Vision A premier government corporation that ensures sustainable, affordable and progressive social health insurance which endeavors

to influence the delivery of an accessible quality health care for all Filipinos. Mission As a financial intermediary, PhilHealth shall continuously evolve a sustainable National Health Insurance Program that shall: Lead towards universal coverage Ensure better benefits for its members at affordable premiums; Establish close coordination with its clients through a strong partnership with all stakeholders; and, Provide effective internal information and management systems to influence the delivery of quality health care services.

Core Values People and Partnership The alliance we have made are the wheels of our program. Our members are at the core of our operations and it is our duty to serve the public. Harmony Team PhilHealth moves as one, otherwise, we could not have reached nor surpassed our goals. Innovation We support new and bright ideas to improve our operations, and apply the Balanced Scorecards into how we carry out our tasks. Leadership The entire PhilHealth organization leads and drives the health system reforms in the country. Honor, Accountability and Transparency We are the custodians of public coffers and we owe it to the people to keep the program afloat for future generations. Excellence and Lifetime Learning We do not just meet targets; we surpass them because we are movers and shapers. We are the few who make things happen but we continue to learn new things. Health for All We aim for universal coverage. Right now, we cover eight out of every ten Filipinos, and we aspire to sustain this coverage in the long-term.

Business Profile

Nature of Organization: Government Owned and Controlled Corporation Industry: Health Care Financing Industry Affiliation: Member of the International Social Security Association, ASEAN Social Security Association, and Philippine Social Security Association. Funding sources: National and Local Government Units for the annual premium of enrolled Sponsored Members Contribution of members into the Program

Key Program Partners: Institutional and Professional Health Care Providers National Government Agencies Local Government Units Collecting Banks and Agents Legislators Private Organizations

Board Composition Chair: Secretary Vice Chair: President and CEO of PhilHealth Members: Secretary of Labor and Employment Secretary of Interior and Local Government Secretary of Social Welfare and Development Representative of Labor Sector Representative of Employers Sector President and CEO of SSS President and General Manager of GSIS Representative of National Anti-Poverty Commission Representative of Overseas Filipino Workers Sector Representative of Self-Employed Sector Representative of Health Care Providers Sector of Health

History op philHealth Our 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 which was eventually implemented in August 1971.

The Philippine Medical Care Commission (PMCC) was tasked to oversee the implementation of the program which went for almost a quarter of a century. In the 1990s, a vision for a better, more responsive government health care program was prompted by the passage of several bills that had significant implications on health financing. The public's clamor for a health insurance that is more comprehensive in terms of covered population and benefits led to the development of House Bill 14225 and Senate Bill 01738 which became "The National Health Insurance Act of 1995" or Republic Act 7875, signed by President Fidel V. Ramos on February 14, 1995. 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. PhilHealth 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. How to apply for philhealth membership? Registration procedures and documentary requirements Fill out M1b Form (in duplicate copies) Attach clear copy of supporting documents for qualified dependents to be declared Registrant will be issued his/her PhilHealth Identification Number or PIN and the Member Data Record or MDR and shall be asked to pay the required premiums to the PhilHealth Cashier or at any of PhilHealth's accredited collecting banks Premium requirements Health insurance premium for Individually Paying Members is fixed at Php 100/month payable in quarterly, semi-annually or annually. Schedule of payment:

Claims and Benefits 1. Can I use my PhilHealth benefit immediately after I have paid my contribution? o For OWP members of PhilHealth, their entitlement to PhilHealth benefit commences on the day of their payment. They only need to present a copy of their valid Enhanced Member Data Record (MDR) or valid PhilHealth Premium Payment Receipt (i.e. Ereceipt/PhilHealth Official Receipt/MI-5/gove o rnment official receipt) together with the other required claim documents. Please be reminded that confinement of the patient must also be within the membership coverage to be eligible for the benefit. As an active OFW member of PhilHealth, what are the benefits that I am entitled to? o As an OFW, the benefits that you and your qualified dependents can avail are the following:

2.

Hospitalization benefit * Outpatient Benefit (Day surgeries, dialysis and cancer treatment procedures like chemotherapy and radiotherapy)* Enhanced Outpatient Benefit Package (in selected DOH hospitals in the Philippines) Special Benefit Packages Maternity Care Package * TB-DOTS (Directly Observed Treatment Shortcourse) Package (available in the Philippines only) SARS Package Avian Influenza / Influenza Pandemic o Bird Flu Package * in PhilHealth Accredited Hospitals in the Philippines and confinement in hospitals abroad

3.

What are the documents that I need to prepare/submit so that I can avail of my PhilHealth benefits? o To avail the benefits, the following documents must be submitted. Please take note that additional documents may also be required depending on the case. Original and properly accomplished PhilHealth Claim Form 1* Valid Enhanced Member Data Record (MDR) or valid PhilHealth Premium Payment Receipt (i.e. E-receipt/PhilHealth Official Receipt/MI-5/government official receipt) If patient is the dependent and his name is not yet posted in the list of the member's qualifed dependent, submit additional document that will show the relationship of patient to the member Special Power of Attorney (SPA) or Authorization Letter for the representative spouse/dependent authorizing cheque to be put under the name of his authorized representaive (optional only and if with member's claim) Local Confinement Outright deduction - this means that PhilHealth benefit is outrightly deducted by the hospital from the patient's bill upon discharge. To avail this, submit the above mentioned documents to the Billing Section of the hospital prior to the patient's discharge Direct Reimbursement - this means that the hospital did not deduct PhilHealth benefit from the patient's bill and member has the option to file the claim directly with PhilHealth. To avail this benefit, submit the documents (please refer to paragraph 1 mentioned hereof) to PhilHealth within 60 days from the date of discharge together with following additional documents: Original and properly accomplished PhilHealth Claim Form 2 Original and properly accomplished PhilHealth Claim Form 3 (for confinement in primary Hospital) Original Official Receipt (OR) or waiver from the hospital and doctor certifying that PhilHealth benefit was not deducted from the patient's bill Hospital Operative Record (if with surgical procedure)

Confinement Abroad

Submit the documents (please refer to paragraph 1 mentioned hereof) to PhilHealth within 180 days from the date of discharge together with the following additional documents: Official Receipt or statement of account for hospital bill and professional fee (should have breakdown of charges for room and board, drugs and medicines, xray and other laboratory procedures, medical supplies, operating room fee and doctors's professional fee) Medical Certificate from the attending physician stating the final diagnosis, date of confinement and procedure done to the patient Note: Documents written in foreign language should be translated to English. * In case the member is currently abroad, PhilHealth Claim Form 1 may be accomplished and signed in his/her behalf by his/her authorized representative. This form can be secured from the hospital, any PhilHealth Office or it can be downloaded from this website. 4. I am scheduled for confinement abroad for an operation, is this confinement covered as my PhilHealth benefit? o Confinement due to sickness or for an operation is compensable with PhilHealth even if it is done abroad. You have 180 days or 6 months within which to file your claim for reimbursement in any PhilHealth office near your residence locally. My dependent was confined before and a claim was filed for this confinement. I would like to know what is the status of my claim? o You can e-mail us at owp or text your queries at 0918-9635396 the following information for proper verification of your claim: Patient's Name (firstname, middlename, lastname) Date of confinement Name of Hospital I have read in your website that one of the requirements for filing of claim for confinement abroad is a copy of receipt for the hospital bill and professional fee (PF) of the doctor. What are the other documents that I can submit as a substitute for this since they do not give/issue official receipt? o If you were not given an official receipt for the payment you made for the hospital bill and PF, you may submit instead a copy of your statement of account. It must contain the breakdown of charges for room & board, medicines, medical supplies, x-ray & other laboratory procedures, operating room fee and professional fee. Abroad, we have insurance in my work who shouldered all my bill for my confinement. Can I still file this claim with PhilHealth as my hospitalization benefit? o If the insurance was part of your benefit as an employee of their company, you cannot file this claim with PhilHealth because you were not the one who paid for your hospitalization. But if a certain amount is being deducted from your monthly salary as a premium payment for this insurance, you can file this claim with PhilHealth. How long does it take to process a PhilHealth claim? o Processing of claim is 60 days from the date it was received by the PhilHealth Office. There are cases wherein processing will go beyond this period if the claim documents submitted are incomplete, with incorrect data in the forms or with inconsistencies. For this case, the claims are either returned to the hospital or to the member to correct and comply the deficiency of their claims and are given 60 days from the date of receipt of the returned claim to refile it with us.

5.

6.

7.

8.

9.

I was confined before and it is only now that I was informed that as an active OFW member of PhilHealth, I can file a claim for my hospitalization benefit. What should I do so that I can still file this claim with your office? o You need to complete all the required documents for your confinement and you are given 60 days from the date of discharge from the hospital to file your claim if confinement is in the Philippines and 180 days if confinement was in abroad. 10. As the legal spouse of the member, why can't the PhilHealth cheque be issued under my name, instead, it was named after my husband who is currently abroad? o Under PhilHealth rules, payment is allowed only to the member, hospital or doctor. A cheque can only be named under a dependent's name (i.e. legal spouse) if an authorization letter or special power of attorney is submitted stating such request to name his cheque in favor of his legal dependent. Philhealth Benefits PHILHEALTH Benefits Inpatient coverage: PhilHealth provides subsidy for room and board, drugs and medicines, laboratories, operating room and professional fees for confinements of not less than 24 hours. Please refer to the table of rate ceilings/maximum allowances for inpatient coverage. Click below:

Outpatient coverage: Day surgeries, dialysis and cancer treatment procedures such as chemotheraphy and radiotheraphy in accredited hospitals and free-standing clinics. Special benefit packages: Enhanced Outpatient Benefit Package Coverage for up to the fourth normal delivery! Newborn Care Package TB treatment through DOTS SARS and Avian Influenza Package Influenza A (H1N1) Package