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PhilHealth is a government-mandated health insurance program. It stands for Philippine Health Insurance Corporation. It is our national health insurance program that Filipino citizens can (and should) enrol in. 

Healthcare is one of the most important aspects in a community, and one of the best ways to maintain our health is through a proper healthcare system. Studies conducted at Harvard Medical School and Cambridge Health Alliance show a link between the lack of health insurance and an increase in the risk of death.

However, simply knowing that health is our wealth is not enough. More often than not, it may come at a hefty price and not everyone is able to afford it. In the unfortunate case of the Philippines where there is an abundance of people living in poverty, the demand for public health care assistance is greatly needed. This is where PhilHealth enters our community as a platform for strength and support in the field of health care.

Established in the early 1960s, PhilHealth is a government-owned and government-controlled health care program that aims to provide and ensure the following: 1) health insurance coverage for all Filipinos, 2) health care services that are of quality and affordability, and 3) responsible management of its economic resources. 

The key to maximizing your health insurance is to understand how it works and what benefits it can provide. In the case of PhilHealth, here is what you should know:

PhilHealth

Who are Qualified?

Employed

Employees that work for private and government sectors, as well as household employees and sea-based OFWs whose premiums are jointly covered by both employee and employer are qualified.

Overseas Workers

Land-based overseas contract workers whose premiums are paid before their departure.

Individuals

Self-practicing or self-employed professionals who contribute to the program voluntarily.

Sponsors

Families that are less fortunate and can’t afford their own insurance can be covered by National Government Units, Local Government Units, private individuals, and companies. Families and individuals belonging to the lowest 25% of the Philippine population are also qualified for this program.

Lifetime

Having reached the age of retirement and making at least 120 months of contribution, retirees and pensioners are entitled to a lifetime coverage.

Dependents

In addition to the qualified individuals, here is a list of people who are entitled to PhilHealth coverage without additional premium, as long as the main member declared them and they are also a part of his member data record.

  • Legal spouse who is a non-member or an inactive member
  • Children
  • Parents, step-parents, and adoptive parents who are non-members or inactive members and above the age of 60

Benefits

Members of PhilHealth and their dependents are entitled to the following benefits:

Inpatient 

When a member or a dependent is confined (for no less than 24 hours), they are subsidized for the following:

  • Room and board
  • Services of health care professionals
  • Diagnostic, laboratory, and other medical examination services
  • Use of surgical or medical equipment and facilities
  • Prescription drugs and biologicals
  • Inpatient education packages

Outpatient

  • Day surgeries
  • Dialysis Cancer
  • Treatment procedures such as chemotherapy and radiotherapy

Special Benefit Packages

Case rates are a format that provides fixed payments based on the case of your sickness regardless of hospital size and length of treatment. Here are examples of the cases acknowledged by PhilHealth and their corresponding fixed rates:

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Having health insurance provides aid for both health care, as well as personal financial wellness. It is therefore our responsibility to make sure that we utilize these benefits provided for our advantage, and at the same time support our neighbors who are less privileged.

 

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