shall register personally in any of the following registration centers that have the necessary facilities to capture the information required to be contained in the registry.  These registration center shall be made available one year after the effectivity of this Act:

  • Philippine Statistics Authority (PSA) Regional and Provincial Offices;
  • Local Civil Registry Offices (LCROs);
  • Government Service Insurance System (GSIS) for its members and their dependents;
  • Social Security System (SSS) for its members and their dependents;
  • Philippine Health Insurance Corporation (PhilHealth);
  • Home Development Mutual Fund (HDMF);
  • Commission on Elections (COMELEC);
  • Philippine Postal Corporation (PHLPost); and
  • Other government agencies and GOCCs as may be assigned by the PSA.

Take note:

  • The list of offices of the above-mentioned agencies, which will be designated as registration centers, shall be posted on the PSA website.
  • The above agencies shall each designate an area for the setting up of registration centers by the PSA.  The PSA shall provide the necessary facilities, manpower, equipment, registration system, and resources to carry out the registration in the registration centers.
  • In the case of Filipino citizens residing abroad, the registration shall be made in the nearest Philippine Embassy or Philippine Foreign Service post, or other registration centers that may be designated by the Department of Foreign Affairs in coordination with the PSA.

 

Source:

www.psa.gov.ph

https://bit.ly/2Tfvhyv (PDF Copy of the IRR)

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2 Feb 23

Last week, the President signed into law the bill that intends to automatically enroll every Filipino in the National Health Insurance Program or Republic Act No. 11223.  The program will be handled by the Philippine Health Insurance Corporation or PhilHealth.

What can Filipinos look forward to with the new health law?

Every Pinoy is now considered to possess immediate eligibility and therefore, must have access to all aspects of health care including:

  1. Preventive Health Care:
    1. Wellness visits and standard immunizations
    2. Screenings for blood pressure, cancer, cholesterol, depression, obesity.
    3. Pediatric screenings for hearing, vision, and developmental disorders.
    4. Other similar procedures.
  2. Promotive Health Care
    1. Child and family nutrition
    2. Injury prevention
    3. Physical activities
    4. Smoking cessation programs
    5. Other similar procedures.
  3. Curative Health Care
    1. Chemotherapy
    2. Antibiotics
    3. Radiation therapy
    4. Dialysis treatment
    5. Surgeries
  4. Rehabilitative Health Care
    1. Physical and occupational therapy
    2. Speech-language pathology
    3. Psychiatric rehabilitation services
    4. Other similar procedures.
  5. Palliative Health Care
    1. For patients with chronic diseases and need oxygen support.
    2. End-stage heart failure
    3. Debilitating stroke
    4. Cancer that has spread beyond the original tumor/site.
    5. End-stage liver failure, kidney failure, or multi-system organ failure.
    6. End-stage HIV/AIDS that does not respond to anti-viral treatments.
    7. Other similar cases.
  6. Medical, dental, mental, and emergency health services

Patients needing such medical assistance (or any other type of assistance not mentioned above) would be registered with a primary health care provider of their choice and will be included in PhilHealth’s primary care benefits package.

In order for PhilHealth to sustain the demand for quality health care under the new law, membership rates will gradually increase by .5% annually.  This, too, shall cause income ceilings for contributions to go up by Php 10,000 per year.  Contributory members can look forward to getting more benefits as their premiums increase to encourage the able members to pay higher premiums.

What are your thoughts on the Universal Health Care law?  We’d be glad to know.

 

References:

www.doh.gov.ph

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SSS and PhilHealth Contribution Tables for 2019

1 jan 08

Happy New Year, fellow SSS and PhilHealth members!

We are sharing with you this year’s contribution tables to serve as your guide, especially if you are a kasambahay employer and a voluntary member.

SSS Contribution Table 2019 for Employed Members, OFWs, and voluntary members:

sss-contribution-table-ofw-voluntary-self-employed-2019

PhilHealth Contribution Table 2019 for Employed Members

philhealth

Last year, PhilHealth increased its monthly premium contributions for employed members.  Effective January 2018, an employed member’s contribution is 2.75% computed straight based on the monthly basic salary, with a salary floor of Php 10,000 and a ceiling of Php 40,000, equally shared by the employer and the employee.

Kasambahay contributions shall still be shouldered by the employer if the kasambahay is receiving a monthly salary of no more than Php 5,000.  Otherwise, the kasambahay shall pay his or her share.

PhilHealth Contribution Table 2019 for OFWs

The Php 2,400/year contribution rate still applies to OFWs under the OWP (Overseas Workers’ Program) applicable to land-based OFWs.

They have the option to pay the annual amount in full or make two payments of Php 1,200 every six months.

PhilHealth Contribution Table for Self-employed, Individually Paying Members

If the member’s monthly income is Php 25,000 and below, the contribution rate is Php 2,400 per year.

If his monthly income is above Php 25,000, his contribution rate is Php 3,600 per year.

They may choose to pay on a quarterly, semi-annual, or annual basis.

PhilHealth Contribution Table for Sponsored Program Members

A sponsored member’s annual premium is Php 2,400.

He is also entitled to identified in-patient hospital care (including the Z Benefit Package), out-patient care services, and other health care services provided by accredited health care centers and providers.

Sources:

http://www.sss.gov.ph

http://www.philhealth.gov.ph

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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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