How To Get Your Philhealth Number And ID?

The Philippine Health Insurance Corporation (PhilHealth), has been mandated by law to provide a social health insurance coverage to all Filipinos. 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.

 

There are 7 types of members in Philhealth, namely the Members in the Formal Economy, Members in the Informal Economy, Indigent Members, Sponsored Members, Overseas Filipinos, Senior Citizens, and the Lifetime Members. Only the individuals belonging to the following category may use the Electronic System for Registration: Employed Members, Self-Employed, Overseas Filipino Worker, and the Retirees in the Government and the Private Sector.

 




 

The Philhealth has an Electronic Registration System. This online facility is offered to the public initially for the individual Registration of members in the formal and the informal sector. This is considered as Phase 1 component of the Electronic Registration and Amendment System (ERAS). Click this to register online, https://eregister.philhealth.gov.ph/

 

 

Inpatient Benefits

  • These benefits are paid to the accredited Health Care Institution (HCI) through All Case Rates

 

  • The case rate amount shall be deducted by the HCI from the member’s total bill, which shall include professional fees of attending physicians, prior to discharge

 

  • The case rate amount is inclusive of hospital charges and professional fees of attending physician

 

  • Availment condition: Member must have at least three (3) months’ premium contributions within the immediate six (6) months prior to the month of availment

 

  • Documents needed: copy of Member Data Record or PhilHealth Benefit Eligibility Form (PBEF) and duly accomplished PhilHealth Claim Form 1

 

  • Where available: all accredited HCIs*

*Different case rate amounts for selected medical conditions are being implemented when done in Primary Care facilities (PhilHealth Circular 14, s-2013)

 

  • Only admissible cases shall be reimbursed

 

 

 

Outpatient Benefits

  1. Day surgeries (ambulatory or outpatient surgeries) are services that include elective (non-emergency) surgical procedures ranging from minor to major operations, where patients are safely sent home within the same day for post-operative care
  • Payments for these procedures are made to the accredited facility through All Case Rates

 

  • The case rate amount shall be deducted by the HCI from the member’s total bill, which shall include professional fees of attending physicians, prior to discharge

 

  • The case rate amount is inclusive of hospital charges and professional fees of attending physician

 

  • Availment condition: Member must have at least three (3) months’ premium contributions within the immediate six (6) months prior to the month of availment

 

  • Documents needed: copy of Member Data Record and duly accomplished PhilHealth Claim Form 1

 

  • Where available: Accredited Ambulatory Surgical Clinics (ASCs)

 

 

  1. Radiotherapy

  • The case rate for radiotherapy using cobalt is P2,000 per session and P3,000 per session for linear accelerator

 

  • Includes radiation treatment delivery using cobalt and linear accelator

 

  • Claims for multiple sessions may be filed using one (1) claim form for both inpatient and outpatient radiation therapy

 

  • May be availed of even as second case rate (full case rate amount)

 

  • 45 days benefit limit: One session is equivalent to one day deduction from the 45 allowable days per year

 

  • If procedure is done during confinement, only the total number of confinement days shall be deducted

 

  • Exempted from Single Period of Confinement (SPC) rule (admissions and re-admissions due to same illness or procedure within 90-calendar day period)

 

  • Availment condition: Member must have at least three (3) months’ premium contributions within the immediate six (6) months prior to the month of availment

 

  • Where available: Accredited HCIs including Primary Care Facilities that are accredited for the said service

 

 

  1. Hemodialysis

  • The Case Rate for hemodialysis is P2,600 per session

 

  • Covers both inpatient and outpatient procedures including emergency dialysis procedures for acute renal failure

 

  • Claims for multiple sessions may be filed using one (1) claim form for both inpatient and outpatient hemodialysis

 

  • May be availed of even as second case rate (full case rate amount)

 

  • 90 days benefit limit: One session is equivalent to one day deduction from the 90 allowable days per year

 

  • If procedure is done during confinement, only the total number of confinement days shall be deducted

 

  • The procedure is exempted from Single Period of Confinement rule (admissions and re-admissions due to same illness or procedure within 90-calendar day period)

 

  • Availment condition: Member must have at least three (3) months’ premium contributions within the immediate six (6) months prior to the month of availment

 

  • Where available: All Accredited HCIs – this benefit is no longer restricted to hospitals and free standing dialysis centers provided that the service is within their capability as provided for in the DOH license

 

 

  1. Outpatient Blood Transfusion

  • The case rate for outpatient blood transfusion is P3,640 (one or more units)

 

  • Includes Drugs & Medicine, X-ray, Lab & Others, Operating Room

 

  • Covers outpatient blood transfusion only

 

  • One day of transfusion of any blood or blood product, regardless of the number of bags, is equivalent to one session

 

  • May be availed of as second case rate (full case rate amount)

 

  • 45 days benefit limit: One session for each procedure is equivalent to one day deduction from the 45 allowable days per year Exempted from the SPC rule

 

  • Where to avail: All Accredited HCIs

 

 

5. Primary Care Benefits

i. Preventive Services

  1. Consultation
  2. Visual inspection with acetic acid
  3. Regular BP measurements
  4. Breastfeeding program education
  5. Periodic clinical breast examinations
  6. Counseling for lifestyle modification
  7. Counseling for smoking cessation
  8. Body measurements
  9. Digital rectal examination

 

ii. Diagnostic Examinations (as recommended by the doctor)

  1. Complete blood count
  2. Urinalysis
  3. Fecalysis
  4. Sputum microscopy
  5. Fasting blood sugar
  6. Lipid Profile
  7. Chest x-ray

 

 

iii. Drugs and Medicines

  1. Asthma including nebulisation services
  2. Acute Gastroenteritis (AGE) with no or mild dehydration
  3. Upper Respiratory Tract Infection (URTI)/Pneumonia (minimal and low risk)
  4. Urinary Tract Infection (UTI)

 

  • Payments for these services are made to the primary care provider through Per Family Payment Rate (PFPR)

 

  • Availment condition: Indigent and Sponsored Members, as well as migrant workers and their legal dependents should avail of these benefits within the effectivity of their coverage as indicated in their PhilHealth ID cards or Member Data Records. iGroup (Gold) members may avail themselves of these benefits within the validity of their group policy contracts, while DepEd personnel may avail themselves of the benefits as long as they are still active members of PhilHealth

 

  • Documents needed: Copy of Member Data Record or PhilHealth ID

 

  • Where available: accredited rural health units, health centers or outpatient departments of selected government hospitals where members are enlisted

 

Find More Here


 

Benefit Package and Amount of Benefit

Acute Lymphocytic / Lymphoblastic Leukemia (standard risk) P210,000.

Breast Cancer (stage 0 to IIIA) P100,000.

 

Prostate Cancer (low to intermediate risk) P100,000.

 

End-state renal disease eligible for requiring kidney transplantation (low risk) P600,000.

 

Coronary Artery Bypass Graft Surgery (standard risk) P550,000.

 

Surgery for Tetralogy of Fallot in Children P320,000.

 

Surgery for Ventricular Septal Defect in Children P250,000.

 

 

Cervical Cancer:

Chemoradiation with Cobalt and Brachytherapy (low dose) or Primary surgery for Stage IA1, IA2 – IIA1 P120,000

 

Chemoradiation with Linear Accelerator and Brachytherapy (high dose) P175,000

 

Z MORPH (Mobility, Orthosis, Rehabilitation, Prosthesis Help) – first right and/or left below the knee P15,000

 

– both limbs P30,000

 

 

Selected Orthopedic Implants

Implants for Hip Arthroplasty – Implants Hip Prosthesis, cemented* P103,400

 

– Total Hip Prosthesis, cementless** P169,400

 

– Partial Hip Prosthesis, bipolar P73,180

 

See more of the benefits here, https://www.philhealth.gov.ph/benefits/

 

Or from this page, http://www.doh.gov.ph/sites/default/files/publications/Family_Guide_on_Philhealth.pdf

Or read the PDF below

Family_Guide_on_Philhealth

 

 

The National Health Insurance Act of 1995 (RA No. 7875) institutionalized social health insurance in the country through the National Health Insurance Program (NHIP) or Philhealth. The NHIP aims to reduce out-of-pocket spending as well as the inequities in health financing. This is done by pooling funds from members who are healthy, and can afford health payments, and subsidizing those who are sickly and cannot afford medical care.

 

For employed members, the amount of premium shall not exceed 2% of the members’ respective monthly salaries to be shared equally by the employer and the employee. For those without visible means of income, the national government (NG) and the local government unit (LG) share the payment of premium.  The Philippine Health Insurance Corporation (PHIC) manages Philhealth.

 

 

 

 

Contact information

Philippine Health Insurance Corporation

Citystate Centre, 709 Shaw Boulevard

1603 Pasig City, Philippines

Telephone: 02 441 7442

 

 

This is the Philhealth Portal for easymember inquiry and registration, https://www.philhealth.gov.ph/services/

 

Read more https://www.philhealth.gov.ph/members/lifetime/registration.html

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