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HECO Members: Rosales, Samonte, Santos, Susi, Tan 2BMT CORPORATE PROFILE Vision Adequate and Affordable Social

Health Insurance Coverage for ALL Filipinos. Mission To ensure adequate financial access of every Filipino to quality health care services through the effective and efficient administration of the National Health Insurance Program. 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 of Health 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

MEMBERSHIP: A. OWP (Overseas Worker Program) a. Qualifications i. Active landbased OFWs who underwent the normal process of registration as an OFW at POEA Offices ii. OFWs who are currently abroad but are not yet registered with PhilHealth b. Registration procedures, documentary and premium requirements:

i. Submit duly accomplished PhilHealth Membership Registration


Form together with applicable documents for each qualified dependent declared. ii. Also submit any of the following documents as proof of being an active OFW: 1. Valid Overseas Employment Certificate (OEC) or E-receipt 2. Valid overseas employment contract or certificate of employment 3. Valid re-entry visa 4. Valid job contract iii. Pay the one-year premium of Php 900. For your convenience, premium payments covering the entire contract (equivalent to the number of years provided for in your contract) is highly encouraged. B. Employed Sector Program- mandated by law a. Government Sector i. Employees of the government, whether regular, casual or contractual, who renders services in any government branches, military or police force, political subdivisions, agencies, or instrumentalities, including government-owned and controlled corporations, financial institutions with original charter, constitutional commissions, and is occupying either an elective or appointive position, regardless of status of appointment.

b. Private Sector - employees who render services in any of the following: i. Corporations, partnerships, or single proprietorships, nongovernment organizations, cooperatives, non-profit organizations, social, civic, or professional or charitable institutions, organized and based in the Philippines ii. Foreign corporations, business organizations, non-government organizations based in the Philippines iii. Foreign governments or international organizations with quasi-state status based in the Philippines which entered into an agreement with PhilHealth to cover their Filipino employees iv. Foreign business organizations based abroad with agreement with PhilHealth to cover their Filipino employees v. Sea-based OFWs vi. Household employees c. Registration procedures and documentary requirements

i. For newly hired employees without PIN yet:


(Also applicable to existing employees similarly without PIN) Fill out PhilHealth Membership Registration Form Attach clear copy of supporting documents for qualified dependents declared Submit to the HR Department for them to forward the above documents to PhilHealth together with Er2 Form (Report of EmployeeMembers).

After processing, PhilHealth will send the member, through the employer, his/her PhilHealth Identification Number or PIN and a copy of the Member Data Record ii. ii. For newly hired employees with PIN already:

Report to your employer your PIN for them to indicate the same in their Er2

C. Individually Paying Program: a. Classifications:

1. Self-employed individuals - those who work for him/herself and is therefore


both the employer and employee, including but not limited to the following: o Self-earning professionals like doctors and lawyers o Business partners and single proprietors / proprietresses o Actors, actresses, directors, scriptwriters and news reporters who are not under an employer-employee relationship o Professional athletes, coaches, trainers and jockeys o Farmers and fisherfolks o Workers in the informal sector such as ambulant vendors, watch-your-car boys, hospitality girls, tricycle drivers, etc. 2. Separated from employment - those who were previously formally employed (with employer-employee relationship) and are separated from employment. 3. Employees of international organizations and foreign governments based in the Philippines without agreement with PhilHealth for the coverage of their Filipino employees in the program. 4. All other individuals not covered under the previous categories mentioned, including but are not limited to the following: o Parents who are not qualified as legal dependents, indigents or retireess/pensioners o Retirees who did not meet the minimum of 120 monthly premium contributions to qualify as non-paying members o Children who are not qualified as legal dependents o Unemployed individuals who are not qualified as indigents b. Registration procedures and documentary requirements Fill out PhilHealth Membership Registration Form 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

c. 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:

Quarterly Pay until the last working day of the quarter being paid for.

Semi-annual Pay until the last working day of the first quarter of the semester being paid for.

Annual Pay until the last working day of the first quarter of the year being paid for. Example: Period: January to December Deadline: March 31

Example: Example: Period: January to Period: January to June March Deadline: March 31 Deadline: March 31

indigent families availing health insurance covered under the Sponsored Program The Sponsored Program is open to qualified indigents belonging to the lowest 25% of the Philippine population. Families that will be given health insurance coverage for one year are identified through the family data survey using the framework of Community-based Information System - Minimum Basic Needs or CBIS-MBN. The CBIS-MBN is being conducted by the Department of Social Welfare and Development through its local social welfare development offices. Who shoulders the premiums for qualified indigents? The Sponsored Program is being made possible through the partnership of PhilHealth and sponsors such as local governments (LGUs), private individuals and corporations and members of Congress, among others. The National Government (through PhilHealth) and the abovementioned sponsors jointly pay the annual premium of Php 1,200 for each enrolled family. C. entitlement to PhilHealth's lifetime coverage as Lifetime Members: o o Old-age retirees and pensioners of the GSIS, including uniformed and non-uniformed personnel of the AFP, PNP, BJMP and BFP who have reached the compulsory age of retirement before June 24, 1997, and retirees under Presidential Decree 408; GSIS disability pensioners prior to March 4, 1995; SSS pensioners prior to March 4, 1995: SSS permanent total disability pensioners; SSS death/survivorship pensioners SSS old-age retirees/pensioners; Uniformed members of the AFP, PNP, BFP and BJMP who have reached the compulsory age of retirement on or after June 24, 1997, being the effectivity date of RA 8291 which excluded them in the compulsory membership to the GSIS; Retirees and pensioners who are members of the judiciary; Retirees who are members of Constitutional Commissions and other constitutional offices;

Former employees of the government and/or private sectors who have accumulated/paid at least 120 monthly premium contributions as provided for by law but separated from employment before reaching the age of 60 years old and thereafter have reached 60 years old; Former employees of the government and/or private sectors who were separated from employment without completing 120 monthly premium contributions but continued to pay their premiums as Individually Paying Members until completion of the required 120 monthly premium contributions and have reached 60 years old as provided for by law; Individually Paying Members, including SSS self-employed and voluntary members, who continued paying premiums to PhilHealth, have reached 60 years old and have met the required 120 monthly premiums as provided for by law; Retired underground mine workers who have reached the age of retirement as provided for by law and have met the required premium contributions. a. Registration procedures and documentary requirements for Lifetime Memership: Submit the following to any PhilHealth Office nearest you:

1. Duly accomplished PhilHealth Membership Registration Form


2. Two (2) latest 1" x 1" ID picture 3. Certified True Copy (CTC) of the SSS or GSIS Retirement Certification or the following as applicable: o For SSS Retirees/Pensioners: Printout of Death, Disability and Retirement (DDR) from any SSS office indicating that the type of claim is retirement in nature and the effectivity date of pension; and Printout of contributions issued by any SSS office indicating the latest contributions (if he/she retires after March 4, 1995. For GSIS Retirees - any of the following: Certification/Letter of Approval of Retirement from the GSIS indicating the effectivity date of retirement; Service Record issued by the employer/s indicating not less than 120 months of service excluding leave of absences without pay; Certification/retirement Gratuity from the employer indicating not less than 120 months of service. For AFP, PNP, BFP and BJMP Retirees/Pensioners - those who are in active military service until they retire at age 56 and those separated by retirement or other reasons prior to the said age but have reached the age of 60, shall submit any of the following: Statement of Services issued by previous employer indicating not less than 120 months of service excluding leave of absences without pay; Certification/Letter of Approval of Retirement from the GSIS indicating not less than 120 months of service; General, Bureau or Special Order indicating the effectivity date of retirement.

4. Certified true copy (CTC) of Birth Certificate or any two of the following: o Certified true copy (CTC) of Birth Certificate or any two of the following: o CTC of Baptismal Certificate o CTC of Marriage Contract/Certificate o Passport o Driver's License o SSS Members ID o Alien Certificate of Registration (ACR) o Service Record/s o Employee ID o School records o Voter's ID o Senior Citizens ID o Duly notarized joint affidavit of two disinterested persons attesting to the fact of birth of the registrant 5. Any other valid documents acceptable by PhilHealth Member will be issued his/her PhilHealth Lifetime Member Card which is a valid ID to be used in all PhilHealth transactions. HEALTHCARE PROVIDERS Accreditation Process What is Accreditation? It is a process whereby the qualifications and capabilities of health care providers are verified in accordance with the guidelines, standards and procedures set by the Corporation. Why the need for accreditation? To participate in the National Health Insurance Program. To assure that health care services rendered by them are of the desired and expected quality. A. Institutional Health Care Providers Who may apply? Hospitals Ambulatory Surgical Clinics (ASCs) Free Standing Dialysis Clinics (FSDCs) Rural Health Units/Health Centers (RHUs/HCs) as providers of the Out Patient Benefit Package for sponsored members of PHIC Maternity Care Clinics - for low risk, normal spontaneous deliveries Anti-TB/DOTS Clinics

When to apply?

1. Initial or Re-accreditation - anytime 2. Renewal o Hospitals, ASCs and FSDCs: January 1 to 31 of the succeeding year o OPB, Maternity Care and Anti-TB/DOTS Package Providers: September 1 - 30 of the current year.

Status of Accreditation No. of Accredited Facilities 1,622 40 56 823 1,437 796 4,774

Institutional HCP (as of June 2011) Hospitals Ambulatory Surgical Clinics Free Standing Dialysis Clinics Maternity Care Clinics Rural Health Clinics Anti-TB-DOTS Clinics Total

B. Professional Health Care Providers Who may apply? Physicians Dentists Midwives

When to apply? 1. Initial or Re-accreditation - anytime 2. Renewal o 120 - 91 days prior to the expiry of accreditation.

Status of Accreditation No. of Accredited 9,809 11,361 178 424

Professional HCP (as of June 2011) General Practitioners Medical Specialists Dentists Midwives

Total EMPLOYERS Employer registration with PhilHealth

21,772

All government and private sector employers shall be required to register with PhilHealth to enable them to provide social health insurance coverage to their employees. Private sector employers, including those of household helps, who have registered with the SSS prior to July 1, 1999 are considered automatically registered and will only be required to update their records with PhilHealth. Registration procedures and documentary requirements 1. Submit the following at any PhilHealth Office: For Government Sector Employers Employer Data Record or ER1 Form (in duplicate) M1a forms for each employee (in duplicate)

For Private Sector Employers Employer Data Record or ER1 Form (in duplicate) Business permit/license to operate and/or any of the following as applicable: Nature of Entity Single proprietorships Additional Documents Required Department of Trade and Industry (DTI) Registration Securities and Exchange Commission (SEC) Registration Securities and Exchange Commission (SEC) Registration Cooperative Development Authority (CDA) Registration Barangay Certification and/or Mayor's Permit

Partnerships and corporations

Foundations and non-profit organizations

Cooperatives

Backyard industries/ventures and microbusiness enterprises

2. After processing, the employer will be issued the following: PhilHealth Employer Number (PEN) and the Certificate of Registration PhilHealth Identification Number (PIN) and Member Data Record (MDR) for concerned employees

3. Employers shall be asked to display the Certificate of Registration in their offices as proof of registration with PhilHealth.

Amending Employer Data An employer may request revision or amendment in data previously furnished by submitting the following: Employer data Amendment Form or ER3 Any of the following to substantiate the request for amendment: Additional Documents Required Certificate of filing of business name with DTI or Articles of Partnership/Incorporation If due to bankruptcy - any of the following: Financial Statement Income Tax Return Board Resolution

Nature of Amendment Correction/change of business name/legal personality Temporary suspension of operation

Separation of employees - all of the following: Latest submitted prescribed PhilHealth form Separation paper of last employee

If due to fire or demolition - all of the following: Certification from the City/ Municipal Fire Department Certification from the concerned city or municipality

Termination/dissolution

For single proprietorships - all of the following: Approved application for business retirement by the

City or Municipal Treasurer's Office Death Certificate in case of death of owner

For partnerships or corporations - any of the following: Deed of Dissolution approved by SEC Minutes of Meeting certified by the corporate secretary

For Cooperatives: Certificate/Order of Dissolution/Cancellation issued by the CDA

Under fortuitous events as defined by law - to submit applicable documents as determined by PhilHealth Mergers Submit any of the following: Deed of Merger/Merger Agreement duly certified by SEC Memorandum of Agreement filed with SEC

Change of ownership Resumption of operation

Deed of Sale/ Transfer/Assignment Prescribed PhilHealth form reporting newly hired or re-hired employees. Submit applicable documents as determined by PhilHealth

Closure due to fortuitous events

Reporting your Employees to PhilHealth

If reporting for:

Grace period

Report form to be used

Newly hired employees Separated employees

Within 30 calendar days from assumption ER2 Form to office. Indicate in the RF1

Within 30 calendar days from separation.

Employers shall also be required to keep true and accurate work records that should contain information as PhilHealth may prescribe. Such records shall be open for inspection by PhilHealth or any of its authorized representatives. PhilHealth Premium Rates The monthly health insurance premium of an employee is pegged at 2.5 percent of the salary base of the range within which their basic monthly salary belongs. Only half of the required monthly premium is shouldered by the employee which are automatically deducted and withheld from their salary, while the other half is paid for by the employer. The employer's counterpart in the payment of contributions shall not in any manner be charged to the employee. Payment and Reporting Procedures 1. Deduct from the employee's salary the corresponding amount of premium. 2. Together with the employer's counterpart, the premiums shall be remitted to PhilHealth or at any accredited collecting bank/agent on or before the 10th day of the month following the month being paid for. Use the ME-5 Form in remitting your premiums. 3. To facilitate posting of your premium payments, employers shall be required to report their payments to PhilHealth on a monthly basis using the revised Remittance Report Form (RF-1). Starting with your July 2008 payments, submission of monthly RF-1 must be made on or before the 15th of the month following the applicable month. Your RF-1 shall be filed with your respective PhilHealth Office or you may drop them in drop boxes located in selected accredited banks nearest you. You may also continue reporting your payments in text file format using the PhilHealth Premium Remittance System or PPRS. Take your premium payments and reporting to the next level by availing of our Epay Service via Bank of the Philippine Islands, Citibank, Unionbank and Security Bank Corporation!