PhilHealth for Kasambahay

Screen shot 2013-07-22 at 6.12.16 PMThe Kasambahay Law makes PhilHealth contributions mandatory for our household helpers.  PhilHealth offers health cash benefits that can be used by our helpers in the event they get hospitalized.  It is their health insurance, something they would very well need especially in their senior years.

For helpers with salaries below P5,000,  employers will shoulder the whole cost of the contribution.  For helpers with salaries above P5,000,  employees and employers will have a share on the contribution based on the PhilHealth Monthly Contribution Chart.

Disclaimer: This is a direct copy from the PhilHealth leaflets issued by PhilHealth personnel when they conducted a seminar and one-stop registration for our village last July 12, 2013. The only thing changed was the order of presentation. Words in italics are my personal notes.  Click on links for downloadable forms.

A.   Registration

1.   Fill up Philhealth Members Registration Form(PMRF) for helper.  Requirements are indicated in the downloadable form link.

2.   Fill up Employers Data Record (ER1) and PhilHealth Report of Employee-Members Forms (ER2).

*Use blank ball pen in filling up form.

B.   Monthly Contribution Table - Philhealth Contribution Schedule

C.   Payment Centers

PhilHealth contributions are accepted at SM Retail Service Counters, M. Lhuillier and PhilPost.  Fill up Philhealth Premium Payment Slip and submit to payment center.

Employer must submit a Employer's Remittance Report (RF-1) on or before the 15th day after the applicable month.  Example remittance report for month of January should be submitted not later than February 15.  The report can be submitted to PhilHealth offices or online at the PhilHealth website.

D.   PhilHealth Summary of Benefits

PhilHealth provides numerous benefit coverage.  It includes CASE RATES where common medical cases have pre-determined cash benefits already ex.  for Pneumonia (Moderate Risk) benefit deductible from hospital bill is at P15,000. For full list of Case Rates click this

For medical cases not included in the list of Case Rates,  PhilHealth offers an allowance to cover portion of the hospital fees, medicines, professional fees of doctors, etc.  For the chart of maximum allowances click this.

E.   Requirements to Avail Philhealth Benefit and Procedures in Availment

The following must first be met to avail of your PhilHealth benefits:

  • Payment of at least three (3) monthly premiums within six (6) months prior to the month of confinement.
  • Confinement in an accredited hospital for at least 24 hours (except when availing of outpatient care and special packages) due to illness or injury requiring hospitalization.
  • Attending physicians must also be PhilHealth-accredited.
  • The 45 days allowance for hospital room and board is not consumed yet.

Availment Procedures:

Outright/automatic deduction of benefits

1. Submit the following to the billing section prior to hospital discharge:

  • Duly accomplished PhilHealth Claim Form 1
  • Clear copy of Member Data Record (MDR)For qualified dependent not listed in the MDR, submit clear copy of applicable proof of dependency.

2. Agree with your attending physicians on how much is left to be paid for their services over the professional fee (PF) benefit.

3. Upon submission of all applicable documents, the billing section will compute and deduct your benefits from your total hospital bill.

Direct Filing/reimbursement

Submit the following to PhilHealth or through the hospital in addition to the documents mentioned earlier within 60 calendar days from the date of discharge:

  • PhilHealth Claim Form 2 (to be filled up by the hospital and attending physicians)
  • Official receipts of payments made to the hospital and to the doctor's waiver
  • Operative record, if surgical procedures was performed

PhilHealth Contact Details:

Call Center: 441-7442

www.philhealth.gov.ph

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