PHILHEALTH

EARLY HISTORY

THE call to serve the rural indigents echoed since the early '60s when the Philippine Medical Association introduced the MARIA Project which prioritized aid to communities in need of medical assistance. The Project would then be considered a valuable precursor to the Medicare program, from which a medical care plan for the entire Philippines was created. On August 4, 1969, Republic Act 6111 or the Philippine Medical Care Act of 1969 was signed by President Ferdinand E. Marcos

Recent History

In the 1990s, a vision for a better, more House Bill 14225 responsive and Senate Bill government health 01738 which care program was became The prompted by the National Health passage of several Insurance Act of bills that had 1995 or Republic significant implications on health Act 7875, signed financing. by President Fidel

V. Ramos on

Creation of Philhealth

The law paved the way for the creation of the Philippine Health Insurance Corporation (PhilHealth), mandated to provide social health insurance coverage to all Filipinos in 15 years' time.

Objective of PhilHealth

It is the main objective of the NHIP to provide all Filipinos with the mechanism to gain financial access to quality health care services within the first 15 years of its implementation. Coverage of the employed members in the government and private sectors,

Who is entitled for coverage

Employed 1.1 government sector 1.2 Private sector including household help and sea-based OFW. Individually Paying 2.1 Self-employed 2.2 Land-based OFWs 2.3 Privately sponsored/ employee of international organization. Enrolled Indigents Retiree Members

Philhealth Card
The PhilHealth Identification Card shall contain vital information which will be the basis of the members identification, eligibility for availment of program services and other transactions with the Corporation. The issuance of the PhilHealth Identification Card shall be accompanied by a clear explanation of the enrollees rights, privileges and obligations as a member. A member shall be assigned a permanent and unique PhilHealth Identification Number (PIN) contained in the PhilHealth

Membership

Requirements for Membership Registration A person intending to register with the NHIP, regardless of membership category, shall submit to the Corporation the appropriate and properly

Obligations of the Employer All government and private employers are required to register their employees with the Corporation and shall be issued a permanent and unique PhilHealth Identification Number.

It is likewise the obligation of the employer to report to the Corporation its newlyhired employees within thirty (30) calendar days from assumption to office.

Payment of NHIP Premium Contributions a. The members monthly contribution shall be deducted and withheld automatically by the employer from the formers salary, wage or earnings. The employers counterpart in the payment of contribution shall not in any manner be charged to the employee. b. The monthly premium contribution of employed members shall be remitted by the employer on or before the tenth (10th) calendar day of the month following the applicable month for which

Schedule of Premium Contributions The schedule of premium contributions shall be determined by the Corporation on the basis of applicable actuarial studies to be issued to members and employers in the government and private sectors through a PhilHealth circular. Provided, that the amount of premium shall not exceed three percent (3%) of the members respective monthly salaries to be shared equally by the employer and employee

BENEFITS
Benefit Package The benefits under the NHIP shall consist of the following: a. In-patient hospital care 1. Room and board 2. Services of health care professionals 3. Diagnostic, laboratory, and other medical examination services 4. Use of surgical or medical equipment and facilities 5. Prescription drugs and biologicals;

b. Out-patient care 1. Services of health care professionals 2. Diagnostic, laboratory and other medical services 3. Use of surgical or medical equipment and facilities 4. Personal preventive services 5. Prescription drugs and biologicals; c. Health education packages; d. Emergency and transfer services; and e. Such other health care services that the Corporation determines to be appropriate and cost-effective.