2017 WZ]o, o Z ] ]Ì v[ Z · Kaagapay naming ang mga miyembro sa pagtataguyod ng pagkakaisa bilang isang konseptong mahalaga sa pagkamit ng layunin. Patuloy naming paghuhusayin ang

Republic of the Philippines

PHILIPPINE HEALTH INSURANCE CORPORATION Citystate Centre, 709 Shaw Boulevard, Pasig City

Call Center (02) 441-744 Trunkline (02) 441-7444

www.philhealth.gov.ph

Annex A Corporate Order No. __________

teamphilhealth www.facebook.com/PhilHealth [email protected] www.youtube.com/teamphilhealth

2017 PhilHealth Citizen’s Charter

This Citizen’s Charter was developed in support of Republic Act 9485 or the “Anti-Red Tape Act of

2007.”Moreover, this is also a testament to the Corporation’s uncompromising goal to consistently

deliver the best possible customer service in all its frontline offices.

…dahil dito po sa PhilHealth, aming sineseguro na may

“Sulit na Benepisyo sa Bawat Miyembro, Dekalidad na Serbisyo para sa Lahat“

http://www.philhealth.gov.ph/

VISION

Bawat Filipino,Miyembro, Bawat Miyembro, Protektado, Kalusugan ngLahat, Segurado

MISSION

Benepisyong Pangkalusugang Sapat

At De-kalidad para sa Lahat

VALUES

Integridad Inobasyon Agarang Serbisyo

Taos-Pusong

Paglilingkod Pagmamalasakit

Angkop na Benepisyo

Panlipunang

Pagkakabuklod

PANUNUMPA SA SERBISYO

Kami ay nangangakong ilalaan ang mga sarili sa pagsasakatuparan ng Kalusugang Pangkalahatan.

Sisikapin naming makapagbigay nang mabilis at dekalidad na serbisyong pangkalusugan sa lahat ng

Pilipino, ano man ang edad, kasarian o estadong pamumuhay.

Kaagapay naming ang mga miyembro sa pagtataguyod ng pagkakaisa bilang isang konseptong mahalaga sa pagkamit ng layunin.

Patuloy naming paghuhusayin ang aming mga serbisyo at titiyakin ang mga ito’y umaayon sa

nagbabagong panahon at sumasabay sa pandaigdigang pamantayan.

Titiyakin naming laging mauuna ang serbisyo-publiko at taas noo na mag lilingkod sa bayan.

Sisikapin naming maging huwarang kawani at makamit ang tunay na pagbabago sa ating bansa.

Contents

Topic Page PhilHealth Vision, Mission and Values 2

Panunumpa sa Serbisyo 2

PART ONE: LOCAL HEALTH INSURANCE OFFICES (LHIOs) 4

Enrollment Procedures for Members 5

o Employees (Formal Economy: Government and Private) 5

o Household Employees(e.g. Kasambahays and Family Drivers) 5

o Lifetime Members Program- Retirees 6

o Senior Citizen Members 7

o Informal Economy (Informal Sector, I-Group (Organized Groups), Migrant Workers) 8

o Sponsored Program Members 10

o Indigent Members (NHTS-PR) 10

Declaration of Dependents 10

Registration Procedures for Employers (Government, Private and Household Employers) 12

Registration Procedures for Electronic Premium Remittance System (EPRS) Account of Employers 13

Payment of Premium Contributions (Formal/Informal Economy, Migrant Workers and Sponsored) 13

Submission of Reports (Formal Economy) 14

Inquiry (Membership and Claims Concerns) 14

Updating of Records – Members & Employers 15

Application for Accreditation – Health Care Institutions (HCIs) and Professionals (HCPs) 21

Filing of Claims

o Fee-For-Service (FFS) and Case Rates (CR) – Filed by Member and Health Care Facility 31

o All Case Rates (ACR) - Filed by Member and Health Care Facility 32

Check Releasing 35

Request for Records 35

Matrix of Service Standards (LHIOs) 36

Enrollment (Government, Private, & Household Employees, Lifetime Members, Senior Citizen Members, Informal Sector, Foreign National, Migrant Workers)

37

Updating of Membership Records 42

Request for Records (e.g. MDR, Certificates, ID/PIC, etc) 42

Registration (Formal Sector: Government, Private and Household Employers) 43

Payment of Premium Contributions 44

Submission of RF1 Remittance Reports for GIDA Areas 45

Inquiry / Public Assistance 45

Filing of Claims - Filed by Member and Health Care Facility 46

Submission of Application for Accreditation (HCIs and HCPs) 48

Check Releasing 50

Request for Services 51

Feedback Mechanism 51

LHIO Process Flow Chart 52

PART TWO: PHILHEALTH EXPRESS 53

Services Offered 54

Enrollment Procedures: Government, Private & Household Employees, Lifetime Members, Senior Citizen Members, Informal Economy (Informal Sector, Migrant Workers, Foreign Nationals)

55

Registration Procedures for Employers (Government, Private and Household Employers) 59

Inquiry 60

Updating of Records (Members and Employers) 60

Submission of Reports (Employers) 61

PhilHealth Express – Process Flowchart 62

Feedback and Redress Mechanism 63

Anti-Fixer Campaign Banner and Calling Card 65

Annexes

o Annex A: Premium Contribution Table (Formal Economy and Kasambahay) 67

o Annex B: Premium Contribution Table (Informal Economy, Sponsored and Migrant Workers) 68

o Annex C: Schedule of Accreditation Fee for Health Care Institutions 69

| PhilHealth Citizen’s Charter 2017 4

Local Health Insurance Offices (LHIOs)

Frontline Services Offered and Clientele

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ENROLLMENT PROCEDURES FOR MEMBERS

Employees (Formal Economy: Government and Private)

Frontline Services & Clientele Documentary Requirements PhilHealth Forms Fees Duration

Employees (Newly hired and existing employees with or without PIN yet)

None * For declaration of dependents see separate section on “Declaration of Dependents”

ER2 and PMRF (if no PIN yet)

ER2 Only (If with

PIN)

No service fee 25 minutes (for 5 PMRFs and below)

6-200 PMRFs for 3 working days

201 – 400 PMRFs for 5 working days

401 and above for 10 working days

Household Employees (i.e., Kasambahays and Family Drivers)

Frontline Services & Clientele

Documentary Requirements PhilHealth Forms Fees Duration

Household Employees (Newly hired and existing Household employees with or without PIN yet)

None * For declaration of dependents see separate section on “Declaration of Dependents”

Household Employment Unified Report (HEUR2)and Kasambahay Unified Registration Form (KURF) for Kasambahays (if without PIN yet)

HEUR2 and PMRF for Family Drivers(if without PIN yet)

HEUR2 only(If with PIN)

No service fee 25 minutes (for 5 PMRFs and below)

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Lifetime Members Program Retirees


General Requirements for all categories of retirees

2 Latest 1x1 ID photo Specimen signature * For declaration of dependents see separate section on “Declaration of Dependents”

PMRF No service fee 30 minutes per PMRF

Specific Requirements per Category

SSS Retirees/ Pensioners

Printout of Death, Disability and Retirement (DDR) from any SSS office indicating that the type of claim is retirement in nature and the effectivity date of pension; or

Printout of contributions issued by SSS office indicating the latest contributions (if they retired after March 4,1995)


GSIS retirees Any of the following:

Certification/Letter of Approval of Retirement from GSIS

Service Record issued by employer/s indicating date of retirement and total number of service not less than 120 months

Certification/Retirement Gratuity from employer indicating not less than 120 months of service.


Uniformed Members of the AFP, PNP and BFP Retirees/ Pensioners (those who are inactive military service until they retire at age 56 and those separated by retirement or other reasons prior to the said age but have reached the age of 60)

Any of the following:

Statement of Services from previous employer indicating not less than 120 months of service

Certification/Letter of Approval of Retirement from GSIS not less than 120 months of service

General, Bureau or Special Order indicating effectivity of retirement.


Receiving of the documents for retiring

Photocopy of the following documents, duly certified by the employer: Approved retirement

PMRF No service fee 3 minutes

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employees whose application for the Lifetime Member Program (LMP) will be facilitated by the employer three (3) months prior to the date of retirement

application and proof of contributions or Service Record

Senior Citizen Members



Senior Citizens a. 1 x 1 photo taken within the last six (6) months; and

b. Senior Citizens' Identification Card issued by the OSCA in the city or municipality where the elderly resides or ANY of the following as proof of status as senior citizen:

i. Philippine passport; ii. Birth certificate; iii. Baptismal Certificate; iv. Valid Driver’s license; v. Voter’s ID; vi. SSS/GSIS ID; vii. Valid Professional Regulatory

Commission (PRC) ID; viii. Postal ID; ix. National Bureau of

Investigation (NBI) Clearance; x. Overseas Filipino Worker’s ID; xi. Valid identification cards issued

by recognized government institutions/agencies/corporations that specify the full name, sex, date of birth, address and signature of owner; or

xii. In the absence of the abovementioned documents, the following may be accepted, subject to PhilHealth validation: - Certificate from the National

Council for the Welfare of Disabled Persons (NCWDP);

- DSWD or Local DSWD certification;


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- Barangay Certification; and - Affidavit from two (2)

disinterested persons certifying the age and identity of the elderly person.

Receiving of the documents for OSCA or other Senior Citizen Group enrollment application for the Lifetime Member Program (LMP) will be facilitated by the employer three (3) months prior to the date of retirement

a. Electronic text file of Senior Citizens with the following: i. Full name (family, first, middle,

including name extension if applicable);

ii. Birth date; iii. Sex; iv. Full name (family, first, middle,

including name extension if applicable) of legal spouse and/or qualified dependents; and

v. Address with the following breakdown: - Unit/Room/Floor No.; - Building Name; - Lot/Block/House/Building

No.; - Street; - Subdivision/Village; - Barangay (required field); - City/Municipality (required

field); and - Province (required field).

b. Endorsement letter;

Preferably with filled-out PMRFs

PMRF No service fee 3 minutes

Informal Economy Informal Sector, i-Group (Organized Groups) & Migrant workers


Informal Sector (formerly known as I ndividually Paying Members)

None

* For declaration of dependents see separate section on “Declaration of Dependents”


i-Group (Organized Group)

Signed MOA

Applicable Certification from BSP, COA, SEC, DTI or LGU(delete this), instead a Letter of Intent shall be submitted

PMRF IPAF(to delete)

No service fee 10 minutes per PMRF

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Migrant Workers (Land-based)

None If warranted: Any of the following as proof of being

an active OFW: o Valid Overseas Employment

Certificate (OEC) or E- receipt of current year or is valid for one (1) year from date of transaction; or

o Working Visa/Re-entry Permit; or o Valid Employment Contract; or o Valid Company ID issued by

Employer abroad; or o Cash Remittance receipt from

member abroad at least 2 months prior to the date of renewal/payment; or

o Valid workers' Identification (ID) Card issued by the host country (i.e.Hongkong ID, Iqama of Saudi, Permessod' Soggiorno and Cartad' Identita of Italy);or

o Any other equivalent document that will prove that the member is an active OFW.



Foreign Nationals

Alien Certificate Registration (ACR)this should be Alien Certificate of Registration Identity Card (ACR I-Card)

PRA Identification Card or Special Resident Retiree’s Visa (SRRV)



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Sponsored Program Members



Sponsored Members (e.g. LGUs, Private Institutions, Individuals, etc.)

MOA and OBR

Certified List/PMRF



Indigent Members (NHTS-PR)



Indigent Members (Included in the DSWD’s NHTS-PR list)

(Pre-identified by the DSWD) * For declaration of dependents see separate section on “Declaration of Dependents”


DECLARATION OF DEPENDENTS

Dependents: Spouse, Children & Parents



Members’ Declaration of Dependents

None*

*If warranted (Case-to-Case basis but not limited to the following), supporting documents may be required from the applicant/s(see requirements below)

PMRF No service fee 25 minutes (for 5 PMRFs and below)




Documentary Requirements for Declaration of Dependents 1. Dependents: Spouse

(a) Spouse Marriage certificate/Contract with registry number For marriage which took place abroad, marriage certificate stamped “Received” by the Philippine

Embassy or consular office exercising jurisdiction over the place of marriage

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(b) Muslim Spouse Affidavit of Marriage issued by the Office of Muslim Affairs (OMA), which passed through the Shari’a

Court and must be registered/authenticated in the National Statistics Office (NSO) 2. Dependents: Children

(a) Legitimate or illegitimate children below 21 years old Birth Certificate with registry number or Baptismal Certificate reflecting the name of the member

as parent For births which took place abroad, Birth Certificate Stamped “received” by the Philippine

embassy or Consular office exercising jurisdiction over the place of birth

(b) Adopted children below 21 years old Court Decree/Resolution of Adoption or Birth Certificate of the adopted child/ren in which adoption

is annotated thereto

(c) Stepchildren below 21 years old Marriage Certificate (with registry number) between biological parents and step father/stepmother

and Birth Certificate/s (with registry number) of the stepchildren (d) Mentally or physically disabled children who are 21 years old and above

Birth Certificate and original Medical Certificate issued by the attending physician within the past 6 months stating and describing the extent of disability

(e) Foster Child

Foster Placement Authority from DSWD 3. Dependents: Parents

(a) Parent/s 60 years old and above Birth Certificate with registry number of both registrant and parent (in the absence of Birth

Certificate of parent, any proof attesting to the date of birth of parent/s)

(b) Step parents 60 years old and above Marriage Certificate/Contract with registry number between biological parent of the member-child

and the stepparent; Birth Certificate of the stepparent (in its absence, a notarized affidavit of 2 disinterested persons

attesting to the date of birth); Birth Certificate of the member-child indicating the name of his/her biological parent; and Death Certificate of member’s deceased biological parent

(c) Adoptive parents 60 years old and above Court Decree/Resolution of Adoption or photocopy of Birth Certificate of the child in which the

adoption is annotated thereto; and Birth Certificate/s of adoptive parents or in its absence, a notarized affidavit of 2 disinterested

persons attesting to the date of birth

(d) Parents with permanent disability totally dependent with member Original Medical Certificate issued by the attending physician within the past 6 months stating and

describing the extent of disability

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REGISTRATION PROCEDURES FOR EMPLOYERS (Formal Economy) Government and Private



Manual Registration

Government Employers

None Employer Data Record Form

(ER1)

No service fee 15 minutes per ER1

Private Employers

A. Direct to PhilHealth (Non-PBR) Business permit / license to operate

and/or any of the following: o Department of Trade and Industry

(DTI) Registration (Single proprietorship)

o Securities and Exchange Commission (SEC) Registration (Partnerships, Corporations, Foundations, & Non-Profit Organizations)

o Cooperative Development Authority (CDA) Registration (Cooperatives)

o Barangay Certification and/or Mayor’s Permit (Backyard Industries/Ventures and Micro-Business Enterprises)

ER1 No service fee 15 minutes per ER1

Electronic Registration

Private Employers

A. Registration through the Securities and Exchange Commission – Integrated Business Registration System (SEC-IBRS) No Documentary requirement

No service fee c/o SEC (Not Frontline

Service of PhilHealth)

B. Registration through the Philippine Business Registry (PBR) No Documentary requirement

No service fee c/o DTI (Not Frontline

Service of PhilHealth)

Registration Procedures for Household Employers


Household Employers

None Household Employer Unified

Registration Form (HEUR1)

No service fee 15 minutes per HEUR1

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Registration Procedures for Electronic Premium Remittance System Account of Employers


ALL Employers (Government and Private. Optional for Household Employers)

Manual Submission(Walk-in) No Documentary requirement

PhilHealth Online Access Form

(POAF)

No service fee Within 3 working days

Electronic Submission

No Documentary requirement

Electronic PhilHealth

Online Access Form

(e-POAF)

No service fee Within 3 working days

PAYMENT OF PREMIUM CONTRIBUTIONS

Formal / Informal Economy and Migrant Workers


Documentary Requirements PhilHealth Forms Premium Duration

Formal Economy

Formal Sector-Employed Segment

For EPRS Users with 10 and below employees: EPRS-generated Statement of

Premium Accounts

Statement of Premium Account

(SPA)

(Refer to schedule of Premium

Contributions in Annex 1)

10 minutes per

transaction

For non-EPRS Users located in GIDAS or in Areas where there are ACAs but no available Internet Service Provider (ISP): None

PhilHealth Premium Payment

Slip

(PPPS)

10 minutes per

transaction

For Kasambahays None

PhilHealth Premium

Payment Slip

10 minutes per

transaction

Informal Economy

Informal Sector(formerly known as Individually Paying Member)

None PPPS Refer to schedule of premium contributions in Annex B, Table 2)

No additional service fee

10 minutes per

transaction

i-Group Billing Statement

Statement of Premium Accounts (SPA)

PPPS (Members need to pay per schedule as provided in Annex B, Table 2)


10 minutes per

transaction

Migrant Workers (Land-Based)

None PPPS Refer to schedule of premium contributions in Annex B, Table 3)

10 minutes per

transaction

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Foreign Nationals None PPPS Refer to schedule of premium contributions in Annex B, Table 4)

10 minutes per

transaction

Note: This is included in the request for system enhancement

Sponsored Program



Sponsors (e.g. LGUs, Legislators, Private Institutions, Individuals, etc)

Billing Statement PPPS Refer to schedule of premium contributions in Annex B, Table 2)


10 minutes per

transaction

SUBMISSION OF REPORTS (Formal Economy) Manual Submission (Only for Non‐EPRS Employers located in GIDAS or in Areas where there are ACAs but no available Internet Service Provider (ISP).



Hard/Soft copyRF1 users(employers with 10 and below employees)

Employers Remittance Report(RF1)

Text file or MS Excel format Text file

PhilHealth Agents Receipt (PAR) or PhilHealth Official Receipt (POR)

Bills Payments (from accredited collecting agents)

RF1

No service fee 20 minutes per

transaction

Digital/Softcopy RF1users(employers with 11 and above employees)

Text file or MS Excel format Text file

PhilHealth Agents Receipt (PAR) or PhilHealth Official Receipt (POR)

Bills Payments (from accredited collecting agents)

None No service fee 30 minutes per

transaction

INQUIRY (Membership and Claims Concerns)


General Information about PhilHealth membership (e.g. requirements,

None Applicable forms such as PMRF, Claim Forms 1, 2 & 3, ER 1, 2 & 3,

No service fee 8 minutes per transaction

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forms, premium, eligibility, etc.)

Premium Payment Slip

Info materials such as Pamphlets, brochures, flyers

PhilHealth Refund– Claims (All Members)

Request Letter None No service fee 10 minutes

UPDATING OF RECORDS – MEMBERS



All members *Thru employers (List of employees per Section 15 (a) of RIRR of RA 7875, as amended. Being implemented thru PC No. 031-2015 and PhilHealth-SOP-02-01-005)

A. For correction of name If warranted, Birth certificate or 2

valid IDs with correct name or marriage certificate plus another valid ID with correct name/ Affidavit of 2 disinterested persons

PMRF/

Employers’ List* No service fee 15 minutes

per PMRF/ER3

B. For change of name (PC 50, s-2012) If warranted, Annulment/Court

Decision/Barangay Certificate/NSO with annotation/

PMRF/


per PMRF/ER3

C. Correction of date of birth If warranted, Birth certificate or 2

valid IDs with correct date of birth or marriage certificate with correct date of birth plus another valid ID with correct date of birth.

PMRF/


per PMRF/ER3

D. Change of civil status If warranted, Marriage Contract

Certificate/Court Decision

PMRF/

Employers’ List*

No service fee 15 minutes per

PMRF/ER3

E. New and additional dependents If warranted, Birth Certificate of

the dependent/Court Decision on Adoption/Foster Parental Authority from DSWD/Medical Certificate for parents below 60 years old and children above 21 years old with permanent disability

PMRF/


per PMRF/ER3

F. Change and correction of information of dependent/s Birth Certificate of the

dependent/Court Decision on Adoption/Marriage Contract

If warranted: Death Certificate of Spouse

PMRF/


per PMRF/ER3

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UPDATING OF RECORDS – EMPLOYERS

Updating of Records –Employers (Single Proprietorship)



Single Proprietorship

A. Correction/change of business name/legal personality

Certificate of Registration of Business Name from Department of Trade and Industry

Employer Data Amendment Form (ER3)

No Service Fee 15 minutes per ER3

B. Temporary suspension of operation due to: Bankruptcy o Financial Statement; or o Income Tax Return(ITR)

Fire/Demolition– o Certification from the Fire

Department of the locality; or o Certification from the

Municipal/ City Hall

Separation of employee/s– o Report on the Separation of the

Last Employee/s; and o Separation paper of the last

employee/s Termination / Dissolution o For single proprietorship -

approved application for Business Retirement by the Municipal/City Treasurer’s Office

o For partnership or corporation – Deed of Dissolution approved by SEC or minutes of the meeting certified by the Corporate Secretary

o For cooperatives – Certificate/Order of Dissolution/Cancellation issued by the CDA

o Under fortuitous events as defined by law – applicable supporting documents as may be determined by the Corporation

ER3 No Service Fee 15 minutes per ER3

C. Change of ownership Deed of Sale/

Transfer/Assignment signed by both parties*


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D. Resumption of Operation – Prescribed PhilHealth Form reporting newly hired or re-hired employees Death of managing owner (Family

Business)– Death Certificate of the

managing owner and waiver from the other legal heirs

Resumption of Operation Notice of Resumption of

Operation from the employer, and List of Employees.


Updating of Records – Employers (Partnership)



Partnership

A. Correction of business name Certificate of Registration from

Securities Exchange Commission; or Certificate of

Articles of Partnership duly approved by Securities Exchange Commission


B. Change of business name

Certificate of Amended Articles of Partnership duly approved by Securities Exchange Commission


B. Change of legal personality (Partnership to Corporation)

Certificate of Articles of Incorporation duly approved by Securities Exchange Commission; and

Deed of Dissolution of Partnership approved by Securities Exchange Commission


C. Temporary suspension of operation due to:

Bankruptcy o Financial Statement; or o Income Tax Return(ITR) for the

year showing non-operation/no earnings

• Fire/Demolition/Flood o Certification from the Fire


Municipal/City Hall


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Strike o Notice of Strike duly licensed by

DOLE • Separation of employee/s o Report on the Separation of the


employee/s

Updating of Records – Employers (Corporation)



Corporation A. Correction of business name

Certificate of Registration from SEC; or

Certificate of Articles of Partnership duly approved by SEC


B. Change of business name

Certificate of Amended Articles of Incorporation duly approved by SEC


C. Change of legal personality (Corporation to Partnership) • Certificate of Articles of

Partnership duly approved by SEC; and

• Deed of Dissolution as Corporation approved by SEC


D. Temporary suspension of operation due to: • Bankruptcy o Financial Statement; or o Income Tax Return (ITR) for

the year showing non-operation/no earnings; or

o Board Resolution certified by the Corporate Secretary

Fire/Demolition/Flood o Certification from the Fire

Department of the locality; or

o Certification from the Municipal/City Hall

Strike o Notice of Strike duly licensed by

DOLE • Separation of employee/s o Report on the Separation of the


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employee/s

E. Termination/Dissolution

Deed of Dissolution approved by Securities Exchange Commission; and

Minutes of the Board Meeting duly certified by the Corporate Secretary


F. Merger/Consolidation

Deed of Merger/Merger Agreement duly approved by SEC; or

Memorandum of Agreement filed with SEC


G. Change of ownership • Sale o Deed of

Sale/Transfer/Assignment signed by both parties

o License to Operate (LTO) reflecting the name of Owner

• Death of managing owner (Family Business) o Death Certificate of the

managing owner and waiver from the other legal heirs


H. Resumption of Operation • Notice of Resumption of Operation

from the employer, and • List of employees


Updating of Records – Employers (Cooperative)


Cooperative A. Correction of business name • Certificate of Registration from

Cooperative Development Authority(CDA); or

• Certificate of Articles of Cooperation duly approved by CDA


B. Change of business name • Certificate of Amended Articles of

Cooperation duly approved by CDA


1. Temporary suspension of operation due to: • Bankruptcy o Financial Statement; or


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o Income Tax Return (ITR) for the year showing non-operation/no earnings;

• Fire/Demolition/Flood– o Certification from the Fire


Municipal/City Hall • Separation of employee/s o Report on the Separation of the


employee/s

2. Termination/Dissolution Dissolution of Cooperation duly

approved by CDA


3. Resumption of operation • Notice of Resumption of Operation

from the employer, and List of employees


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APPLICATION FOR ACCREDITATION - Health Care Institutions (HCIs)

Submission of Application for Initial Accreditation of Health Care Institutions (HCIs)



C. Hospital

D. Infirmary/ Dispensary

E. Birthing Home

F. Ambulatory Surgical Clinic(ASC)

G. Dialysis Clinic (Hemodialysis and Peritoneal Dialysis)

H. PCB1 Provider

I. DOTS Provider

J. Animal Bite Package Providers

General Requirements

1. Properly accomplished Provider Data

Record (PDR)

2. Duly signed and properly filled out

Performance Commitment (PC)

applicable for single HCI or group of

HCIs

3. Electronic copies of recent photos

(JPEG format) of the following

required areas of the facility, taken

within three months, to be

submitted in CD or USB:

a. Internal area

a.1. Hospital

PhilHealth ward, ER, OR, RR,

DR, ICU (if applicable)

a.2. ASC

Reception area/ waiting

area;

Operating room;

Laboratory, if available

a.3. Dialysis Clinic

Reception area/ waiting

area;

Dialysis stations;

Nurses’ station;

Reverse osmosis room

a.4. Infirmary/ Dispensary

Emergency room;

PhilHealth ward

Laboratory (if available)

Pharmacy (if available)

a.5. PCB1 Provider

Reception/ waiting area

consultation room/

examination room

Laboratory (if available)

a.6. Birthing Home/ Maternity

Care Package Provider

PhilHealth ward

• Providers Data

Record • Performance

Commitment (PC)

• Performance

Commitment

specific for

PCB1 providers

• Level 3 – Php10,000

• Level 2 – Php8,000


• Infirmary/ Dispensary – Php3,000

• Birthing Home – Php1,500

• PCB1 – Php1,000

• DOTS – Php1,000

• ABPP – Php1,000

30 minutes

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Emergency room

Recovery room

Operating room, etc

a.7. TB DOTS Provider

Consultation area;

Laboratory

a.8. Animal Bite Package

Provider

Consultation area

b. External Area

Facade of the facility

4. Duly signed Statement of Intent

(SOI) for HCIs applying for initial or

re-accreditation which filed from

October to December of the year

5. Proof of payment of accreditation

fee.

Specific Requirements (to be submitted in addition to the General Requirements) Level 1 Hospital; Infirmary/ Dispensary; Ambulatory Surgical Clinic; and Dialysis Clinic (performing Hemodialysis):

A. Specific Requirements for 3-year rule in operation 1. Updated DOH License applicable to the accreditation period applied for 2. DOH license from 3 previous years or any of the alternative documents.

B. Alternative Documents if cannot comply with the 3-year rule

1. Supporting documents showing the Managing Health Care Professional’s (HC Professional) Education and Work experience such as: 1.1. Certificate of Completion of a Masteral Degree in hospital administration or other related degree; 1.2. Any of the following proof of the work experience of the Managing HC Professional for three (3)

years in a similar or analogous or at least the same level of accredited HCI it is applying for such as:

Service record from accredited government facility; or

Certification from the Board of the Corporation or Foundation; or

Certification from the Facility Owner of the private facility 2. DOH LTO as Level 2 or 3 hospital; or 3. Certification from the LGU (signed by the LCE) that the LGU where the HCI operates cannot

adequately or fully service its population; or 4. Any proof that the HCI is an extension or branch of a HCI that has been accredited for at least 2

years such as: 4.1. Securities & Exchange Commission (SEC) Registration, including Articles of incorporation

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4.2. Deed of Sale 4.3. Cooperative Development Authority (CDA) certificate Department of Trade and Industry

certificate (For private HCIs) PCB1 Provider

1. Duly signed and properly filled out Performance Commitment (PC) with specific provision for PCB 2. MOA with referral secondary laboratory for providers with no capability to provide lipid profile and FBS

(signed by representative/s of the applicant HCI and referral facility; name of the HCI and HCI representatives are reflected in the MOA; signatories in the MOA are also the signatories in the Performance Commitment)

3. Location map

4. Additional Requirement to Provide Outpatient Malaria Package: 4.1. Certificate of Training in Malaria issued by DOH/CHDs 4.2. Any of the following proof that the staff is an employee of the applicant HCI:most recent payroll

with the name of the staff in it or remittance form 1 or contract of service/service record Birthing Home; and Maternity Care Package Provider (MCP):

1. Updated DOH License applicable to the accreditation period applied for or Certificate of Compliance as a BEmONC facility (for automatic accreditation)

2. Certificate as Newborn Screening Facility or letter of approval as a Newborn screening facility (NSF) issued by the CHD or Newborn Screening Reference Center (NSRC)

3. Location map 4. Any of the following for applicable referral system:

4.1. MOA or Proof of Affiliation of the physician with at least a Level 1 PhilHealth accredited hospital 4.2. MOA with referral physician/s for OB and Pedia cases as applicable 4.3. MOA with a DOH-certified BEmONC - CEmONC network (if not BEmONC Certified)

5. Location map

6. Business Permit (for private facilities) 7. Additional Requirement to Provide IUD insertion in the facility:

Certificate on “Family Planning Competency-Based Training” (FPCBT) Level 2 of the accredited Physician or Midwife who performs the IUD insertion, or Residency Training certificate on Obstetrics and Gynecology of the accredited physician

Dialysis Clinic Performing Peritoneal Dialysis

1. Certificate from the Philippine Society of Nephrology as PD Center 2. Certificate of participation to Philippine Renal Disease Registry 3. It should have an on-going Quality Assurance Program

TB DOTS Package Provider (DOTS); and Animal Bite Package Provider (ABPP)

1. Updated DOH-PhilCAT Certificate for DOTS and Certification as an Animal Bite Treatment Center (ABTC/ABC) from the DOH - National Rabies Prevention and Control Program Office

2. Location map

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Submission of Application for Continuous Accreditation of Health Care Institutions (HCIs)



A. Hospital B. Infirmary/

Dispensary C. Birthing Home/

Maternity Care Package Provider

D. Ambulatory Surgical Clinic

E. Dialysis Clinic (Hemodialysis and Peritoneal Dialysis)

F. PCB1 Provider

G. DOTS Provider

H. Animal Bite Package Providers

General Requirements 1. Properly accomplished Provider Data

Record (PDR) 2. Duly signed and properly filled out

Performance Commitment (PC) applicable for single HCI or group of HCIs

3. Latest audited financial statement reflecting the total income received from PhilHealth. If the latest audited FS is not yet available, the HCI shall submit any of the following: a. If LGU-owned facilities; a

statement of income and expense, including total income received from PhilHealth issued by the municipal auditor

b. If private facilities; statement of income and expenses including total income received from PhilHealth issued by either an internal or external auditor

4. Proof of payment of accreditation

fee

• Providers Data Record

• Performance Commitment (PC)

• Performance Commitment specific for PCB1 providers

• Level 3 – Php10,000




• Birthing Home – Php1,500

• PCB1 – Php1,000



30 minutes

Specific Requirements (to be submitted in addition to the General Requirements) Level 1 Hospital; Infirmary/ Dispensary; Ambulatory Surgical Clinic; Dialysis Clinic (performing Hemodialysis); and Birthing Home:

Updated DOH license TB DOTS Provider; and Animal Bite Package Provider:

Updated DOH-PhilCAT Certificate for DOTS and Certification as an Animal Bite Treatment Center (ABTC/ABC) from the DOH - National Rabies Prevention and Control Program Office

PCB1 Provider:

PC with Special provisions for PCB1 provisions Maternity Care Package Provider

1. Newborn Screening facility certificate 2. Proof of referral system:

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a. Proof of Affiliation/ MOA with at least a level 1 PhilHealth accredited hospital b. MOA with referral physician/s for Obstetrics & Gynecology and Pediatric cases, as applicable c. MOA with a DOH-certified BEmONC-CEmONC network (if not BEmONC Certified)

Submission of Application for Re-Accreditation of Health Care Institutions (HCIs) The following are the conditions for re-accreditation of health care institutions:

A. Health care institutions whose previous accreditation has lapsed or whose subsequent application was denied (HCI shall exhibit that reason for denial has been addressed);

B. Health care institutions that failed to submit the requirements for continuous accreditation within the prescribed period;

C. Resumption of operation after closure/ cessation of operation D. Health care institution that transferred location. Requirements shall be submitted within ninety (90)

calendar days from actual transfer of location. E. Upgrading of facility level or category; F. Acquisition of additional service capability that would require change in license/ certificate, as

applicable, issued by the relevant authority. G. Upgrading of facility level or category (e.g. ASC to level 1 hospital) H. Change in classification of health care institution (e.g. general hospital to special hospital, birthing home

to infirmary). I. Change of ownership. Requirements shall be submitted within ninety (90) calendar days from actual

change of ownership.

Table 1. Requirements for HCIs applying for re-accreditation under the Conditions A, B, C and D:

Frontline Services

& Clientele Documentary Requirements PhilHealth Forms Fees Duration


Dispensary C. Birthing Home D. Ambulatory

Surgical Clinic E. Dialysis Clinic

(Hemodialysis and Peritoneal Dialysis)

F. PCB1 Provider G. DOTS Provider H. Animal Bite

Package Providers




3. Photos of the HCI (only if there are improvement/ renovation undertaken)

4. Proof of payment of accreditation fee

5. Duly signed Statement of Intent (SOI) for HCIs applying for initial or re-accreditation which filed from October to December of the year

6. Request letter for re-accreditation




• Level 3 – Php10,000




• Birthing Home/ MCP – Php1,500

• PCB1 – Php1,000



30 minutes

Specific Requirements (to be submitted in addition to the General Requirements) Hospital; Infirmary/ Dispensary;

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Ambulatory Surgical Clinic; Dialysis Clinic (performing Hemodialysis); and Birthing Home/ Maternity Care Package Provider

Updated DOH license DOTS Provider; and Animal Bite Package Provider

Updated DOH-PhilCAT Certificate for DOTS and Certification as an Animal Bite Treatment Center (ABTC/ABC) from the DOH - National Rabies Prevention and Control Program Office

Primary Care Benefit Provider

PC with special provisions for PCB1 providers

Table 2. Requirements for HCIs applying for re-accreditation under the Conditions E, F, G and H:



A. Hospital

B. Infirmary/ Dispensary

C. Birthing Home/ Maternity Care Package Provider






3. Updated DOH license/ DOH certificate

4. Photos of additional service/ area. 5. Proof of payment of accreditation

fee 6. Duly signed Statement of Intent

(SOI) for HCIs applying for initial or re-accreditation which filed from October to December of the year



• Performance Commitment

• Level 3 – Php10,000




• Birthing Home/ MCP – Php1,500

• ASC – Php5,000

• DC – Php5,000

30 minutes

Table 3. Requirements for HCIs applying for re-accreditation under the Conditions I:



A. Hospital

B. Infirmary/ Dispensary

C. Birthing Home/ Maternity Care Package Provider





3. Any of the following as proof of change in ownership: For private HCIs, any of the

following: a. SEC registration including




• Level 3 – Php10,000




• Birthing Home/MCP – Php1,500

30 minutes

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E. Dialysis Clinic

(Hemodialysis and Peritoneal Dialysis)

F. DOTS Provider Providers

G. Animal Bite Package Providers

Articles of Incorporation b. Deed of Sale c. Cooperative Development

Authority (CDA) d. Department of Trade Industry

(DTI) certificate For government HCIs

a. Provincial to Municipal – usufruct agreement between the province and municipality

b. Local to National – corresponding Republic Act

4. Proof of payment of accreditation fee

5. Duly signed Statement of Intent (SOI) for HCIs applying for initial or re-accreditation which filed from October to December of the year


• ASC – Php5,000

• DC – Php5,000



Submission of Requirements for Profile Update of Health Care Institutions (HCIs)

1. Change of Name of HCI

Frontline Services

&Clientele Documentary Requirements PhilHealth Forms Fees Duration






F. PCB1 Provider G. DOTS Provider

Providers H. Animal Bite

Package Providers

1. Duly signed and properly filled out Performance Commitment (PC) applicable for single HCI or group of HCIs;

2. DOH LTO reflecting new name of the HCI

3. Letter of request containing the following information: previous name, new name, effectivity of new name



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2. Change in Medical Director/ Head of Facility/ Local Chief Executive

Frontline Services

&Clientele Documentary Requirements PhilHealth Forms Fees Duration







Package Providers

1. Duly signed and properly filled out Performance Commitment (PC) applicable for single HCI or group of HCIs;

2. Letter of request containing the effectivity of the date of change



3. Any other change/s in the profile of the HCI not for re-accreditation such as but not limited to

the following: a. Contact number (e.g. telephone number, fax number, e-mail address) b. Affiliate doctor/s

Frontline Services

& Clientele Documentary Requirements PhilHealth Forms Fees Duration







Package Providers

1. Letter of request. 2. Applicable documents such as list of

additional affiliate doctors.

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APPLICATION FOR ACCREDITATION - Health Care Professionals (HCProfs)



A. Physician (General Practitioner, General Practitioner w/ Training, Medical Specialist)

B. Dentist

C. Midwife

General Requirements 1. Properly accomplished Providers

Data Record for Professionals 2. Duly signed Performance

Commitment for Health Care Professional

3. 1 x 1 ID picture (2pcs) 4. PRC license, PRC claim stub or

certification from PRC – updated 5. Proof of payment of required

premium contributions (MI5 or Official Receipt or Certification from PhilHealth of Paid Premium Contributions or RF1 for the employed)

Providers Data Record

Performance Commitment for Health Care Professional

None 30 minutes

Specific Requirements (to be submitted in addition to the General Requirements) General Practitioner with Training

Proof of completed residency training local or abroad (one-time submission only) Medical Specialist

Philippine Specialty Board Certificate (one-time submission only) Midwife

Any of the following evidences of Competency on the Expanded Functions of Midwives (not required for graduates from school year 1995 and onwards):

Certificate of Training from a program accredited by the Continuing Professional Education (CPE), Council of the Board of Midwifery of the Professional Regulation Commission (PRC); or

Training Certificate from DOH-recognized training program; or Certificate of Apprenticeship for one or more years with a PhilHealth-accredited Obstetrician-

Gynecologist/OB DOH Specialist or an accredited midwife done in an accredited facility

Submission of Application for Re-accreditation/Upgrading from General Practitioner with or without Training to Medical Specialist


A. General Practitioner

1. Properly accomplished Providers Data Record for Professionals

2. Duly signed Performance


Performance

None 30 minutes

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B. General Practitioner w/ training





6. Philippine Specialty Board Certificate (one time submission only)


Submission of Application for Re-Classification from General Practitioner to General Practitioner with Training



General Practitioner

1. Properly accomplished Providers Data Record for Professionals

2. Duly signed Performance Commitment for Health Care Professional




6. Proof of completed residency training local or abroad (one time submission only)


Performance Commitment for Health Care Professional

None 30 minutes

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FILING OF CLAIMS UNDER FEE-FOR-SERVICE(FFS) and CASE RATE (CR) (as per PhilHealth Circular No. 11, 11A and 11B, s.2011)

Direct Filing for Members (FFS & CR)

Frontline Services & Clientele Documentary Requirements

PhilHealth Forms

Fees Duration

Member

(Direct filing)

1. Hospital and doctor’s waiver and original official receipts of full payment

2. Original official receipts or photocopies of the same authenticated by PHIC staff (with original copies seen) for medicines bought outside the hospital or laboratory tests performed outside the hospital during confinement The authenticated photocopies is

applicable in cases where original ORs are required by and submitted to HMOs

3. Operative Record (if surgery was performed)

4. Hospital Statement of Account duly signed by the hospital clerk or representative of the patient

5. Anesthesia and Surgical or Operative Record (if surgery was performed).

Member-Data Requirements: 6. For Formal Economy/Employed

members, Claim Form 1 duly signed by Employer

7. For Informal Economy members, latest Proof of Payment.

8. For Indigents, Sponsored or Lifetime members, clear copy of PhilHealth ID or MDR

If confined abroad: 9. Medical Certificate or Clinical Abstract

indicating final diagnosis of patient, confinement period and services rendered written in English

Additional requirements for confinements in non-accredited health care institutions: 10. Health Care Institution’s DOH License 11. Clinical Abstract or CF3 indicating case

was emergency and justification for impossibility of transferring patient to accredited health care institution.

Claim Form 1

Claim Form 2

Claim Form 3

or Clinical

Abstract

(FFS: If

Necessary;

Case Rate

payment:

Mandatory)

Member Data

Record (MDR)

No service

fee

10 minutes

per claim

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Health Care Institution Filed Claims (FFS & CR)


PhilHealth Forms

Fees Duration

Health Care

Institution (HCIs)

1. Operative Record with surgical

technique (if surgery was performed)

2. Statement of Account (mandatory for

fee-for-service only)

3. Original Official Receipts of medicines

bought outside the hospital and x-

ray/laboratory test performed outside

the hospital during confinement*

*X-ray/Laboratory results – mandatory for

case payment

Member-Data Requirements

4. For Informal Economy members, latest

Proof of Payment.

5. For Indigents, Sponsored or Lifetime

members, clear copy of PhilHealth ID or

MDR


bought outside the hospital or

laboratory tests performed outside the

hospital during confinement (if

applicable)

Claim Form 2

Claim Form 3

or Clinical

Abstract

(if required by

policy)

From Member

Claim Form 1

Member Data

Record (MDR)

No service

fee

30 minutes

(for every

100 claims)

FILING OF CLAIMS UNDER ALL CASE RATES (ACR) (as per PhilHealth Circular No.35, s.2013)

Direct Filing for Members (ACR)


PhilHealth Forms

Fees Duration

Member

(Direct filing)

1. Waiver Form for Directly Filed Claims

2. Original official receipts or photocopies

of the same authenticated by PHIC staff

(with original copies seen) for

medicines bought outside the hospital

or laboratory tests performed outside

the hospital during confinement

The authenticated photocopies is

applicable in cases where original ORs

are required by and submitted to

HMOs

Claim Form 1

(this shall be

the only form

required for

confinements

abroad)

Claim Form 2

Claim Form 3

or:

o Clinical

Abstract;

No service

fee

10 minutes

per claim

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PhilHealth Forms

Fees Duration

3. Hospital Statement of Account duly

signed by the hospital clerk

4. For Formal Economy/Employed

members, Claim Form 1 duly signed by

Employer

5. For Informal Economy members, latest

Proof of Payment.

6. For Indigents, Sponsored or Lifetime

members, clear copy of PhilHealth ID or

MDR

7. For PhilHealth Benefit Eligibility Form

(PBEF) with a “No” response due to

membership issue, necessary

supporting documents (e.g. Proof of

premium payment, Marriage

Certificate, etc.) or secondary

documents as listed in PhilHealth

Circular Nos. 50 and 1, s. 2013shall be

attached.

8. Anesthesia and Surgical or Operative

Record (if surgery was performed).

9. For certain procedure listed in Annex

No. 10 of PhilHealth Circular No. 35,

s.2013, Doctor’s order, Nurse’s notes or

official results shall be required instead

of Anesthesia and Surgical or Operative

Record.

10. For confinements abroad:

Certification from the attending

physician as to the final diagnosis,

period of confinement and services

rendered with English translations

from hospital or Embassy for all

documents.

Any proof of payment of hospital bills

and professional fees from the HCI

where the patient was confined.

11. Additional requirements for

confinements in non-accredited health

care institutions:

Health Care Institution’s DOH License

Clinical Abstract or CF3 indicating

case was emergency and justification

for impossibility of transferring

patient to accredited HCI.

o Photocopy

of clinical

charts

Member Data

Record (MDR),

PhilHealth

Benefit

Eligibility Form

(PBEF) or

Cares Form 1

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Health Care Institution-Filed Claims (ACR)


PhilHealth Forms

Fees Duration

Health Care

Institution-Filed

Claims

General Requirements:

Hospital-Data

1. Operative and Anesthesia Record for

claims for surgical procedure

2. For certain procedure listed in Annex

No. 10 of PhilHealth Circular No 35, s.

2013, Doctor’s order, Nurse’s notes or

official results shall be required instead

of Anesthesia and Surgical or Operative

Record.

3. For PhilHealth Benefit Eligibility Form

(PBEF) with a “No” response due to

membership issue: necessary supporting

documents (e.g. Proof of premium

payment, Marriage Certificate, etc.) or

secondary documents as listed in

PhilHealth Circular Nos. 50 and 1, s.

2013 shall be attached.

Member-Data 4. Latest Proof of Payment (for Informal

Economy members) 5. Clear copy of PhilHealth ID or MDR (for

Indigents, Sponsored or Lifetime members)


bought outside the hospital or

laboratory tests performed outside the

hospital during confinement (if

applicable)

Claim Form 2

Claim Form 3

for Maternity

Care Package

and Primary

Care Facilities

PhilHealth

Benefit

Eligibility

Form (PBEF)

with a “Yes”

response

Member forms

Claim Form 1

Member

Data Record

No service

fee

30 minutes

(for every

100 claims)

Additional Requirements for Specific Benefits/Claims: A. TB-DOTS Package

Claims for TB DOTS Package shall have a copy of completed NTP Treatment Card. Copy of NTP Treatment Card prior to treatment shall no longer be required.

B. Animal Bite Treatment Package

For this Package, providers may use Claims Summary Form attached as Annex B of PC 15, s 2012 instead of Claim Form 2. Moreover, submission of Claim Form 3 is not required.

C. Newborn Care Package (NCP)

Claims for NCP shall have a copy of certificate of live birth. A copy from the facility without the registry number is acceptable as long as the records officer/clinic administrator of that facility certifies that it is the same copy which will be submitted for registration to local civil registrar. The Claim Form 2 shall have an attached filter collection card number of the NBS specimen. Also, Claim Form 3 is not required

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Check Releasing


PhilHealth Forms

Fees Duration

Members Photocopy of 2validIDsoftheMember

For authorized representative: o Authorization letter; o Photocopyof2validIDsofthemember;

and o 2valid IDs of the representative

and/or Special Power of Attorney (SPA)

None No service fee

15 minutes

Stakeholders Valid identification of the authorized representative

None No service fee

30 minutes

Request for Records (Employers)


PhilHealth Forms

Fees Duration

Employers If through representative:

Authorization letter from the employer

Any valid ID of the representative

Request Form No service fee

15 minutes

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MATRIX OF SERVICE STANDARDS

Frontline Services: LHIOs

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ENROLLMENT

Formal Sector: Government &Private Employees

Client Step PhilHealth Action Office/Person Responsible

Duration*

1. Secure information, PhilHealth Member Registration Form (PMRF), Report of Employee-Members (Er2 Form) and queuing number at the Public Assistance Desk or, if applicable, Special Lane Section for PWDs/pregnant women and Senior citizens.

1. Direct client/s to the appropriate front line service.

2. Provide the priority number to client/s.

Public Assistance

Staff

1 minute

2. Submit duly accomplished PMRF together with the Report of Employee-Members (Er2 Form) and supporting documents once the number is called

3. Receive and screen duly accomplished PMRF, Er2 and supporting documents

4. Reconcile the name/s of the employees indicated in the Er2 form against the attached PMRF

5. Return received copy of Er2 (if submitted PMRFs are more than 5); or advise the client to wait for the release of PhilHealth Identification Card (PIC) and Member Data Record (MDR) if submitted PMRFs are 5 and below at the Releasing Counter

Frontline Officer

25 minutes (for 5 PMRFs and below)




3. Receive advice and received copy of ER2 from the Frontline Officer if documents submitted are to be mailed or proceed to the Releasing Counter once the name of the company/ business is called.

6. Endorse PMRFs to Support Officer for processing

7. Process PMRFs (Detailed Processing) 7.1. Verify if name of employee already

exists in the system 7.2. Encode data indicated in the PMRF

in the system 7.3. Print PhilHealth Identification Cards

(PIC) and Member Data Record (MDR)

8. Release the PhilHealth Identification Card/s (PIC) and Member Data Record/s (MDR)

Frontline Officer

Frontline Officer

4. Receive copy of PIC and MDR at the Releasing Counter

Note: Under normal circumstances per transaction

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Household Employees (e.g. Kasambahays and Family Drivers)


Duration*

1. Secure and submit duly accomplished Kasambahay Unified Registration Form (KURF) and/or PMRF (for Family Driver)together with the Household Employment Unified Report (HEUR2) form and supporting documents (if any) to the frontline staff

2. Sign the processed HEUR2 and KURS and hand them back to the front line officer.

1. Receive and screen submitted KURF/PMRF and supporting documents

2. Reconcile the name/s of the Kasambahay/Family Driver indicated in the HEUR2 form against the attached KURF/PMRF

3. Acceptance of submitted KURF/PMRF 3.a. For 5 KURF/PMRF and below, advise client

to wait for the release of PIC, MDR and copy ofprocessedHEUR2

3.b. For more than 5 KURF/PMRF, receive the documents and inform client to return after 3 days for the release of PIC, MDR and copy of processedHEUR2.

4. Process KURFs/PMRF (for Family Drivers)

4.a. Verify if name of household employee already exists in the system.

4.b. Update / Encode data indicated in the

KURF in the system (via KURS). 4.c. Print PIC and MDR 4.d. Print and sign the processed HEUR2 and

KURF in 3 copies. 4.e. Require the client to sign also the above-

mentioned 3 copies. 4.f. Hand-over 1 duly-signed copies of the

processed HEUR2 and KURF to the client, and keep the 2 other originally-signed copies for endorsement to SSS and for PhilHealth record.

Frontline Officer


3. Receive copy of processedHEUR2withapplicant’s signature, PIC and MDR from the frontline staff

5. Release the copy of processedHEUR2, PIC and MDR to household employee/ representative


Lifetime Members


Duration*

1. Secure information, PhilHealth Member Registration Form (PMRF) and queuing number at



Public Assistance

Staff

1 minute

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Duration*

the Public Assistance Desk or if applicable, Special Lane for PWDs/ Pregnant Women and Senior Citizens,

2. Submit duly accomplished PMRF and supporting document/s, if applicable, once the number is called.

3. Receive and screen duly accomplished PMRF with supporting documents

4. Encode/clean-up detected multiplicity/assign/update member data and scan signature of member.

5. Print the Member Data Record (MDR) and Identification Card.

Frontline Officer

30 minutes per PMRF

6. Laminate the printed Identification Card with the ID picture of the Client/Member, if applicable

7. Release the laminated Identification Card to Client/Member together with the Member Data Record (MDR) and have the member sign/acknowledge receipt of documents

Frontline

Officer

3. Receive the Identification Card and Member Data Record (MDR) and acknowledge receipt




Duration*

1. Secure information, PhilHealth Member Registration Form (PMRF) and queuing number at the Special Lane for PWDs/Pregnant Women and Senior Citizens

1. Direct client to the appropriate lane 2. Provide priority number

Public Assistance Staff

1 minute

2. Submit duly accomplished PMRF and supporting documents after the number is called

3. Receive and screen duly accomplished PMRF with supporting document/s.

4. Encode/clean-up detected multiplicity/update member data if with existing record. If none, issue PIN.

5. Print Member Data Record (MDR) and PhilHealth Identification Card

Frontline officer

10 minutes per PMRF

3. Sign name in the PhilHealth ID card

6. Release MDR and PhilHealth ID Frontline officer

4. Receive the Identification Card & Member Data Record (MDR)

7. Acknowledge receipt of documents Frontline officer


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Informal Sector (Formerly known as Individually Paying Program/IPP Members)


Duration*

1. Secure and fill-up (information), PhilHealth Member Registration Form (PMRF) and get queuing number at the Public Assistance Desk or if applicable, Special Lane for PWDs/ Pregnant Women and Senior Citizens.



Public Assistance

Staff

1 minute

2. Submit duly accomplished PMRF and supporting documents and payment slip once the number is called.


4. Evaluate the completeness of data in the PMRF

5. Encode/assign/update in the MCIS 6. Print the Member data Record (MDR)

and PhilHealth Identification Card (PIC) of the Client/Member

7. Endorse payment slip to the assigned payment processor and advise to proceed to the Payment Processor window and return after payment has been made

Frontline Officer

10minutes per PMRF

3. Proceed to the Cashier’s window once number is called, tender payment (premium contribution) and receive Official Receipt

8. Encode payment slip and assign number

9. Advise member to proceed to Cashier’s Window once the number is called

Payment Processor/ Collecting

Officer

5 minutes

4. 5. Proceed to Frontline Officer and

receive PIC and MDR

10. Receive payment from client, print Official Receipt (OR) and issue OR

Collecting Officer

5 minutes

*Note: Under normal circumstances per transaction excluding queuing for payment

Foreign Nationals


Duration*

1. Secure information, PhilHealth Member Registration Form (PMRF) and queuing number at the Special Lane for PWDs/Pregnant Women and Senior Citizens


Public Assistance Staff

1 minute

2. Secure/Submit duly accomplished

3. Receive and screens duly accomplished PMRF and verify authenticity of

Frontline Officer

10 minutes per PMRF

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PMRF, PRA Identification Card or Special Resident Retiree’s Visa (SRRV) , Alien Certificate of Registration Identity Card (ACR I-Card) and supporting documents after the number is called

supporting documents. 4. Evaluate the completeness of data in the

PMRF 5. Encode/assign/update member’s data in

the MCIS 6. Advise Client /Member to pay to the

nearest Accredited Collecting Agent (ACA) and return after the payment has been made and submit PhilHealth’s copy of Official Receipt (OR)

7. Print Member Data Record (MDR) and PhilHealth Identification Card (PIC) of the Client/Member


8. Encode payment slip and assign number 9. Advise member to proceed to Cashier’s

Window once the number is called

Payment Processor/Collecting Officer

5 minutes

4. Proceed to Frontline Officer and receive PIC and MDR

10. Receive payment from client, print Official Receipt (OR) and issue OR

Collecting Officer

5 minutes


Migrant Workers (Land-based)


Duration*

1. Secure information, PhilHealth Member Registration Form (PMRF) and queuing number at the Public Assistance Desk or if applicable, Special Lane for PWDs/ Pregnant Women and Senior Citizens



Public Assistance

Staff

1 minute

2. Submit duly accomplished PMRF and supporting documents and payment slip once the number is called.

3. Receive and screen duly accomplished PMRF with supporting documents and payment slip

4. Encode/assign/update member’s data 5. Endorse payment slip to the assigned

Payment Processor/ Collecting Officer and advise client to proceed to the Payment Processor window and return after payment has been made

Frontline Officer

10 minutes per PMRF

3. Proceed to the Payment Processor desk and receive

6. Encode payment slip and assign number

Payment Processor/

5 minutes

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Duration*

priority number 7. Advise member to proceed to Cashier’s Window once the number is called

Collecting Officer


8. Receive payment, issue OR and advice client/member to proceed to Frontline Officer to get PhilHealth Identification Card (PIC) / Member Data Record (MDR)

Collecting Officer

5 minutes

5. Receive PIC and MDR from Frontline Officer

9. Print and release MDR and PIC Frontline Officer


Updating of Membership Records


Duration*

1. Secure information, PhilHealth Member Registration Form (PMRF) and queuing number at the Public Assistance Desk or If applicable, Special Lane for PWDs/ Pregnant Women and Senior Citizens



Public Assistance

Staff

1 minute

2. Submit duly accomplished PhilHealth Member Registration Form (PMRF)/ER3and supporting documents once number is called


4. Encode/update Client/Member’s data 5. Print amended Member Data Record

(MDR)/ PhilHealth Identification Card (PIC- if applicable)

6. Release amended MDR/PIC(if applicable) to the member or Employer Data Record (EDR) to the Employer

Frontline Officer

15 minutes per PMRF/ER3

3. Receive updated MDR/PIC (if applicable)/EDR


Request for Records (e.g. MDR, Certificates, ID/PIC, CE1)


Duration*

1. Secure information, queuing number and request from the Public Assistance Desk or if applicable, Special Lane Section for PWDs/ pregnant women and Senior Citizens



Public Assistance

Staff

1 minute

2. Submit duly accomplished request for documents

3. Receive properly filled-out request form with supporting documents

Frontline Officer

15 minutes (per requested

LHIO

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Duration*

form(with supporting documents if applicable) once number is called

(if applicable) 4. Process request of client 5. Release requested documents and

require member to acknowledge receipt of documents

form/ document)

3. Receive requested document and acknowledge receipt


REGISTRATION (Formal Sector)

Employers (Government and Private)


Duration*

1. Secure information, Employer Data Record (ER1)and queuing number at the Public Assistance Desk or if applicable, Special Lane Section for PWDs/ pregnant women and Senior Citizens



Public Assistance

Staff

1 minute

2. Submit duly accomplished Employer Data Record (ER1 Form) and supporting documents (e.g., Unified Registration Record (URR) issued by the Securities and Exchange Commission (SEC) or Info Sheet issued by DTI containing their SEC or DTI Registration Certificate Number, PEN, TIN, and employer numbers issued by SSS and Pag-IBIG Fund; ; or business permit for those who have not passed thru the SEC-IBRS or PBR)once the number is called

3. Receive and screen duly accomplished ER1 Form together with supporting documents(e.g., URR or Info Sheet; or business permit)

4. Search in MCIS the issued PEN found in the URR or Info Sheet; or Encode to MCIS (applicants which have not passed thru the SEC-IBRS or PBR)

5. Print the Employer Data Record and Certificate of Registration

6. Release the Employer Data Record and Certificate of Registration

Frontline Officer

15 minutes per ER1

3. Receive the Employer Data Record and Certificate of Registration


LHIO

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Duration*

1. Secure and fill-out Household Employer Unified Registration (HEUR1) form

Frontline Officer

s 15 minutes per HEUR1

2. Submit duly accomplished form and supporting documents to the frontline staff

3. Sign the processed HEUR1 and hand them back to the front line officer

1. Receive and screen duly accomplished HEUR1 and supporting documents

2. Process HEUR1 in the KURS 2.a. Encode in the KURS’ Household employer module. 2.b. Print and sign the processed HEUR1 in 3 copies. 2.c. Require the client to sign also the said 3 copies. 2.d. Hand‐over one (1) duly‐signed copies of the processed HEUR1 to the client, and KEEP the two (2) other originally‐signed copies for endorsement to SSS and for PhilHealth record.

3. Print the Employer Data Record (EDR).

4. Receive the EDR and copy of processed HEUR1 with applicant’s signature.

4. Release the Employer Data Record and COR to household employer/representative


PAYMENT OF PREMIUM CONTRIBUTIONS


Duration*

1. Secure information, PhilHealth Premium Payment Slip (PPPS) and queuing number at the Public Assistance Desk or if applicable, Special Lane Section for PWDs/ pregnant women and Senior Citizens



Public Assistance

Staff

1 minute

2. Submit duly accomplished PPPS to Cashier's window and tender payment once priority number is called

3. Receive and encode payment slip, 4. Receive money from the

Client/Member and print Official Receipt(OR)

5. Release/ Issue PhilHealth Official Receipt

Note: LHIOs may combine all PhilHealth actions

Collecting Officer

10minutes per transaction

Receive PhilHealth Official Receipt


LHIO

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SUBMISSION OF RF1 REMITTANCE REPORTS FOR GIDA AREAS (Only for non EPRS users located in GIDAS or areas with no ISP)


Duration*

1. Secure information and/or queuing number at the Public Assistance Desk or if applicable, Special Lane Section for PWDs/ pregnant women and Senior Citizens



Public Assistance

Staff

1 minute

2. Submit remittance report (RF-1) and/or diskette/ flash drive once number is called

3. Receive and screen remittance report (as to number and/or data stored in the diskette/flash drive).

4. Stamp “received” on the remittance report

5. Return received copy of remittance report/flash drive to client.

Frontline Officer

20 minutes per transaction

30 minutes (soft copy)per transaction

3. Receive copy of acknowledged remittance report


INQUIRY / PUBLIC ASSISTANCE


Duration*

Proceed to the Public Assistance Desk/ Corner and ask for information.

Accommodate client’s inquiry Frontline Officer

8 minutes


LHIO

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FILING OF CLAIMS

Filing of Claims By Members (Direct Filing)


Duration*




Public Assistance

Staff

1 minute

2. When priority number is called, submit duly accomplished acknowledgement receipt form, PhilHealth claims with supporting documents once priority number is called

3. Receive and screen claims as to completeness of documentary requirements (non-medical).

4. Stamp “received” the acknowledgement receipt form and return copy to client/member or return acknowledgement receipt and PhilHealth claim if with deficiency for client/member’s compliance

Frontline Officer

10 minutes

3. Receive acknowledgement receipt or claim with deficiency

5. Advise Client/Member to expect notice/Benefit Payment Notice (BPN) (within the 60-day period) or to comply with the required/deficient documents/information.


Filing of Claims By Health Care Institutions (HCIs)


Duration*




Public Assistance

Staff

1 minute

2. When priority number is called, proceed to Frontline Service Counter and submit claims together with the transmittal list

3. Receive and screen claims as to the correct number and names of claimants against transmittal list.

Frontline Officer

30 minutes for every 100

claims

3. Affix initials to copy of transmittal list, if with correction.

4. Stamp “received” on the transmittal list if there are no deficiencies in the transmittal and total number of claim; if there is/are name/s listed but no claims attached, cross-out name/s in the list and have the transmittal list initialed by the hospital representative/health care provider.

4. Receive copy of acknowledged 5. Return received copy of transmittal list

LHIO

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Duration*

transmittal list

to hospital representative/health care provider and advise client that processing of claims will be done within the 60-day period


LHIO

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SUBMISSION OF APPLICATION FOR ACCREDITATION

Application for Accreditation of Health Care Institutions (HCIs)


Duration*

1. Secure queuing number and information and payment slip at the Public Assistance Desk or if applicable, Special Lane Section for PWDs/ pregnant women and Senior Citizens



Public Assistance

Staff

1 minute

2. Submit duly accomplished application forms for accreditation and supporting documents together with the properly-filled -out payment slip once priority number is called

3. Receive Provider Data Record (PDR), other accreditation documentary requirements and payment slip (order of payment)

4. Screen application and other documentary requirements as to completeness of requirements

5. Write down the HCI data in the receiving logbook

Frontline Officer

30 minutes

3. If the application is not complete, get the receiving copy of the application, receive deficiency letter and explanation on the content of the letter and sign under “disposition” column in the receiving logbook

6. If the application is not complete, return the application to the HCI, furnish a Deficiency Letter, explain the content of the deficiency letter and ask HCI representative to sign under “disposition” column in the receiving logbook

7. If the application is complete, stamp complete the file copy and the receiving copy (PDR and the 1st page of the other requirements)

8. Endorse payment slip (order of payment) to client and advice to proceed to the Payment Processor window and return after payment has been made.

4. Proceed to Cashier 9. Receive payment for accreditation of the HCI, print and release Official Receipt

Collecting Officer

5. Proceed to frontline service counter and get receiving copy of the PDR and other requirements.

10. Release the receiving copy of the PDR and other requirements to the HCI representative

11. If LHIO has an Integrated PhilHealth Accreditation System (iPAS) , they will encode the following HCI data in the receiving module of IPAS: 11.a. Name of HCI 11.b. Address 11.c. Date of submission 11.d. OR number 11.e. Amount of payment 11.f. Date of Payment 11.g. Manner of submission 11.h. Documents submitted

Frontline Officer

LHIO

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Application for Accreditation for Health Care Professionals (HCPs)


Duration*

1. Secure queuing number and information and payment slip at the Public Assistance if applicable, Special Lane Section for PWDs/ pregnant women and Senior Citizens



Public Assistance

Staff

1 minute

2. Submit duly accomplished application form for accreditation and supporting documents

3. Receive application for accreditation, and other supporting documents

4. Screen as to completeness of requirements

5. Write down the HC Professional data in the receiving logbook

Frontline Officer

30 minutes

3. If the application is not complete, get the application and all other requirements, receive the deficiency letter and sign under “disposition” column in the receiving logbook

6. If the application is not complete, return the application to the HCI, furnish Deficiency Letter, explain content of deficiency letter and ask HCI representative to sign under “disposition” column in the receiving logbook

4. If the application is complete, get the receiving copy of all the requirements and receipt of payment.

7. If the application is complete, stamp complete the file copy and receiving copy of the application and the 1st page of the other requirements.

8. Release receiving copy of the application to the HCI applicant

9. If LHIO has iPAS, encode the following HCI data in the receiving module of IPAS 9.a. Name of HC Professional 9.b. Address 9.c. Date of submission 9.d. Manner of submission 9.e. Documents submitted


LHIO

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CHECK RELEASING

Check Releasing (Pick-up by Member)


Duration*

1. Secure queuing number at the Public Assistance Desk or if applicable, Special Lane Section for PWDs/ pregnant women and Senior Citizens



Public Assistance

Staff

1 minute

2. Present valid IDs once number is called at the Check Releasing Counter/Cashier’s window

3. Verify if claim check is available, if not, advice client/member of status of the check (if not yet available, etc.)

4. Validate IDs presented if check is available and release to client/member.

5. Require member to acknowledge receipt of the check by signing the logbook.

Frontline Officer

15 minutes

3. Acknowledge receipt of check.


Check Releasing (Pick-up by Stakeholders)


Duration*

1. Secure information and queuing number at the Public Assistance Desk or if applicable, special lane section for PWDs/pregnant women or Senior Citizens



Public Assistance

Staff

1 minute

2. Present valid company IDs once priority number is called at the Check Releasing Counter/Cashier’s window

3. Receive and validate company ID Frontline Officer

30 minutes

3. Countercheck/validate cheques received then acknowledge receipt of check, affix signature in the logbook and disbursement voucher

4. Verify if check is available, if not, advice client of status of the check, if check is available release check to client.

5. Require client to acknowledge receipt of the check by signing the logbook and disbursement voucher.

4. Issue official receipt 6. Receive the official receipt and file


LHIO

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REQUEST FOR SERVICES (e.g. Replacement of check; Adjustment of benefit payment; Adjustment of premium contribution; Filing of complaints against health providers/professionals; and Walk-in inquiries)


Duration*

1. Secure queuing number, information and applicable forms at the Public Assistance Desk or if applicable, Special Lane Section for PWDs/ pregnant women and Senior Citizens



Public Assistance

Staff

1 minute

2. Submit duly accomplished forms and supporting documents (if applicable) once priority number is called

3. Receive request form/applicable forms 4. Check/Evaluate documents received. 5. Provide feedback on requested

service; advise member/stakeholder appropriately

6. Ask member/stakeholder to affix signature in logbook to acknowledge filing of request

Frontline Officer

15 minutes per

transaction


FEEDBACK MECHANISM


Duration*

1. Proceed to the Local Health Insurance Office (LHIO)Head

1. Accommodate/handle client’s concern/s

2. Provide feedback and/or resolve the client’s concern

3. Advise/Assist client to fill-up feedback form (if necessary)

4. Politely close the conversation 5. Record the transaction

LHIO Head 20 minutes

2. Fill out feedback form 6. Retrieve the feedback form in the feedback box daily and record and resolve the issues in the feedback form

7. Refer to the appropriate office

Administrative Staff

Daily

3. Awaiting feedback 8. Provide feedback if necessary Concerned Office

Within 10 calendar days upon receipt


LHIO

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PhilHealth Express

PhilHealth’s Satellite Offices situated in Malls

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PhilHealth Express – Services Offered

Membership

Services Forms Fees Duration*

Enrollment

Employee (for 5 PMRFs and below) PMRF None 25 minutes (for 5 PMRFs and below)

Lifetime Members (accepts and screens documents for membership registration only)

PMRF None 10 minutes per PMRF

Senior Citizen PMRF None 10 minutes per PMRF

Informal Economy

Informal Sector (formerly known as IPM) PMRF None 10 minutes per PMRF

Migrant Workers (Land-based) PMRF None 10 minutes per PMRF

Foreign Nationals PMRF None 10 minutes per PMRF

Kasambahay HEUR2, KURF None 25 minutes (for 5 PMRFs and below)

Registration

Employer - Registration

Government ER1, ER2, PMRF None 15 minutes per ER1

Private ER1, ER2, PMRF and URR or Info Sheet, if

applicable.

None 15 minutes per ER1

Household Employer HEUR1 None 15 minutes per HEUR1

Inquiry

General Information (all members) None None 8 minutes

Updating of Records

Members PMRF/ Employer’s List* None 15 minutes per

PMRF/ER1

Employers ER3 None 15 minutes per ER3

Submission of Reports

Employer: Hard copy RF1 Users (Employers with 10 and below Employees)

RF1 None 20 minutes per

transaction *Thru employers (List of employees per Section 15 (a) of RIRR of RA 7875, as amended. Being implemented thru PC No. 031-2015 and PhilHealth-SOP-02-01-005)


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ENROLLMENT

Enrollment Procedures for Government and Private Employees


Duration*

1. Submit duly accomplished PMRF forms together with the Report of Employee-Member (ER2) and supporting documents to the frontline staff

1. Receive and screen duly accomplished PMRF, ER2 and supporting documents;

2. Reconcile the name/s of the employees indicated in the ER2 form against the attached PMRF;

3. Acceptance of submitted PMRF 3.a. For 5 PMRF and below: Inform client to

wait for the release of PhilHealth Identification Card (PIC) and Member Data Record (MDR)

3.b. For more than 5 PMRF: Receive the documents and inform client to return after a week for the release of PIC and MDR*

4. Processing of PMRF 4.a. Verify if name of employee already

exists in the system; 4.b. Update / Encode data indicated in the

PMRF in the system; and 4.c. Print PIC and MDR

Frontline Officer


6-200 PMRFs – 3 Days

201-500 PMRFs – 5 Days 501 and above

PMRFs – 10 Days

2. Receive copy of ER2, PIC and MDR from the frontline staff

1. Release the PIC and MDR and copy of ER2 to employer / representative.


Enrollment Procedures for Household Employees (e.g. Kasambahay& Family Drivers)


Duration*

1. Secure and submit duly accomplished Kasambahay Unified Registration Form (KURF) together with the Household Employment Unified Report (HEUR2) form and supporting documents (if any) to the frontline staff

1. Receive and screen submitted KURF and supporting documents

2. Reconcile the name/s of the Kasambahay indicated in the HEUR2 form against the attached KURF

3. Acceptance of submitted KURF 3.a. For 5 KURF and below, advise client to

wait for the release of PIC, MDR and copy of HEUR

3.b. For more than 5 KURF, receive the documents and inform client to return after 3 days for the release of PIC, MDR and copy of HEUR2.

4. Process KURFs/PMRF (for Family Drivers):

Frontline Officer


6-200

PMRFs – 3 Days

201-500 PMRFs – 5 Days

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Duration*

2. Sign the processed HEUR2 and KURF and hand them back to the front line officer

4.a. Verify if name of household employee already exists in the system. 4.b. Update / Encode data indicated in the KURF in the system (KURS). 4.c. Print PIC and MDR 4.d. Print and sign the processed HEUR2 and KURF in 3 copies. 4.e. Require the client to sign also the abovementioned 3 copies. 4.f. Hand‐over one (1) duly‐signed copies of the processed HEUR2 and KURF to the client, and KEEP the two (2) other originally‐signed copies for endorsement to SSS and for PhilHealth record.

501 and above

PMRFs – 10 Days

3. Receive copy of processed HEUR2 and KURF with applicant’s signature, PIC and MDR from the frontline staff

5. Release the copy of processed KURF and HEUR2, PIC and MDR to household employee/ representative


Lifetime Members


Duration*

1. Secure and fill-out accomplished PMRF

Frontline Officer

10 minutes per PMRF

2. Submit duly accomplished PMRF together with the supporting documents

1. Receive and screen duly accomplished PMRF and supporting documents.

2. Verify if name of the enrollee already exists in the system. Encode/Clean-up detected multiplicity/ assign/ update member record.

3. If no record, assign PIN & encode data indicated in PMRF.

4. Print PhilHealth Identification Card (PIC) and MDR.

3. Affix signature in the PhilHealth Identification Card (PIC)

5. Let the enrollee signed the PIC 6. Attached the 1x1 picture of the

enrollee to the PIC and laminate.

4. Receive PIC and MDR from PhilHealth frontline staff

7. Release PIC and MDR to member


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Duration*

1. Secure and fill-out PhilHealth Member Registration Form (PMRF)


Frontline officer

10 minutes per PMRF

2. Submit duly accomplished PMRF and supporting documents

3. Receive and screen duly accomplished PMRF & supporting document/s.

4. Verify if name of the enrollee already exists in the system. Encode/ Clean-up detected multiplicity/ assign/ update member record.

5. If no record, assign PIN & encode data indicated in the PMRF

6. Print Member Data Record (MDR) and PhilHealth Card

3. Affix signature in the PIC

7. Assist member 8. Release MDR and PhilHealth ID

4. Acknowledge receipt of PhilHealth ID and MDR

9. Assist member in signing the logbook


Informal Economy

Informal Sector (Formerly known as Individually-Paying Program)


Duration*

1. Secure / Submit duly accomplished PMRF and supporting documents to the frontline staff

1. Receive and screen duly accomplished PMRF and supporting documents


3. Encode/assign/update member's data in the MCIS

4. Print the Member Data Record (MDR) and PhilHealth Identification Card (PIC) of the Client / Member

5. Advise Client/Member to pay to the nearest Accredited Collecting Agent (ACA) and return after payment has been made and submit PhilHealth's copy Official Receipt (OR)

Frontline Officer

10 minutes per PMRF

2. Pay the required premium contribution to the nearest ACA

3. Return to frontline staff and submit PhilHealth's copy Official Receipt (OR) as proof of payment

6. Receive PhilHealth's copy Official Receipt from Client /Member

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Duration*

4. Receive PIC and MDR from frontline staff

7. Release PIC and MDR to Member


Migrant Workers (Land-Based)


Duration*

1. Secure/Submit duly accomplished PMRF, proof of working abroad and other supporting documents

1. Receive and screen duly accomplished PMRF, proof of working abroad and supporting documents



4. Verify in the system the payment status of the Client/Member and provide Payment Slip indicating the coverage period and the amount to be paid in order to avoid overlapping of payments.



Frontline Officer

10 minutes per PMRF



7. Receive PhilHealth's copy Official Receipt (OR) from Client /Member


8. Release PIC and MDR to Client/Member


Foreign Nationals


Duration*

1. Secure/Submit duly accomplished PMRF, Alien Certificate of Registration (ACR) and other supporting

1. Receive and screen duly accomplished PMRF, ACR and supporting documents


Frontline Officer

10 minutes per PMRF

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Duration*

documents






6. Receive PhilHealth's copy Official Receipt (OR) from Client /Member


7. Release PIC and MDR to Client/Member


Registration Procedures for Employers (Formal Economy) Government and Private


Duration*

1. Secure and fill-up Employer Registration form (ER1)

2. Submit duly accomplished forms and supporting documents (e.g., URR or Info Sheet; or Business Permit for those who have not passed thru the SEC-IBRS or PBR) to the frontline staff

1. Receive and screen duly accomplished ER1 form together with supporting documents

2. Search in MCIS the issued PEN found in the URR or Info Sheet; or Encode to MCIS (for applicants which have not passed thru the SEC-IBRS or PBR)

3. Print the Employer Data Record (EDR) and Certificate of Registration (COR)

Frontline Officer

15 minutes per ER1

3. Receive the EDR and COR 4. Release the Employer Data Record and COR to employer / representative




Duration*

1. Secure and fill-out Household Employer Unified Registration (HEUR1) form

Frontline Officer

15 minutes per HEUR1

2. Submit duly accomplished form and supporting

1. Receive and screen duly accomplished HEUR1 and supporting documents, if

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Duration*

documents to the frontline staff

3. Sign the processed HEUR1 and hand them back to the front line officer;

applicable 2. Process HEUR1 in the KURS:

2.a. Encode in the KURS’ Household employer module. 2.b. Print and sign the processed HEUR1 in 3 copies. 2.c. Require the client to sign also the said 3copies. 2.d. Hand‐over one (1) duly‐signed copies of the processed HEUR1 to the client, and KEEP the two (2) other originally‐signed copies for endorsement to SSS and for PhilHealth record.

3. Print the Employer Data Record (EDR)

4. Receive the EDR and copy of processed HEUR1 with applicant’s signature

4. Release the Employer Data Record to household employer/representative


INQUIRY


Duration*

1. Proceed to the counter and ask the Frontline staff for the needed information

*Priority shall be given to PWDs, Pregnant Women and Senior Citizens

1. Accommodate Client/Member queries 2. Provide satisfying action to the

member's query/ies

Frontline Officer

8 minutes


UPDATING OF RECORDS

Members


Duration*

1. Secure / Submit PMRF /KURF and supporting documents to the frontline staff

1. Receive and screen duly accomplished PMRF /KURF Form and supporting documents

2. Update Member's data 3. Print amended MDR/PIC (if applicable)

Frontline Officer

15 minutes per

PMRF/KURF

2. Receive updated MDR/PIC (if applicable)

4. Release amended MDR/PIC to the member (if applicable)


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Employers


Duration*

1. Secure / submit Employer Data Amendment Form (ER3)/ HEUR1 and supporting documents to the frontline staff

1. Receive and screen duly accomplished Employer Data Amendment Form (ER3)and supporting documents

2. Update employer's data 3. Print amended Employer Data Record

(EDR)

Frontline Officer

15 minutes per

ER1/HEUR1

2. Receive updated EDR 4. Release amended Employer Data Record (EDR) to employer / representative


SUBMISSION OF REPORTS

Employers(only for non EPRS users located in GIDAS or areas with no ISP)


Duration*

1. Submit Remittance Report (RF1-hard copy) to the frontline staff

1. Receive and screen RF1 as to number of employees and other data in the RF1 and the attached Official Receipt/s

2. Stamp "Received" on RF1 with 10 employees and below and return copy of received RF1 to employer / representative.

Frontline Officer

Hard Copy – 20 minutes per transaction Softcopy -30 minutes per transaction 2. Receive copy of acknowledged

RF1


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Feedback and Redress Mechanism

Client Feedback Form (Page 1)


Client Feedback Form (Page 2)


Anti-Fixer Campaign Banner


Anti-Fixer Calling Card

3.5 inches

2 inches


Annex A

Table 1.Premium Contribution Table for the Formal Economy including sea-based employees and Kasambahay (January to December 2014 only perPC57, s2012)

Salary Bracket

Salary Range Salary Base Total Monthly Premium

Employee Share*

Employer Share

1

8,999.99 and below

8,000.00

200.00

100.00

100.00

2

9,000.00-9,999.99

9,000.00

225.00

112.50

112.50

3

10,000.00-10,999.99

10,000.00

250.00

125.00

125.00

4

11,000.00-11,999.99

11,000.00

275.00

137.50

137.50

5

12,000.00-12,999.99

12,000.00

300.00

150.00

150.00

6

13,000.00-13,999.99

13,000.00

325.00

162.50

162.50

7

14,000.00-14,999.99

14,000.00

350.00

175.00

175.00

8

15,000.00-15,999.99

15,000.00

375.00

187.50

187.50

9

16,000.00-16,999.99

16,000.00

400.00

200.00

200.00

10

17,000.00-17,999.99

17,000.00

425.00

212.50

212.50

11

18,000.00-18,999.99

18,000.00

450.00

225.00

225.00

12

19,000.00-19,999.99

19,000.00

475.00

237.50

237.50

13

20,000.00-20,999.99

20,000.00

500.00

250.00

250.00

14

21,000.00-21,999.99

21,000.00

525.00

262.50

262.50

15

22,000.00-22,999.99

22,000.00

550.00

275.00

275.00

16

23,000.00-23,999.99

23,000.00

575.00

287.50

287.50

17

24,000.00-24,999.99

24,000.00

600.00

300.00

300.00

18

25,000.00-25,999.99

25,000.00

625.00

312.50

312.50

19

26,000.00-26,999.99

26,000.00

650.00

325.00

325.00

20

27,000.00-27,999.99

27,000.00

675.00

337.50

337.50

21

28,000.00-28,999.99

28,000.00

700.00

350.00

350.00

22

29,000.00-29,999.99

29,000.00

725.00

362.50

362.50

23

30,000.00-30,999.99

30,000.00

750.00

375.00

375.00

24

31,000.00-31,999.99

31,000.00

775.00

387.50

387.50

25

32,000.00-32,999.99

32,000.00

800.00

400.00

400.00

26

33,000.00-33,999.99

33,000.00

825.00

412.50

412.50

27

34,000.00-34,999.99

34,000.00

850.00

425.00

425.00

28

35,000.00 and up

35,000.00

875.00

437.50

437.50

*Employee share represents half of the total monthly premium while the other half is shouldered by the employer. **For “Kasambahay” receiving a wage of less than Five Thousand Pesos (P5,000.00) per month, the employer will shoulder both the employee and employer share based on the premium schedule.


Annex B

Table 2.Premium Contribution Table for the Informal Economy /Sponsored Members

Member Category Premium Rates

Self-Earning Individuals 3,600/annum

PRA Foreign Retirees 15,000/annum

Other Foreign Retirees 17,000/annum

Informal members with income P25,000 and below 2,400/annum

Sponsored Members 2,400/annum

Table 3.Premium Contribution Table for Migrant Workers

Member Category Premium Rates

Land-based 2,400/annum


Annex C Table 4.Schedule of Accreditation Fee for Health Care Institutions

INSTITUTIONS INITIAL, CONTINUOUS/

RE-ACCREDITATION (PRIVATE/GOVERNMENT)

Level III Hospitals (teaching Hospitals) P 10,000.00

Level II Hospitals P 8,000.00

Level I Hospitals P 5,000.00

Primary Care Facility (Infirmary/Dispensary) P 3,000

Specialty Hospital Based on the service Capability of the hospital

Ambulatory Surgical Centers (ASCs) P 5,000.00

Free Standing Dialysis Centers (FDCs)- HD and PD P 5,000.00

Primary Care Benefit Providers (PCB) P 1,000.00

TB-DOTS Provider P 1,000.00

Non-Hospital Maternity Care Providers P 1,500.00

PCB (OPB) and DOTS Providers P 1,000.00

PCB (OPB) and MCP Providers P 1,500.00

PCB, DOTS and MCP Providers P 1,500

MCP and DOTS Providers P 1,500.00

Animal Bite Package Providers P 1,000