PhilHealth

Presented by: Flolet C. Aguirre Leana M. Dizon Jeadverl F. Guinto Maria Louise M. Munar Rochelle Ann S. Pangan Dominick D. Canlas Rashid Paul P. Gerona Kevin Ashley L. Yap

History
MARIA Project August 4, 1969 PMCC House Bill 14225 and Senate Bill 01738 Philippine Health Insurance Corporation (PhilHealth)

Vision, Mission and Core Values

Vision Mission

Core Values
People and Partnership Harmony Innovation Leadership Honor, Accountability and Transparency Excellence and Lifetime Learning Health for All

Know the Rules!

PhilHealth does not pay for all your health care costs. PhilHealth pays only for covered items and services when its rules are met. Members usually give a co-payment for the portion of the actual cost that is not covered by PhilHealth

PhilHealth
Govt owned and controlled corporation Created by Republic Act 7875 National Health Insurance Program (NHIP) Amended by Republic Act 9241 Access to health care is a basic right of citizens
Universal coverage

Members and Dependents

Our Members
1. Employees (govt and private)

monthly payment (3% salary)

2. Individually Paying Program (voluntary)

- quarterly payment (1,200/year)

3. Overseas Workers Program

- Annual payment (900/year)

Our Members
4. Non-paying (pensioner) - no payment for life 60 years old With total 120 monthly contributions 5. Sponsored (thru partnership with LGUs)

- annual payment, eligibility for 1 year

Your Dependents
Spouse Children < 21 years old Parents > 60 years old

Benefits

45 Days Annual Allowance

45 days allowance per year for the principal (member)

Another 45 days shared among dependents

Your benefits
Illness requiring hospitalisation Outpatient:
Surgical procedures
Cataract surgery BTL Vasectomy Endoscopy Excision Suturing

Drugs and Medicines

Only drugs used during confinement will be paid
Drugs must be written in generic name

Closed formulary only drugs listed in the preferred list* will be covered by PhilHealth
*6th edition of the Philippine National Drug Formulary (PNDF)

Drugs and Medicines

Only drugs, supplies, and lab used on confinement shall be paid
Must be supported by official receipts

Fee for Service Scheme:

physician charges separately for each patient encounter or service rendered expenditures increase if more services are provided or a more expensive service is substituted for a less expensive one Needs itemization

Benefit Periods
PhilHealth benefits are divided into benefit periods A benefit period is essentially a single hospital stay, including re-hospitalisation of up to 90 days

In each benefit period, PhilHealth will only pay 1 benefit

Professional Fee

Private Patient, Government Hospital

PAY TO DOCTOR

NO Stamp: PF is made to the Chief

Service Patient, Pay Hospital

Name of Surgeon PAY TO CHIEF

NO Stamp: PF is made to the MD who signed Form 2

Eligibility Rules

Are you eligible?

For employed, at least 3 monthly contributions within the immediate 6 months prior to admission the 45-days allowance for room and board has not been consumed yet confinement in an accredited hospital of not less than 24 hours

Additional Tips for Better Payment

1. Eliminate down coding by providing complete descriptions 2. Rank procedures by order of importance 3. Dont send documents not required 4. Submit claims promptly and frequently 5. Complete forms ASAP 6. Fill in all blanks. Type NA 7. Make it a practice to follow up with Claims Dept.

Contact Details:

www.philhealth.gov.ph qarp@philhealth.gov.ph 0918-9001618