PhilHealth (Philippine Health Insurance Corporation) is the government-run national health insurance program in the Philippines. It provides members with access to affordable healthcare services by covering a portion of hospitalization costs, outpatient procedures, and preventive care. Both employers and employees contribute to the fund, and membership is mandatory for all employed individuals.
How PhilHealth Works
PhilHealth operates on a social insurance model where monthly contributions create a pool of funds to pay for members' healthcare needs. When a member needs medical care at an accredited facility, PhilHealth covers a portion of the costs based on the type of care and membership status. Members may need to pay the difference between the actual cost and PhilHealth coverage.
Contribution Rates
The contribution rate is 5% of the monthly basic salary, shared equally between employer and employee (2.5% each). There are minimum and maximum salary floors and ceilings that cap contributions. Self-employed and voluntary members pay the full contribution themselves. Contributions are due monthly and must be remitted by the employer.
Benefits Coverage
- Inpatient care: Room and board, drugs, medical supplies, operating room fees
- Outpatient care: Diagnostic procedures, outpatient treatments
- Maternity care: Pre-natal, delivery, and post-natal care
- Emergency care: Emergency room visits and treatment
- Z Benefits: Coverage for specific catastrophic illnesses
Employer Responsibilities
Philippine employers must register all employees with PhilHealth, deduct the employee share from wages, add the employer share, and remit the total contribution monthly. Employers must also submit contribution reports and keep records of all transactions. Failure to comply can result in penalties, surcharges, and potential legal action from PhilHealth.