Philippine Health

Insurance Corporation
(PhilHealth)
 Table Of
PhilHealth
Contents
MEMBERSHIP OF PHILHEALTH

PHILHEALTH BENEFITS
FUNCTIONS, ROLES AND RESPONSIBILITIES

CORPORATE PARTNERS

ORGANIZATIONAL CHART OF PHILHEALTH IN BACOLOD

 PHILHEALTH
PhilHealth, short for the Philippine Health Insurance
Corporation, is a government-owned and controlled corporation
in the Philippines. It’s the country’s national health insurance
program that aims to provide affordable and accessible health
care services for all Filipinos.

In a nation striving for accessible healthcare, understanding

the intricacies of health insurance becomes paramount. Many
Filipinos grapple with questions surrounding the pivotal entity
that is PHILHEALTH.
 MISSION AND VISION OF PHILHEALTH
MISSION:
The mission is to mobilize
resources through a
sustainable and responsive
health financing system,
fostering partnerships with
stakeholders, and promoting a
culture of excellence and social
responsibility.
VISION:
The vision of PhilHealth is
to be the primary catalyst
in achieving a financially
protected and healthy
Filipino society.
 DOH
The Department of Health (DOH) and the Philippine Health Insurance
Corporation (PhilHealth) have formed a technical working group to
evaluate the proposal to transfer the state health insurer under the Office
of the President.

PhilHealth is currently an attached agency of the DOH. It is responsible

for ensuring access to basic public health services to all Filipinos through
the provision of quality health care and regulation of providers of health
goods and services.

Dr. Teodoro J. Herbosa, Secretary, Department of Health, Chairperson.

 MEMBERSHIP OF PHILHEALTH

Employed or Members in the Formal Economy

- Includes all the employees with offices in the Philippines. Also included are sea-
men and sea-based workers because their agencies are based in the Philippines, as
well as household helpers. The premium ranges from 200-875 per month.

Individually Paying or Self-employed, or Voluntary or Members in the Informal

Economy
- Anyone who is not employed by a company, like professionals, businesspeople,
young retirees and farmers can avail this membership. The premium is 600 per quarter
and 900 per quarter for those earning more than 25,000 a month.

 Overseas Workers or OFWs

- If an OFW passes through POEA and they pay their OEC fees, they are eligible
to be Philhealth members. The premium is 2,400 pesos a year.
Sponsored
- Some non-profit organizations pay for their members, if you are under a non-profit
organization, you fall under this. Premium paid by sponsor is also 2,400 pesos per year
Indigent
- This is for members who have no source of income or those whose income is not
sufficient for their family. DSWD identifies these members.
Lifetime
- Lifetime members are those who were able to pay at least 120 to Philhealth. When
they reach 60 years old, their membership becomes free.

 Senior Citizens
- Those who are already 60, but have never been a member, or were not able to pay
120 premiums for the duration of their membership fall into this category.
PHILHEALTH BENEFITS

INPATIENT BENEFITS
- Coverage for hospitalization expenses, room and board, medicines, laboratory tests,
and other medical procedures while confined in an accredited Philhealth hospital

OUTPATIENT BENEFITS
- Philhealth's outpatient benefits cover the cost of certain outpatient care services,
such as consultation fees, laboratory tests and x-rays.

Z BENEFIT PACKAGES
PhilHealth's Z Benefit packages are a set of comprehensive benefits that are designed
to provide financial protection against illnesses that are considered to be medically and
economically catastrophic. These illnesses include cancer, renal failure and certain
types of congenital anomalies.
MATERNITY CARE PACKAGE
- PhilHealth Maternity Care package (MCP) is a benefit that covers the cost of essential
healthcare services for women about to give birth throughout their pregnancy and normal
delivery (during antenatal, intrapartum, and immediate postpartum periods). The services shall
include antenatal care, intrapartum monitoring, assistance in normal delivery, and post -partum
care within 72 hours and 7 days after delivery.

NEWBORN CARE PACKAGE

- PhilHealth Newborn Care Package (NCP) is a benefit that covers the cost of essential
healthcare services for newborns during the first few days of life. It covers essential newborn
care, newborn screening and hearing screening tests.
PRIMARY CARE BENEFIT
- PhilHealth Primary Care Benefit (PCB) is a benefit that covers the cost of essential
healthcare services for members at the primary care level. It is designed to provide
members with access to preventive, diagnostic and treatment services that can help
them stay healthy and manage their chronic conditions.

ANIMAL BITE PACKAGE

- The Animal Bite Treatment Package (ABT) is a benefit that covers the cost of post -
exposure prophylaxis (PEP) treatment for animal bite victims. PEP is a series of
vaccines and immunoglobulin's that are given to people who have been bitten by
animals that may be infected with rabies.

TB-DOTS PACKAGE
- TB-DOTS Package is a benefit that covers the cost of treatment for tuberculosis
(TB) under the Directly Observed Treatment, short -course (DOTS) strategy. DOTS
is proven, effective way to treat TB and prevent the spread of the disease.
HEMODIALYSIS PACKAGE
- PhilHealth Hemodialysis Package is a benefit that covers the cost of
hemodialysis treatment for people with end -stage renal disease (ESRD) is a
condition in which the kidneys no longer function properly and require dialysis
to remove waste products from the blood.

OUTPATIENT BLOOD PROGRAM

- PhilHealth Outpatient Blood Program (OBP) is a benefit that covers the cost of
blood and blood components for outpatients. The program is designed to help
reduce the financial burden of blood transfusions for PhilHealth members and
their families.
 FUNCTIONS, ROLES, AND RESPONSIBILITY OF
PHILHEALTH
a. To administer the National Health Insurance Program;
b. To formulate and promulgate policies for the sound administration of the Program;
c. To supervise the provision of health benefits and to set standards, rules and
regulations necessary to ensure quality of care, appropriate utilization of services,
fund viability, member satisfaction, and overall accomplishment of Program
objectives;
d. To formulate and implement guidelines on contributions and benefits; portability of
benefits, cost containment and quality assurance; and health care provider
arrangements, payment, methods, and referral systems;
e. To receive and manage grants, donations, and other forms of assistance;
f. To authorize Local Health Insurance Offices to negotiate and enter into contracts in
the name and on behalf of the Corporation with any accredited government or private
sector health provider organization, including but not limited to health maintenance
organizations, cooperatives and medical foundations, for the provision of at least the
minimum package of personal health services prescribed by the Corporation;
CORPORATE PARTNERS

PhilHealth has partnerships with various organizations and institutions to fulfill its
mandate of providing all Filipinos with accessible, available, acceptable, and
affordable health care services.

HEALTHCARE PROVIDERS
- We forge partnerships with only the best in the industry to fulfil our mandate of
providing all Filipinos with accessible, available, acceptable and affordable health
care services that will lead to better health outcomes and improved quality of life.

EMPLOYERS
-We partner with employers in the government and private sectors to ensure
that all their employees are provided with social health insurance coverage as
mandated by law.
 SERVICE PROVIDERS
- We are moving towards electronic transactions and to help us achieve our
goal, we have entered into partnerships with Health IT Providers for our e-claims
and related processes.

 COLLECTING PARTNERS
- We have tapped the services and networks of bank and non-bank institutions
to make premium remittance more convenient for our members and employers.
This section provides a complete list of these partners and their branch locations,
and also includes basic information for collecting agencies that might be interested
to partner with us in premium remittance.
PRESENTED BY:

ALONSABE, LIZA MARIE

EMPEDRAD, MA. LIZA
SAWAL, RHEA A.
BINAS, CHERRY JOY
VILLASAN, JESCIL
VALENCIA, CYRIL
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