WHO ARE ENTITLED TO PHILHEATH COVERAGE?
(www.philhealth.gov.ph)

COVERAGE
Who are covered by the National Health Insurance Program (NHIP)?

The program covers the following:

• Employed Members - all those employed in the government and private sector.
• Individually Paying Members - self-employed, Overseas Filipino Workers, professionals in private practice (doctors, lawyers, dentists, etc.)
• Non Paying Members - the following are entitled to lifetime coverage:

Retirees and pensioners of the GSIS and SSS (including permanent total disability and survivorship pensioners of the SSS) prior to the effectivity of RA 7875 in March 4, 1995.

Members who have reached the age of retirement and have paid at least 120 monthly contributions. Optional Retirees (under RA 1616, PD 1146 or PD 1184) are not yet entitled to lifetime coverage until they reach the age of retirement (60 years old).

Indigent Members - under the indigent component of the NHIP


Who are the legal dependents entitled to free coverage?

The following also enjoy coverage through your membership without paying additional premium:

Legitimate spouse, non-member

Children (legitimate, illegitimate, adopted and step child) below 21 years old, unmarried and unemployed

Note :Children 21 years or above but suffering from any congenital disability, either physical or mental, or any disability acquired that renders them totally dependent on the member for support are also given free coverage as dependents provided your membership remains active.

Parents 60 years old and above, not qualified as Non Paying Members and wholly dependent on the member for support

Employed Sector - With deductions for PhilHealth contributions already mandatory for those in the private and government sectors, this program ensures that Medicare benefits are enjoyed by employees, including our household help, when they are most needed!

What You Need to Submit to be a Member:


M1a - (Member Data Record for Employed Members)

M1b - (Member Data Record for Individually Paying Members)

M1c - (Member Data REcord for Non-Paying Members)

How do I declare my legal dependents?

You may declare your dependents by submitting the following requirements to be attached to membership form:

DEPENDENTS REQUIREMENT

Spouse

Copy of Marriage Contract

Children below 21 years of age

a) Legitimate Birth Certificate whether or not the age is at the borderline

b) Illegitimate/Legitimated

ANY OF THE FOLLOWING:

Birth Certificate acknowledged by any of the parent-member

Notarized Affidavit of Support

c) Legally-adoptedANY OF THE FOLLOWING:

Legal adoption papers

Notarized Affidavit that child is legally adopted

d) Step child

ANY OF THE FOLLOWING:

Birth Certificate

Baptismal Certificate

Affidavit of Support by his mother or his step-father in the absence of the mother or vice versa.

e) 20 years of age

(bordering the age of 21)Birth Certificate

f) If 21 and above but suffering from congenital illness or disabilities. Doctor's certification to the effect that the dependent child is disabled or suffering from congenital illness

Parents

a) 60 years old and above ANY OF THE FOLLOWING:

Birth Certificate

Affidavit of Two (2) Disinterested Persons

Voter's Affidavit

Passport (page indicating data of holder)

b) Step Parent/s 60 years old and above
Photocopy of Marriage Certificate/Contract between biological parent of the member child and the step parent;

Photocopy of Birth Certificate of Step Parent (in its absence, a Notarized Affidavit of Two Disinterested persons attesting to the date of Birth);

Photocopy of Birth Certificate of the member child indicating the name of his/her biological parent; AND Photocopy of Death Certificate of Member's deceased biological parent.

c) Adoptive Parent/s 60 years old and above

Photocopy of Court Decree/Resolution of Adoption OR photocopy of Birth Certificate of the child in which the adoption is annotated thereto; AND

Photocopy of Birth Certificate/s of Adoptive Parent/s
(in its absence, a Notarized affidavit of two disinterested persons attesting to the date of birth).