Who qualifies as an indigent PhilHealth beneficiary? What are the requirements and the step-by-step process of applying? Can I use my indigent PhilHealth in private hospitals? All these questions will be answered in this blog.

Being a member of the Philippine Health Insurance is a necessity for all Filipinos. It provides discounts and privileges at the course of confinement or any medical procedures you would undertake.

HOW CAN YOU BECOME A MEMBER OF PHILHEALTH ACCORDING TO THE IMPLEMENTING RULES AND REGULATIONS OF THE UNIVERSAL HEALTH CARE ACT (RA 11223)?

  1. FIRST, BY BEING A DIRECT CONTRIBUTOR
  • Refers to those who have the capacity to pay premiums,
  • Are gainfully employed and are bound by an employer-employee relationship,
  • Or are self-learning, professional practitioners, migrant workers, including their qualified dependents, and lifetime members.
  • SECOND, AS AN INDIRECT CONTRIBUTOR

Refers to all others not included as direct contributors, as well as their qualified dependents whose premium shall be subsidized by the national government including those who are subsidized as a result of special laws.

Indirect contributors, including their qualified dependents shall composed of, but not limited to, the following:

  • Beneficiaries of Pantawid Pamilyang Filipino Program and Modified Conditional Cash Transfer( 4Ps/MCCT);
  • Senior Citizens
  • Persons with disability, as defined in RA 10754 (An Act Expanding the Benefits and Privileges of Persons with Disability);
  • Sangguniang Kabataan officials, as defined in R.A. 10742 (Sangguniang Kabataan Reform Act)
  • Those previously identified at point-of-service (POS) or during registration, members previously sponsored by LGUs and those who are not yet in the PhilHealth database and are financially incapable to pay premiums.
  • All Filipinos aged 21 years old and above without the capacity to pay premiums;
  • Indigents identified by the DSWD;

WHAT IS PHILHEALTH INDIGENT AND HOW DO I BECOME A MEMBER?

To this category belong persons who have no visible means of income, or whose income is insufficient for family subsistence, as identified by the Department of Social Welfare and Development (DSWD), based on specific criteria.

PhilHealth shall authorize the DSWD or social welfare officers of the LGUs to determine those who are financially incapable to pay premiums.

WHAT ARE THE REQUIREMENTS IN AVAILING PHILHEALTH AS INDIGENT AND OR INCAPABLE TO PAY PREMIUMS?

  • Barangay Certificate of Indigency
  • Medical Certificate
  • Temporary Hospital Bill
  • Photocopy of Birth Certificate or Marriage Contract
  • Duly filled-out PhilHealth Member Registration Form (PMRF). The Form is available in the Hospital or at any PhilHealth Office, and or can be downloadable in the internet.

HOW DO I PROCESS/RENEW A SPONSORED- INDIGENT PHILHEALTH?

Upon completing the requirements mentioned above,

  1. Go to your Local Government Unit’s City Mayor’s Office or City/Municipal Social Welfare and Development Office. Request for a CERTIFICATION for a Government Sponsored PhilHealth which is valid for 1 year Coverage.

NOTE:

  • The City/Municipal Social Welfare and Development Office’s social workers will assess whether or not you qualify as an indigent member. In addition, they will determine whether you have the capacity to pay your premiums or not.
  • Patients admitted in private rooms are not qualified to apply as an indigent member.

  1. If found qualified, the City Mayor’s Office or City/Municipal Social Welfare’s Office will give you a CERTIFICATION along with your other requirements.
  2. Proceed to the PhilHealth Branch near you and submit your requirements and certification.
  3. They will in turn process and give you your Member Data Record (MDR).
  4. Finally, submit a copy to the hospital or lying-in clinic.

INDIGENT PHILHEALTH IN PRIVATE HOSPITALS (DOES PHILHEALTH COVERS PRIVATE HOSPITALS)

PhilHealth has an accreditation program for private hospitals. Hence, it is important to asks whether the hospital is accredited by PhilHealth or not prior to your admission.

Updated: December 2021

LOOK: REQUIREMENTS IN AVAILING FINANCIAL/MEDICAL ASSISTANCE