MEMBERSHIP SECTION

PRO NCR CENTRAL BRANCH

MEMBERSHIP
REGISTRATION AND AMENDMENT
UNDER

Republic Act No. 11223

Universal Health Care Act
 Republic Act No. 11223

“AN ACT INSTITUTING UNIVERSAL HEALTH CARE FOR ALL

FILIPINOS, PRESCRIBING REFORMS IN THE HEALTH CARE
SYSTEM, AND APPROPRIATING FUNDS THEREFOR”

It is the policy of the State to protect and promote the right to health of all
Filipinos and instill health consciousness among them.
 Universal Health Care Act
The UHC Act of 2019 – Implementing
RA No. 11223 or the UHC signed into Rules and Regulations (IRR) was
law in February 20, 2019 signed October 10, 2019

IRR of RA No. 11223 published Effectivity:

November 6, 2019 November 22, 2019
 UHC Act Provisions for Membership
Chapter III Section 8

Simplified Membership:
1. Direct Contributors
2. Indirect Contributors

4
 Population Coverage
Rule II. Section 5
• Automatic inclusion of every Filipino citizen into the NHIP

IRR: RULE III NATIONAL HEALTH INSURANCE PROGRAM

Section 8. Program Membership
Types of Membership
Direct contributors – those who have the capacity to pay premiums, are
gainfully employed and are bound by an employer-employee
relationship, or are self-earning, professional practitioners, migrant workers,
including their qualified dependents, and lifetime members.

Indirect contributors – refer to all others not included as direct contributors,

as well as their qualified dependents, whose premium shall be subsidized
by the national government, including those who are subsidized as a
result of special laws.
 Specific Sectors Under Each Type of Membership
IRR: RULE III NATIONAL HEALTH INSURANCE PROGRAM
Section 8 Program Membership

Direct Contributors Indirect Contributors

IRR - Section 8.2 IRR - Section 8.2

• Employed with employer-employee relationship • National Household Targeting System (NHTS-PR)

• Self-earning individuals & Professional Listahanan from DSWD
practitioners • Pantawid Pamilyang Pilipino Program/Modified Conditional
• Family Drivers Cash Transfer (4Ps/MCCT)
• Kasambahays (Household) • Senior Citizens (RA 10645)
• Migrant workers (OFWs/Living abroad) • Point of Service (POS)
• Lifetime members • Persons with Disability and other sectors under special laws
• All Filipinos age 21 years old and above with • All Filipinos age 21 years old and above without capacity to
capacity to pay pay
• Sponsored (LGU/Private Entity or Individual)-
GEP
OBLIGATIONS OF THE EMPLOYER (Rule III, Section 15 of RA 10606)

All government and private employers are required to:

a. Register their employees and their qualified dependents by submitting a list of
their employees complete with their salary base and other documents as may
be required.
b. Report to the Corporation its newly-hired employees within 30 calendar days
from assumption to office.
c. Give notice to the Corporation of an employee’s separation within 30 calendar
days from separation.

d. Keep true and accurate work records for such period and containing such
information as the Corporation may prescribe.
e. Allow the inspection of its premises including its books and other pertinent
records.
 INITIAL REGISTRATION PROCEDURE
(GOVERNMENT & PRIVATE DIRECT CONTRIBUTOR)

STEP 1
EMPLOYER REGISTRATION

ER1
Attachments:
 SEC / DTI / CDA
Registrations
BIR Registration
 License to Operate
 INITIAL REGISTRATION PROCEDURE
(GOVERNMENT & PRIVATE DIRECT CONTRIBUTOR)

STEP 2
MEMBER-EMPLOYEE
REGISTRATION

 PMRF
for employees without
PhilHealth Identification
Number (PIN)
 ER2
List of newly hired
employees (with and Under penalty of law, I hereby attest that the information provided, including the documents I
have attached to this form, are true and accurate to the best of my knowledge. I agree and
without PIN) authorize PhilHealth for the subsequent validation, verification and for other data sharing
purposes only under the following circumstances: ......
_________________
PHILHEALTH MEMBER REGISTRATION FORM (PMRF)
Registration and Amendment Form
 PhilHealth Circular 2020-0001, “ The Revised PhilHealth Member
Registration form (PMRF)
Effectivity : February 24, 2020
V. Policy Statement / General Guidelines

A. All new registrants and existing PhilHealth members are required to accomplish
and submit to PhilHealth the revised PMRF for the issuance of a unique and
permanent PIN and/ or to update their membership profile/information.

B. A properly accomplished PMRF shall be accompanied by at least one (1) valid

proof of identity for first time registrants and supporting documents to
establish relationship between member and dependent/s for updating or
amendment.
 PhilHealth Circular 2020-0001, “ The Revised PhilHealth Member
Registration form (PMRF)
Effectivity : February 24, 2020
PROOF OF IDENTITY
A. MEMBER
Birth/Baptismal Certificate with registry number or any valid government issued Identification
Card (ID) with date of birth such as, but not limited to:

• Passport * OFW ID
• Driver's License * TIN ID
• Professional Regulations Commission (PRC) ID * DSWD ID
• Integrated Bar of the Philippines ID * GOCC ID
• National Bureau of Investigation (NBI) Clearance - AFP
• Police Clearance - HDMF ID
• Postal ID * Company ID issued by private entity
• Voter's ID
• GSIS e-Card or SSS UMID Card
• Senior Citizen ID
• OWWA ID
IRR: RULE III NATIONAL HEALTH INSURANCE PROGRAM
Section 8 Program Membership
8.1 Members and qualified dependents:

• Legal spouse/s who is/are not an active member

• Unmarried and unemployed legitimate, illegitimate children, and legitimated/legally

adopted or stepchildren below twenty-one (21) years of age
• Mentally or physically disabled children 21 yrs old and above

• Foster children as defined in RA 10165 (Foster Care Act of 2012)

• Parents who are sixty (60) years old and above, not otherwise an enrolled member
 PhilHealth Circular 2020-0001, “ The Revised PhilHealth Member
Registration form (PMRF)
Effectivity : February 24, 2020
DOCUMENTARY REQUIREMENTS:
B. DEPENDENTS
A. Legal Spouse
• Marriage Certificate/Contract with registry number
• For Muslim spouse, Affidavit of Marriage issued by } ~ the National Commission on Muslim Filipinos,
shall pass through the Shari'a Court and must be - registered/authenticated in the PSA
B. Unmarried and unemployed, legitimate, illegitimate children below 21 years old
• Birth or Baptismal Certificate with registry number or in its absence, a notarized affidavit of two
disinterested persons attesting to the date of birth; or
• C. Stepchildren below 21 years of age
• Marriage Certificate with registry number between the biological parents and stepmother/ stepfather;
• Birth Certificate/ s with registry number of the stepchildren
D. Legally adopted children below 21 years of age •
• Court Decree of Adoption
E. Mentally or physically disabled children who are 21 years or above
• Birth Certificate with registry number and Medical or Certificate issued by the attending physician
stating and describing the extent of disability.
MEMBER DATA RECORD (MDR)

 records of member as
reflected in the database.
Name and Issued to members upon
Address of
member
registration together with the
PhilHealth Identification Card

Record of qualified
 dependents are reflected in
dependents this document if reported by
the member
 MEMBER’S AMENDMENT OF RECORD

MEMBER AMENDMENT

PMRF
- Change/Correction of Name
- Correction of Date of Birth
- Change of Civil Status
- New/Additional Dependent
- Change of Address
Under penalty of law, I hereby attest that the information provided, including the documents I
have attached to this form, are true and accurate to the best of my knowledge. I agree and
authorize PhilHealth for the subsequent validation, verification and for other data sharing
purposes only under the following circumstances: ......
_________________
 EMPLOYER’S AMENDMENT OF RECORD

EMPLOYER AMENDMENT

ER3
- Correction/Change of Business
Name; Business Personality
- Temporary Suspension of Operation
- Termination / Dissolution
- Merger / Consolidation
- Change of Ownership
- Resumption of Operation
REPORTING OF SEPARATED/RESIGNED EMPLOYEES
COMPANY NAME
LIST OF SEPARATED EMPLOYEES
PEN: __________________________

May we request for exclusion of the following employees in our Masterlist who are no longer connected with us.

DATE OF BIRTH
PIN LASTNAME SUFFIX FIRSTNAME MIDDLENAME (mm/dd/yyyy SEPARATION DATE REMARKS
1 192006789112 DELA CRUZ SR JUAN GARCIA 03/26/1977 12/25/2013 dismissed
2
3
4
5
6
7
8
9
10

Prepared by: Certified True and Correct:

_________________________________ _________________________________
Signature over Printed Name/Date Signature over Printed Name/Date
Designation Designation
 EXCLUSIVE FOR BACKLOG REPORTING ONLY
RESIGNED/SEPARATED EMPLOYEES
FOR PIN VERIFICATION

LASTNAME SUFFIX FIRSTNAME MIDDLENAME DATE OF BIRTH GENDER SSS NO. (If any)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

Prepared by: Noted by:

___________________________ ____________________________
Signature over printed name/Date Signature over printed name/Date
Designation Designation
EMPLOYER’S DATA RECORD (EDR)
CERTIFICATE OF REGISTRATION (COR)
 PhilHealth Circular 2020-0023
“Implementation of the PhilHealth Portal”
Effectivity : January 14, 2021

• SCOPE:
• THIS COVERS THE FOLLOWING SERVICES:
 Viewing of membership information
 Checking of posted premium contribution
 Downloading and printing of Member Data Record (MDR)

• FOR SELF-PAYING MEMBERS:

 Generation and printing of the Statement of Premium Account (SPA) starting November
• 2019 onwards
 Online payment of contributions
 Viewing of SPA history
 Immediate posting of premium payments
 PhilHealth Circular 2020-0023
“Implementation of the PhilHealth Portal”
Effectivity : January 14, 2021
• POLICY STATEMENTS:
• Access to personal records and payment of contribution online –
member is required to register in the Philhealth Member Portal
• PIN (Philhealth Identification Number) is used to create an account and
password.
• Use of smartphone or laptop and internet connection is required
• For amendment of personal records, PMRF and supporting documents
are required to submit to nearest LHIO’s/ can be send via email.
• In case of contribution discrepancies, send a copy of the official receipts
via email for validation or request for adjustments
 PRO NCR-Central Branch
MEMBERSHIP SECTION
Quezon City
Tel No. 02-8332-3132

member.proqc@philhealth.gov.ph
Thank you.!!!
Employers’ Forum 2022
Collection Section
PRO NCR Central
Employers’ Forum 2022
PRO NCR Central
Collection Section

DIRECT CONTRIBUTORS
***EMPLOYED***
OBLIGATIONS OF THE EMPLOYER

All government and private employers are required to:

a. Register their employees and their qualified dependents by submitting a list of

their employees complete with their salary base and other documents as may
be required.
b. Report to the Corporation its newly-hired employees within 30 calendar days
from assumption to office.

c. Give notice to the Corporation of an employee’s separation within 30 calendar

days from separation.

d. Keep true and accurate work records for such period and containing such
information as the Corporation may prescribe.

e. Allow the inspection of its premises including its books and other pertinent
records.
 PAYMENT AND REPORTING PROCEDURES

STEP 1
Deduct the amount of monthly premium
corresponding to the employee’s share from
the basic monthly salary.

For those whose basic monthly salary is below the income

floor, the premium contribution shall be computed based on
the income floor, while those whose basic monthly income is
above the income ceiling, the premium contribution shall be
computed based on the income ceiling.
 PC NO. 2018-0001
Clarificatory Guidelines on the Computation of Premium for Members Under
the Formal Economy

What is Monthly Basic Salary?

The term Monthly Basic Salary (MBS) shall be understood to mean as the fixed basic rate of an employee
which shall not include sales commission, overtime pay, allowances, thirteenth month pay, bonuses or other
gratuity payments.

Deductions to the employee’s pay occasioned by his/her undertime, tardiness, leave(s) without pay,

absences, or other similar circumstances shall also be excluded in this computation.

A. For daily-wage workers with a six-day work week schedule, who do
not work and are not considered paid on Sundays or rest days shall be
computed as follows:

Applicable Daily Rate x 313

MBS =
12

B. For daily-wage workers with a five-day work week schedule, who do

not work and are not considered paid on Saturdays and Sundays or
rest days shall be computed as:

Applicable Daily Rate x 261

MBS =
12
Employers’ Forum 2022
PRO NCR Central
Collection Section

* Until further notice on the 4% premium adjustment for 2022

 2022 PREMIUM RATE
3% of Monthly
Basic Salary
MONTHLY BASIC MONTHLY EMPLOYER EMPLOYEE
SALARY PREMIUM SHARE SHARE

P10,000.00 P300.00 P150.00 P150.00

(Income floor) (minimum)

P60,000.00 P1,800.00 P900.00 P900.00

(Income ceiling) (maximum)

* Until further notice on the 4% Premium Adjustment for 2022

Employers’ Forum 2022
PRO NCR Central
Collection Setion

KASAMBAHAY (R.A. No. 10361)

The premium of the Kasambahay shall be shouldered solely by the

household employer. However, if the Kasambahay is receiving a
monthly salary of five thousand pesos (P5,000.00) or above the
Kasambahay shall pay his/her proportionate share.

SELF-EARNING INDIVIDUALS

The prescribed premium rate is computed straight based on their

monthly income at the prescribed rate per year.

Deadline of payment – within the applicable month/ quarter.

 PAYMENT AND REPORTING PROCEDURES

STEP 2

Remit the employee’s premium

contribution, together with the
employers share to any Accredited
Collecting Agents nationwide on or
before the due date.
Employers’ Forum 2022
PRO NCR Central
Collection Section

DEADLINE OF PAYMENT

Monthly premium contributions shall be

remitted on or before the month following the
following the applicable period

PENs ending in 0-4 Every 11th -15th day

PENs ending in 5-9 Every 16th – 20th day

Kasambahay Every 25th day

 In case the deadline for the payment of premium falls on a weekend or holiday, payment
shall be made on the next working day.

All premium contribution payments beyond the aforementioned shall be charged three

percent (3%) monthly interest compounded monthly.

Interest and/ or surcharges = Principal amount x 3%

compounded monthly based
on the number of months delayed

Reporting schedule is within 5 days after the payment deadline

Employers’ Forum 202 2
PRO NCR Central Collection
Section

Interests and/or surcharges

incorporated in the SPA shall form part
of the total amount due for the current
applicable month.
 PAYMENT AND REPORTING PROCEDURES

STEP 3
All employers are required to use the
Electronic Premium Remittance System
(EPRS) application as the mode for the
payment of premiums, and preparation and
submission of remittance report. It is a web-
based application designed to allow access to
employee information through the
employer’s PhilHealth Employer Engagement
Representatives (PEERS).
ONLINE PAYMENT
(PC No. 2020-008)

Employers are required to enroll their

EPRS account at any Accredited Collecting
Agent (ACA) of choice with payment
gateway/ facility Interlinked with EPRS to
be able to remit premium online.

Effectivity – June 2020 applicable period onwards

 Online Collection Scheme

1. Bank of the Philippine Island (via Bizlink)

2. Citibank N.A. (via Citidirect)
3. IPAY-MYEG Philippines, Inc.
4. Land Bank of the Philippines (via EPS)
5. Security Bank Corporation (via Digibanker)
6. Union Bank of the Philippines (via OneHUB)
7. BancNet Inc (via e-Gov facility)
 BancNet’s Member Banks
1. Asia United Bank Corporation
2. Bank of Commerce
3. BDO Unibank Inc.
4. China Banking Corporation
5. CTBC Bank (Philippines) Corp
6. Development Bank of the Philippines
7. East West Banking Corporation
8. Maybank Philippines Inc.
9. Metropolitan Bank and Trust Company
10. MUFG Bank Ltd.
11. Philippine Bank of Communications (PBCOM)
12. Philippine National Bank
13. Philippine Trust Company (Philtrust Bank)
14. Philippine Veterans Bank
15. Rizal Commercial Banking Corporation
16. Robinsons Bank Corporation
17. United Coconut Planters Bank
18. Standard Chartered Bank
19. Sterling Bank of Asia, Inc.
Employers who have not yet enrolled
or if w/ ongoing bank application shall
be required to submit the following
requirements:
a. Letter request addressed to Arsenia B. Torres,
Manager PRO NCR Central Branch stating the
reason for non-compliance/exemption.

b. Supporting documents for the request for

exemption.
If with issued Certificate of Exemption, you
can pay PhilHealth remittance at any
Accredited Banks and at PhilHealth Cashier in
CASH or Manager’s Check only until the
VALIDITY of the Certificate.

Succeeding payment should be thru your bank

enrolled in PhilHealth EPRS online.
 Over-the Counter
Accredited Collecting Agents (ACAs)
Asia United Bank Corporation Local Government Units (selected)
Bank of Commerce Money Mall Rural Bank Inc.
Bank One Savings Corp. Penbank Inc.
BDO Network Bank Inc. Philippine Business Bank Inc.
Camalig Bank Inc. Philippine Veterans Bank
Century Rural Bank Inc. Rizal Commercial Banking Corp.
Century Savings Bank Corp Robinsons Bank Corp.
China Bank Savings Inc. Rural Bank of Bambang Inc.
China Banking Corp. Rural Bank of Jose Panganiban (CN) Inc.
CIS Bayad Center, Inc. Saviour Rural Bank Inc.
Citystate Savings Bank Inc. SM Mart Inc.
Development Bank of the Phils UCPB Savings Bank
East West Rural Bank Inc Union Bank of the Phils.
Land Bank of the Phils. United Coconut Planters Bank
OTTCS E-PAR
(PC No. 2021-0019)

System Validated Statement of Premium Account (SPA) and

PhilHealth Premium Slip (PPPS) as PhilHealth Official
Receipts for Premium Contribution Payment Transactions at
PhilHealth Offices

SAMPLE VALIDATED SPA

SAMPLE VALIDATED PPPS

Employers’ Forum 2022
PRO NCR Central
Collection Section
Employers’ Forum 2022
PRO NCR Central
Collection Section
REMINDERS:
1. REGULARLY UPDATE YOUR MASTER LIST (ADDITIONAL / NEWLY HIRED AND SEPARATED
EMPLOYEES) – PMRF / ER-2 / REQUEST FOR EXLUSION OF SEPARATED EMPLOYEES IN
MASTER LIST.

2. REGULARLY UPDATE YOUR COMPANY’S PROFILE FOR ANY CHANGES THRU SUBMISSION
OF ER-3

3. UPDATE PEER INFORMATION FORM AND SUBMIT A NON-DISCLOSURE AGREEMENT.

4. FOR PERIOD/S OF NO OPERATION / TEMPORARY SUSPENSION OF OPERATION,

SUBMIT THE FOLLOWING DOCUMENTS FOR TAGGING AS TEMPORARILY
CLOSED:
- ER - 3
- BIR 1601-C
- RF-1 indicating list of affected employee/s tagged as NE

5. REMIND EMPLOYEES WITH NO EARNINGS OR THOSE WHO ARE ON LWOP

TO PAY THEIR PREMIUMS AS INDIVIDUALLY PAYING MEMBER.

6. MEMBERS SHOULD RETROACTIVELY PAY THEIR MISSED

CONTRIBUTIONS STARTING NOVEMBER 2019 TO PRESENT.
OTHER MATTERS:
 EMPLOYEES ON MATERNITY LEAVE (Expanded Maternity Leave Law)
- should be included in the regular remittance.

 EMPLOYEES WITH MULTIPLE EMPLOYMENT

- premium should be deducted from all of his employers based on MBS.

 SENIOR CITIZEN WHO IS GAINFULLY EMPLOYED

- premium should be deducted by the employer based on MBS.

 EMPLOYEES WITH ACTIVE SPONSORED / INDIGENT MEMBERSHIP

- premium should be deducted by the employer based on MBS.
- overpayment / double payment can be applied prospectively to remittance gaps.

 EMPLOYEES WITH ADVANCED PAYMENT AS IPM – OVERLAPPING / DOUBLE REMITTANCE

- premium should be deducted by the employer based on MBS.
- overpayment / double payment can be applied prospectively to remittance gaps.
Contribution & EPRS CONCERNS:
Macro Accounts:
(11 employees and above)

8332-3024 to 25
Coordinate (e-mail/call/ text) with your respective
P-AIMS (PhilHealth Accounts Information Management Specialist)
paims.ncrcentral@philhealth.gov.ph

Micro Accounts:
(10 employees and Below)

8332-3119
micro.ncrcentral@philhealth.gov.ph
THANK YOU
 New EPRS
eGov interface
Making a Payment Transaction
Corporate Client
EGOV EPRS Online

1. Generate SPA from EPRS - Payment Management page

EGOV EPRS Online

2. Select the Push Payment button of the SPA for payment

Push Payment button

EGOV EPRS Online

3. Select ONLINE PAYMENT at the PAYMENT OPTION, then select

BANCNET

1. Select Online Payment

2. Select BancNet
EGOV EPRS Online

4. Transaction is routed to the BancNet Landing Page in eGov

User has the option to

PAY NOW or PAY LATER
EGOV EPRS Online

5. Login Maker
EGOV EPRS Online

6. Choose desired SPA

Select desired SPA

EGOV EPRS Online

7. Click Upload
EGOV EPRS Online

8. Login as Approver
EGOV EPRS Online

9. Approver receives notification of records for approval

EGOV EPRS Online

10. Click APPROVAL button

EGOV EPRS Online

11. Select card and other details then input PIN

EGOV EPRS Online

12. Click SUBMIT, then click OK.

EGOV EPRS Online

13. Approval confirmation from bank

EGOV EPRS Online

14. EPRS to send EPAR to eGov. To confirm if EPAR is received, select

PAYMENT INQUIRY

Select Payment
Inquiry
EGOV EPRS Online

15. EPAR will be displayed

EPAR
Confirmation of EPAR
Corporate Client
EGOV EPRS Online

Manual request of EPAR

1. As Approver, click the request EPAR button
eGov automatically
requests for the EPAR
from EPRS

Icon can be clicked to

manually trigger
request of EPAR if
none is received
EGOV EPRS Online Message

2. Message appears if with NO EPAR response was received from EPRS

Message
EGOV EPRS Online
Icon can be clicked to
3. REQUEST EPAR button is available manually trigger
request of EPAR if
none is received
EGOV EPRS Online

4. Message appears if still no EPAR is received from EPRS

EGOV EPRS Online

5. EPAR button will no longer be not available once EPAR is received from
EPRS
Cancelling Transactions
Corporate Client
EGOV EPRS Online

Note: The EPRS record will be locked in EPRS once a payment option is
selected. However, a CANCEL option in
eGov is available if needed.
Sample of locked
records
EGOV EPRS Online
CANCEL button
1. Login as approver. Click on the CANCEL button
EGOV EPRS Online

2. Approver can indicate REMARKS ( ie. Why transaction was cancelled).

Clicks on SUBMIT.
EGOV EPRS Online

3. Message appears if no response is received from EPRS

EGOV EPRS Online

4. CANCEL button will still be enabled for the affected record if no

confirmation is received from EPRS
EGOV EPRS Online

5. Approver can retry if CANCEL button is available. State REMARKS then

click on SUBMIT to retry.
Message appears if still no response from EPRS.
EGOV EPRS Online

6. Click on the CANCEL button on the PAYMENTS INQUIRY page

CANCEL button will no longer be

available once response is received
by EPRS
EGOV EPRS Online
Record is unlocked
7. Record is unlocked at EPRS
EGOV EPRS Online

8. Payments for unlocked records may be pushed from EPRS again

EGOV EPRS Online

9. Payment may be pushed through EGOV again if BancNet is selected as

the payment option in EPRS
• Transaction Monitoring module

Status Report
• Received - report is for validation/posting.
• For Reconciliation - payment is not yet
posted in our system/ or with discrepancy in
the report or payment/ or with error in
encoding the payment details in EPRS
• Posted - report was successfully uploaded in
PhilHealth database.
• Transaction Monitoring module
eRF1
Sample

eRF-1 in PDF format

• Transaction Monitoring module

Last page of the Posted eRF-1

 EPRS CONCERNS:
For Macro Accounts:
(for 11 employees and above)
8332-3024 to 25
paims.ncrcentral@philhealth.gov.ph

For Micro Accounts:

(for 10 employees below)
micro.ncrcentral@philhealth.gov.ph
 www.philhealth.gov.ph

www.twitter.com@teamphilhealth

www.facebook.com/philhealth

address: actioncenter@philhealth.gov.ph
THANK YOU
PHILHEALTH
BENEFITS
 Service Coverage
Every Filipino shall be
granted IMMEDIATE
eligibility and access to:

• Preventive
• Promotive
• Curative
• Rehabilitative, and
• Palliative care
 Entitlement to Benefits
 Immediate eligibility for health benefits under the
National Health Insurance Program (NHIP)
 Failure to pay premiums shall not prevent the
enjoyment of any Program benefits. However,
employers and self-employed direct contributors shall
be required to pay all the missed contribution with
interest
 All Filipinos, who have not yet enrolled with
PhilHealth, are reminded to register with the nearest
Local Health Insurance office (LHIO) or PhilHealth
Express
 PhilHealth Benefit Limit

To be shared
by all
Member dependents
USE OF PHILHEALTH BENEFIT ELIGIBILTY FORM (PBEF)

 Effective November 22, 2019

 All PBEFs will be generated with

automatic “YES” response even
with remarks pertaining to
deficiency in the qualifying
contribution

As per PhilHealth Advisory

No. 004 s 2020
 ENTITLEMENT TO
♥PHILHEALTH BENEFITS♥

INPATIENT BENEFITS
Benefits for sickness or
ailments that need
confinement of not less
than 24 hours.

OUTPATIENT BENEFITS
Day surgeries and treatment
procedures done in accredited
hospitals and free-standing
clinics that don’t require
confinement.
 ENTITLEMENT TO
♥PHILHEALTH BENEFITS♥
CATASTROPHIC OR Z BENEFITS
Life threatening and costly. Covers primary
disease conditions perceived as medically &
economically "catastrophic” (Coronary
Artery Bypass Graft Surgery, cancers such
as breast/ prostate/colon/rectum,
ZMORPH, etc.).
OTHER SPECIAL
BENEFITS & EMERGING
DISEASES
Benefits in line with 3
Millennium Development
Goals and emerging diseases
(ex: Maternity Care Package,
Outpatient HIV/AIDS
Treatment, Ebola, MERS-CoV,
Zika, COVID 19)
PhilHealth Benefit Packages

Package:
MEDICINES
1. Amoxicillin
LABORATORIES 2. Co-Amoxiclav
3. Nitrofurantoin Anti microbial
4 .Cotrimoxazole
5. Ciprofloxacin
SERVICES 1. CBC w/ platelet count
2. Urinalysis
6. Clarithromycin
7. Oral Rehydration Salts - Fluids and
3. Fecalysis
8. Prednisone Electrolytes
4. Sputum Microscopy
5. Fecal Occult Blood 9. Salbutamol Anti
• Initial and follow up 10. Fluticasone +Salmeterol Astma
consultation with a 6. Pap smear
7. Lipid profile (Total 8. 8. 11. Paracetamol- Antipyretics
Primary Care Provider 12. Simvastatin – Anti-dyslipidemia
Cholesterol, HDL and LDL
Cholesterol, Triglycerides 13. Gliclazide - Anti-Diabetic
• Targeted health risk 8. FBS 14. Metformin – Anti-Diabetic
screening and assessment 9. Oral Glucose Tolerance 15. Enalapril
to include DRE, breast Test 16. Metoprolol Anti
exam 10. ECG 17. Amlodipine Diabetic
11. Chest X-Ray 18. Hydrochlorothiazide
12. Creatinine 19. Losartan
20. Aspirin – Anti-thrombotic
 PHILHEALTH
REITERATION
Moving on to better things
 PHILHEALTH
BENEFITS PACKAGE
Moving on to better things
 PC 009 s. 2020
Benefit Packages For Inpatient Care Of Probable And Confirmed COVID-19
Developing Severe Illness/Outcomes
Source: Moneymax

BENEFIT PACKAGE FOR COVID-19

Mild Pneumonia in the elderly or with co-
P 43,997.00
morbidities (C19IP1)
Moderate Pneumonia (C19IP2) P 143,267.00
Severe Pneumonia (C19IP3) P 333, 519.00
Critical Pneumonia (C19IP4) P 786,384.00
 P.C. 8 s 2021 Clarification On The Coverage For COVID-19 Inpatient Benefit
Package
P.C. 20 s 2021 Clarification On The Coverage For COVID-19 Inpatient Benefit
Package (Revision 1)

Cases with pneumonia initially assessed and

managed as COVID-19 but had negative RT-
PCR test results are covered by the
INTERMEDIATE PACKAGE

BENEFIT PACKAGE FOR COVID-19 (INPATIENT)

Intermediate Package for Moderate
P 18,000.00
Pneumonia
Intermediate Package for Severe/Critical
Pneumonia P 38,000.00
Continuation…

Covid-19 Benefit package

PC 007 s. 2021
Implementing Guidelines On The Coverage Of COVID-19 Vaccine Injury Due To
Serious Adverse Effects (SAEs) Following Immunization Resulting In
Hospitalization, Permanent Disability, Or Death Under The COVId-19 National
Vaccine Indemnity Fund (The COVID-19 Vaccine Injury Compensation Package)

BENEFIT PACKAGE FOR COVID-19 VACCINE INJURY

COMPENSATION
Hospitalization due to Serious Adverse Effects P 100,000.00
(SAEs) following COVID-19 immunization (max)
Death or permanent disability due to Serious
Adverse Effects (SAEs) following COVID-19 P 100,000.00
immunization (lump sum)
 Continuation…

PC 017 s. 2020
Covid-19 Benefit package
PC 001 s. 2021

P.C. 2021-0021 Benefit Package For SARS-CoV-2 Testing Using RT-PCR TESTS

PLATE CARTRIDG
BENEFIT PACKAGE FOR COVID-19 TESTING USING BASED RT- E BASED
PCR TEST PCR TEST
All services for testing are procured and provided
P 2,800.00 P 2,450.00
by the testing laboratory
Test Kits/PCR Cartridges are donated to the
P 1,200.00 P 700.00
testing laboratory
Test kits are donated to the testing laboratory; cost
of running the laboratory and RT-PCR machine for P 800.00 P 500.00
testing are subsidized by the government
Continuation…

P.C. 12 s 2020 Guidelines On The COVID-19 Community Isolation Benefit

Package (CCIBP)
P.C. 18 s 2020 Guidelines On The CoViD-19
Community Isolation Benefit Package (CCIBP) - Revision 1

Community Isolation Package

Services:
• 14 days admission
• Food
• Individual hygiene kit P 22,449.00
• Education about respiratory etiquette
• Monitoring of health care professional
• Medicine
• Diagnostic oxygen support
• Referral to a higher facility, if needed
 PC 014 s. 2021
COVID-19 Home Isolation Benefit Package (CHIBP)

PC 004 s. 2022
COVID-19 Home Isolation Benefit Package (CHIBP) Revision 2

CHIBP will serve as an alternative for confirmed

asymptomatic and mild cases needing isolation
and meet the social and clinical criteria for home
isolation and who do not want to stay in a
Community Isolation Unit.
BENEFIT PACKAGE FOR HOME ISOLATION
• Minimum 10-day home isolation
• Consultation (at least twice for the duration of
isolation) Php 5,917.00
• 24/7 daily monitoring of clinical and supportive
(per claim)
care by a nurse thru teleconsultation
• Home Isolation kit (alcohol, facemask,
thermometer, pulse oximeter, drugs and medicines)
• Patient Education
• Patient referral to a higher level facility
 VISIT OUR OFFICIAL WEBSITE

www.philhealth.gov.ph
To summarize, Universal Health Care
is all about...

Service Coverage
-immediate eligibility and access
Population Coverage -comprehensive outpatient
benefit Financial
automatic inclusion of -provision of primary care
Coverage
provider
every Filipino citizen -Zero co-payment
into the NHIP
-Fixed, predictable
co-payment
Reach us at:
#LahatKasama