PhilHealth: Benefits and Definition

Are you a member of PhilHealth?

One of the most important aspects in a community is health care. In a country like Philippines where poverty-rate is still prevailing, the need of public health care assistance is largely needed. This is where one of the governmental sectors, PhilHealth, enters its role as a pillar of support in the field of health care.

What is PhilHealth?


Philippine Health Insurance Corporation (or simply PhilHealth) is a governmental health care program that has been established since the early 1960s, when the Philippine Medical Association pioneered the MARIA Project which prioritized aid to communities in need of medical assistance. Followed by the approval of Republic Act 6111 or the Philippine Medical Care Act of 1969, it was headed by the Philippine Medical Care Commission (PMCC) for almost a quarter of a century.

It was during the 1990s when there came a passage of several bills that had significant implications on health financing for the indigent public, leading to the development of The National Health Insurance Act of 1995. This law paved the way for the creation of PhilHealth, mandated to provide social health insurance coverage to all Filipinos in 15 years' time. With this, the said organization assumed the responsibility of administering the former Medicare program for government and private sector employees from the Government Service Insurance System in October 1997, from the Social Security System in April 1998, and from the Overseas Workers Welfare Administration in March 2005.

What are the benefits of PhilHealth?

Generally, PhilHealth reduces the amount of expenses of upon confinement or acquisition of selected health services, and is available for its members. Specifically, the PhilHealth card entitles the organization's members and its dependents to inpatient and outpatient services in PhilHealth accredited facilities.


Inpatient Coverage

When a member is admitted in the hospital, PhilHealth renders the following: Subsidy for room and board Drugs and medicines X-Ray Laboratory exams Operational rooms Professional Fees for confinement of not less than 24 hours

Outpatient Coverage

Members can also be provided outpatient health care services at any PhilHealth-accredited government health center or private clinics. The outpatient benefit package is available only at PhilHealth-accredited RHUs or some designated PhilHealth accredited government hospitals. The service is free for all Sponsored Program members, to which National Household Targeting System (NHTS) families belong. It includes the following: Day surgeries Dialysis Cancer Treatment procedures such as chemotherapy and radiotherapy

Are You a PhilHealth Member?

There are two kinds of qualified members in PhilHealth: The Members (Government Sector Employees, and Private Sector Employees), and The Dependents (family members of a PhilHealth member). If you are from an NHTS family, you can ask the Barangay Office if the family is enrolled with PhilHealth since they are responsible for distributing the PhilHealth ID to NHTS families.

How do I use my PhilHealth benefits?

You can use your PhilHealth benefits by following the list below. Remember, though, that you can only use your PhilHealth benefits in PhilHealth-accredited hospitals. Show your PhilHealth ID at the admitting section of the hospital. If there is an emergency, inform the emergency room nurse that you are going to use PhilHealth for the admission Before discharge, ask your Ward Nurse for a PhilHealth Claim Form 1 (original). Fill this up and return it to your nurse, or submit it to the billing section together with the photocopy of the PhilHealth ID and MDR Ask your doctor and the billing section if there are additional fees to be paid. The hospital will deduct the PhilHealth benefit before discharge. Remember to keep all original receipts.

For more information regarding PhilHealth, you can browse their official website at philhealth.gov.ph or contact them at (+632) 441-7442.

Mark Hugh Neri

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