If you have family residing in the Philippines, you’ve probably received at least one urgent request for help paying a medical bill. Many in the Philippines lack any sort of health insurance whatsoever. But there is a way to get your relatives basic health insurance that is inexpensive or even free.
The Philippine Health Insurance Corporation (PhilHealth) was created to provide universal health coverage for the Philippines. It is a tax-exempt, government-owned corporation of the Philippines. PhilHealth is attached to the Department of Health. Its stated goal is “Insuring a sustainable national health insurance program for all”. By 2010, it claimed to have achieved “universal” coverage with 86% of the population. This social insurance program provides a means for the healthy to pay for the care of the sick. Those who can afford medical care to subsidize those who cannot. Premiums for the formal sector reach up to 3% of monthly income. Premiums for both the poor and the informal sector are 1,200 pesos annually (about 25 USD). The cost of insurance for the poor is fully subsidized by central and local governments.
|Formal||Employer and worker each pay half, up to 2.5% (maximum of 3%) of income up to 30,000 pesos||As of hire date||3 months|
|Indigent||2,400 pesos annually||National Government fully subsidizes enrollment annually.||None|
|Retiree||Free||Age 60 with 10 years of premium payments|
|Individually Paying||1,800 pesos annually for members earning P25,000 and below|
3,600 pesos annually for members earning more than P25,000
|OFW (Landbased)||1,200 pesos annually||Emigration date||No subsidy. Payment is on emigration date then annually.|
The benefits are essentially the same for each group. The exception is for indigents and the Overseas Filipino Workers (OFWs) who have additional outpatient primary care benefits.
PhilHealth beneficiaries have access to a nearly comprehensive package of services, including inpatient care, catastrophic coverage, ambulatory surgeries, deliveries, and outpatient treatment for malaria and tuberculosis. Those identified as indigent and OFW are also entitled to outpatient primary care. Inpatient care includes room and board, medicines, diagnostic and other services, professional fees and operating room services. These benefits are subject to some limits, which differ based on the level of the health facility/hospital and the severity of the cause of admission. Catastrophic conditions include ambulatory surgeries, including ambulatory dialysis, deliveries and outpatient malaria and TB-DOTS care.
Except for the outpatient primary care that the poor and OFWs are entitled to via public providers, patients have free choice of providers, both public and private. Providers are allowed to charge the patient the difference between the total cost of care and what PhilHealth pays. Annual or lifetime coverage limits exist. These limits are expressed in terms of volumes of services (in days) rather than a peso coverage limit. For example, households are eligible for 45 days of inpatient admission, sharing 45 days among all household members. Each day of ambulatory surgery counts as a day of admission.
While it isn’t perfect, having PhilHealth for your family can provide a basic level of health care for your loved ones, and peace of mind for you. Coverage for a family is about $25 – $80 USD a year. Knowing that minor medical emergencies won’t result in a desperate request for a fast cash transfer? Priceless.
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