Republic of the Philippines

PHILIPPINE HEALTH INSURANCE CORPORATION

Citystate Centre Building, 709 Shaw Boulevard, Pasig City
Healthline: 441-7444 Website: www.philhealth.gov.ph

STATEMENT OF PREMIUM ACCOUNT (SPA)

PEN :
EMPLOYER TYPE :
Business/Agency Name :
Attention :

019000020523
Private
GOOD SHEPHERD ACADEMY INCORPORATED

SPA NO : SPA100003446576
DATE : 07/09/2015

PhilHealth Employer Engagement Representative (PEER)

Remittance Due Date:

July 11 - 15, 2015

CURRENT SPA CHARGES

Applicable Month : June 2015
No. of Employees : 14
Amount of Premium:
Employee Share

1,187.50

Employer Share

1,187.50
_____________

Amount Due :
Interest Incurred :

2,375.00
0.00
_____________

TOTAL DUE FOR CURRENT SPA :

2,375.00
_____________
_____________

TOTAL AMOUNT DUE :

2,375.00
EPRS 4 EASY STEPS IN PREMIUM PAYMENTS

Steps (Employer Activity)

(Timelines)

(Requirement)

1) Membership updating in EPRS and Generation

Within the applicable month and before

Mandatory

of Preliminary Employees Premium List

2) Generation of Statement of Premium Account and
preparation of voucher and check

deadline or due date of payment

Within the applicable month up to

Mandatory

deadline or due date of payment

3) Remittance of PhilHealth Premium Contribution

On or before the due date of payment

Mandatory

4) Posting of Payment to EPRS

within five (5) days after payment

Mandatory

Note :
1. This Statement of Premium Account reflects the total amount due based on membership records as of the last day of the applicable month
2. The total amount due in this SPA shall only pertain and apply to the total amount of premium remittance for the applicable month for which this SPA
was generated. Any arrearages, interest incurred from unpaid remittances, penalty and surcharges that may be due from the employer shall not be
deemed included hereof, unless it is otherwise specifically stated in the SPA.
3. PhilHealth Circular No. 027, s.2013, provides that the salary bracket for the Employed Sector starting January 2014 shall be in accordance with the
following considerations:
a. Premium rate at 2.5% of the basic monthly salary
b. Use of salary bracket which shall start at the minimum of PhP8,000.00 and maximum salary bracket at PhP35,000.00
4. Please Print the SPA as your supporting document to the disbursement voucher. To pay or remit your contribution, please detach and bring the
PhilHealth EPRS Premium Payment Slip(PEPPS) to your nearest PhilHealth LHIO or Business Center or to our Accredited Collecting Agents (ACAs).

................................................................. Cut-off Here .....................................................................

PHILHEALTH EPRS PREMIUM PAYMENT SLIP

Remittance Due Date : July 11 - 15, 2015
PEN :
Business/Agency Name :
Applicable Month :

SPA No. : SPA100003446576

Date Generated : 07/09/2015
Employer Type : Private

019000020523
GOOD SHEPHERD ACADEMY INCORPORATED
June 2015
No. of Employees :

Amount of Premium:
Employee Share
Employer Share

1,187.50
1,187.50
_____________

Amount Due :
Interest Incurred :

2,375.00
0.00
_____________

TOTAL DUE FOR CURRENT SPA :

2,375.00
_____________
_____________

14