Is every Filipino covered by PhilHealth?

Asked by: Raymundo Watsica  |  Last update: February 11, 2022
Score: 4.3/5 (33 votes)

Under the Universal Health Care Law (UHC), all Filipino citizens are automatically eligible to avail the government's health benefits packages. ... Though not all Filipinos are registered in the PhilHealth database, they may still benefit from PhilHealth coverage at the point of service.

Does PhilHealth cover everyone?

PhilHealth has six major membership categories covering nearly the entire population. Those who count under the (1) "Formal" sector are workers employed by public and private companies and other institutions. ... PhilHealth now has an Outpatient and Diagnostic Package limited to indigent beneficiaries.

Who can get PhilHealth?

All unemployed or self-employed employees. This includes professionals or business owners, as well as retirees and farmers. Members who were able to pay at least 120 monthly premiums. Membership becomes free as soon as they reach 60 years old.

How many people have PhilHealth?

With this, PhilHealth has the biggest clientele population today among the financial government institutions in the country with over 100 million registered members. Under the UHC, the entire population is automatically covered, resulting to an employee-client ratio of 1 is to 16,000.

Are doctors free in Philippines?

Healthcare in the Philippines is considered to be of good quality by international standards. ... As such, all Filipino citizens are entitled to free medical care through the Philippine Health Insurance Corporation, known as PhilHealth.


32 related questions found

Is Doctors fee covered by PhilHealth?

PhilHealth is committed to providing you with the most comprehensive understanding of how the professional fee for surgical procedures is computed. ... * This fee only represents PhilHealth payment to the surgeon. It does not include payment to other physicians if required, or hospital costs.

Can I use my PhilHealth even if unemployed?

You can apply for PhilHealth voluntary membership even if you have no job as long as you can pay your monthly premiums. There's also no need to worry about PhilHealth requirements if you're unemployed. Just fill out the registration form and submit it with accurate information.

What age is covered by PhilHealth?

"Any person below 21 years of age, married or unmarried but with a child, shall be enrolled as a member".

Who are exempted from paying PhilHealth?

As per PhilHealth Circular No. 2020-0008, Kasambahays, Family Drivers and employers located in areas classified as Geographically Isolated and Disadvantaged Areas (GIDAs) are exempted from online payment, thus, no need to secure or present a COE.

Is OFW automatic member of PhilHealth?

The UHC law makes all Filipinos automatic members of PhilHealth and eligible to avail of select medical services for free.

How does PhilHealth work in the Philippines?

PhilHealth implements the National Health Insurance Program that aims to provide Filipinos with financial assistance and access to affordable health services. It covers hospital costs, subsidy for room and boarding, medicine, and professional services.

How do I get covered by PhilHealth?

To become eligible to PhilHealth benefits, members should have paid at least a total of nine (9) months premium contributions within the immediate twelve (12)- month period prior to the first day of confinement. The twelve (12)- month period is inclusive of the confinement month.

Is PhilHealth mandatory?

All government and private sector employers are required to register with PhilHealth to enable them to provide social health insurance coverage to their employees.

How much is the contribution of PhilHealth in 2021?

For 2021, the monthly premium contributions shall be at the rate of 3.50% computed straight based on the monthly basic salary, with a salary floor of P10,000 and a ceiling of P70,000, to be equally shared by the employees and their employer.

Is PWD a lifetime member of PhilHealth?

The answer was “No”. Unlike Seniors who become “lifetime members” upon reaching the age of 60, PWDs still need to make monthly contributions to the Philhealth in order to enjoy the benefits afforded by the agency to Filipinos.

Can I use my husband PhilHealth for maternity?

Yes, you and your baby can avail of the PhilHealth maternity benefits as your husband's legal dependents.

What is PhilHealth lifetime membership?

Members under the Lifetime Member Program (LMP) are those who have reached the age of retirement and have paid at least 120 months' premium. They are granted lifetime coverage without having to pay premium contributions anymore.

Can I use my PhilHealth for my child?

Who are qualified as dependents? Legitimate spouse who is not a member; Child or children - legitimate, legitimated, acknowledged and illegitimate (as appearing in birth certificate) adopted or stepchild or stepchildren below 21 years of age, unmarried and unemployed.

How many times can we use PhilHealth in a year?

PhilHealth members are entitled to a maximum of 45 days confinement per calendar year1. The qualified dependents of the member share another set of 45 days benefit per calendar year. However, the 45 days allowance shall be shared among them.

What if I dont pay the PhilHealth contribution?

For failure or refusal to remit (and/or report) contributions the employer shall be punished with a fine of not less than five thousand pesos (Php 5,000.00) but not more than ten thousand pesos (Php 10,000.00) multiplied by the total number of employees of the firm.

What will happen if I stop paying my PhilHealth contribution?

“While no one will be denied of PhilHealth coverage due to non-payment of premiums, Morales also clarified that members lacking contributions shall be billed for the unpaid premiums with interests (compounded monthly) and penalties of at least 3% a month for employers, sea-based OFWs, and kasambahays,” PhilHealth said ...

Is surgery covered by PhilHealth?

Your PhilHealth membership covers ambulatory and non-emergency surgical procedures done on an outpatient basis. These surgeries can either be major or minor, as long as you can be safely sent home within the same day of your operation and recover from home.

How many percent does PhilHealth cover for hospitalization?

If an individual is to claim a medical/ procedure case as a 1st case rate (e.g., Tuberculosis), 100% of the case rate is to be deducted from the total charges. Whereas, if the condition is considered as a 2nd case rate (e.g., Hemodialysis), only 50% of the case rate is to be deducted.

Is hernia covered by PhilHealth?

Repair of abdominal and femoral hernia are included in this benefit. 3. This package covers repair of inguinal, femoral, lumbar, incisional, epigastric, umbilical, and spigelian henua whether reducible, incarcerated or strangulated (RVS Codes 49495-49590, 49650- 49651).

Is PhilHealth mandatory in Philippines?

Coverage in the Philippines

Both private and government employees must contribute to the Pag-IBIG Fund and PhilHealth. Membership is optional, however, for self-employed persons, Overseas Filipino Workers (OFWs), and Non-Working Spouses (NWSs).