MEMORANDUM NO. NGY 18-132

FOR Vice PresidentsSecretary of the UniversityChancellorsDirector, UP PGH

ATTENTiON: Vice Chancellors for AdministrationDeputy Director for AdministrationHeads of Units

SUBJECT Mandatory Phil Health Coverage of Job Orders (JOs),Contract of Service (COS), and Project-Based Personnel

In accordance with PhilHealth Circular No. 2017-0008, individuals, directlyhired Job Orders (JOs), and Project-Based Contractors (PBCs) in the Governmentshall be subject to mandatory PhilHealth coverage as members of the informaleconomy. Consequently, government agencies are authorized to withhold and remittheir full premium contributions as Individually Paying Members under the GroupEnrollment Scheme.

In connection with this, PhilHealth monthly premium contribution shall beautomatically deducted from JOs, COS, and Project-Based Personnel of theUniversity, effective July 2018. Premium contributions shall be based on PhilHealth'sprescribed two-tiered rate:

Php 25,000 and below

Php 3,600.00 Php300.00

Php 2,400.00 Php 200.00

Above Php 25,000

The deadline of remittance of contributions to PhilHealth shall be on every lastworking day of the month or the schedule per arrangement with the CU's regionalPhilHealth office.

Enrolled JOs and PBCs shall be entitled to automatic availment of regularbenefits accorded to the members of the Informal Economy upon remittance of theinitial premium contribution (PhilHealth Circular No. 2017-0008 111.8).

To facilitate implementation, Chancellors and Heads of Units are advised to beguided of the following:

1. The following requirements must be submitted to PhilHealth:

• Consolidated Templates A and B of Enrollees Under the PhilHealth GroupEnrollment Program ("Annex C" of the Circular)

• Attachments! Requirements per Enrollee:o Accomplished PhilHealth Membership Registration Form (PMRF)o ContracUJob Ordero Official Receipt (OR), if monthly premium for voluntary members

already paid for the period of July - December 2018

2. The Letter of Commitment ("Annex A" of the Circular) addressed to therespective PhilHealth Regional Vice President and signed by the Chancellormust be submitted to the CU's nearest Local Health Insurance Office (LHIO).

For strict compliance.

tL-t &/~ARIEL S. BETAN

Assistant Vice President for Administrationand Officer-in-Charge, OVPA

cc: Mr. Danilo L concepcron, President

Reference:Phi/Health Circular 2017-0008 re: Coverage of IndividuaVs, Directly Hired Job Orders, AND Project­Based Contractors in the Government under the Group Enrolment Scheme

Attachl»ents:1. TemplateA: Enrollees Under the Phi/Health GroupEnrollment Program for Enrollment (Without

Existing Phi/Health Identification Number)2. Template B: Enrollees Under the Phi/Health Group Enrollment Program for Enrollment (With

Existing Phi/Health Identification Number)3. Phi/Health Membership Registration Form (PMRF)4. Template: Letter ofCommitment

Template A

ENROLLEESUNDER THE PHILHEALTHGROUP ENROLLMENT PROGRAMFor Enrollment Without Existing PhilHealth Identification Numbe;:)

Last Name First Name MlddleNlme Extension Birthday Sex BararlllY Province Region Monthly Monthly(e.g. Jr., Sr., III) (MM/DD/YYYV) (M or F) Munlclpality/ City Salary Premium •

123456789

1011121314151617181920

• If Monthly Salary is Php 25,000.00 and below, Monthly Premium is Php 200.00;If Monthly Salary is above Php 25,000.00, Monthly Premium is Php 300.00

TemploteSENROLLEESUNDER THE PHILHEALTH GROUP ENROLLMENT PROGRAM

For Updati (With Exlstln« Phil Health Identnkation Number)

last Name First Name Middle Name Extension Birthday Sex Barangay Province Region Monthly Monthly Remarks"''''(e.,.Jr .. Sr.• III) (MM/DD/VYYY) (M orF) Munlclpalltyl City Phil Health Number Salary Premium·

123456789

1011121314151617181920

• If Monthly Salary is Php 25.000.00 and below. Monthly Premium is Php 200.00;If Monthly 5alary is above Php 25.000.00. Monthly Premium is Php 300.00

"If the enrollee has paid PhilHealth monthly premium for the period of July - December 2018 as voluntary member, kindly indicate the month of the latest contribution paid in the Remarks column. Please attach PhilHealth Identification Number (OR) or any proof of payment.

RepubliC of thePhilippinesPHILIPPINE HEALTH INSURANCE CORPORATIONCitystate CentreBuilding, 709 Shaw Boulevard,Pasig CityHeafthtine441-7444 www.phil1ealth.QOV.ph

PMRF

1. Your PhilHealfh Identlfication Number (PIN) IS your unique and permanent number.2. The issuanceof thePIN does not automaticallyqualify youor yourdependentsto beentitled to NHIPbenefits.3. Atwaysuse your PIN in all transactionswith PhilHealth.

Pleasecarefully read instructions at the back before accomplishing this form

PHILHEALTH MEMBER REGISTRATION FORM(October2013)

PhilHeal1hIdentification Number (PIN)"--------'11 1""--:1__:_____,

.'?H}, • ~,,,,.: 'Cl ,;.,~·\-,eF:';.;" ~Last Name First Name Name Extension (JRISRlIII) Middle Name

1.,:....".1.. 1"- . ,-X. 'ic'_,,,-> .:;'.j'}' . . -0.... " oo:?'L ,.co; ~ .....,.,

Last Name First Name Name Extension (JRlSRlIII) Middle Name

IDate 01Birth (mm-dd-yyyy) race of Birth IgsexCivil Status I :Tax 'U""U1o;ctllU.illfo:(TiN}i

10Single 0 Widow( er)10Female 10Married 0 Legally Separated

,./ . 6~1::t····· :'',,' . if" ·,,,,::7& 7"7' ~UniURoom No.JFloor Building Name LoUBlocklHouse/Bldg. No. Street SubdivisionNiliage

Barangay City/Municipality Province Country Zip Code

':'Z{"'i<''''''''i ..••i: ;', ·~ii··.l~~"5··'r'" \, 'j'- ""~ "'~'!ii\~Landline Number (Area Gode + Tel. No.) Mobile Number E-mail Address

"",;;0, 'i" .~",.."'''

PhilHealthIdentification Name Exlension Dateof Birth SexNumber(PIN) last Name First Name (JR/SRlIII) Middle Name mm-dd-yyyy M/F

rChilifren ~""6 FA~{,£!"',;"PhilHeatth Identification Name 8d:ension Mart J ifwilh Date of Birth Sex

last Name First Name MiddJeNameNumber(PIN) (JR/SR/lIQ Disability mm-dd-yyyy M/F

DDD

;,"0P8:f'1'£', ~';'~ci/i"i! ..gp' """~. '''''.~''''':fip. ,.<'.'''''''i'.,,,,,~PhilHeatth Identification NameExtension ,J ifwith Date of Birth

Number (PIN) Father's Last Name Father'sFirsl Name (JR/SR/III) Father's Middle Name (mm-dd-YYYY)DlSabi,il.D

PhilHealth ldentlficetion Name Exlension Mother'sFull Middle ,J Dateof BirthNumber(PIN) Mother'SLastName Mother's First Name (JR/SR/III) Name (mm-dd_yyyy).D;~abi'it;;

D:' ...,"I",,,,,,,..,, .f"· •.c;;:~

3. 1 Formal Economyo Private OGovernment 3. 3 IndigentoPermanent/Regular 0 Casual oContractor/Project-Based o NHTS-PRo Enterprise Owner

o Household Help / Kasambahayo Family Driver3.2 Informal Economy 3.4 Sponsonodo Migrant Worker 0 Local Government Unit (Pleasespecify):____________o Land Based 0 Sea Based 0 National Government Agency (Pleasespecify):________ __o Informal Sector (e.g.Markel Vendor, Street Hawker,PedicablTricycle Driver.etc.) o Others (Please specify),(Pleasespecify):___________________Estimated Monthly Income: Php __________ ... _o No Income

o SeW-Earning Individual (e.g. Doclors. LawyeJS.Enyin.... , Artists. ele.)3.5 Lifetime Member DatelEffectlvity of Retirement:

(Pleasespecify):___________________ o Retiree I Pensioner I I I Io With 120 months contribution I I I I IEstimated Monthly Income, Php mm dd yyyy

o Filipino with Dual Citizenshipand has reached re~remenl age

o Naturalized Filipino Citizeno Citizen of other countries working/residing/studying in the Philippineso Organized Group (Please specify): ____________

Under the penalty of law, I attest that the Please do not write on this portion. For filling-out by PhilHealth Officer:

information I provided in this Form are trueand accurate to the best of my knowledge. Received by: Date: ---~~--

p, ;~;~:~;::;;:~"'iIEvaluated by: _____________ Date: _________Signature over Printed Name Date

PURPOSE:D FOR ENROLLMENT DFOR UPDATING

Last NameSANTOS

First NameJUAN ANDRES

Name ExtensionIII

Middle NameDELACRUZ

INSTRUCTIONS

1. For PURPOSE, put a mart[1] FOR ENROLLMENT if you have never been issued a PhilHealth IdentificationNumber (PIN) or Family Health Card. Marl[LJ FOR UPDATING if you want to update or make corrections tocertain information previously submitted when you enrolled. Fill-out the appropriate portions of the form.

2. Please write in CAPITAL LETTERS.3. ALL FIELDS in item 1 for Member Information ARE MANDATORY. The Member should fill-out all required

information.4. Write N.A. if the information is not applicable.5. All name entries should be in the following formal:

Example: JUAN ANDRES DELA CRUZ SANTOS IIIwin be entered as:

6. For the Deciaration of Dependents, fill-out the names of the living spouse, children and parents in items 2..1, 2.2and 2.3 following the same format above.

Put a mark[1] in the box for item 2.2 if child has disability.Put a mark.Q] in the box for item 2..3if parent has disability.Please indicate FULL MOTHER'S NAME for item 2.3.

7. For declared dependents with disability, please submit a Medical Certificate indicating the details and extentof disability. As defined in the Implementing Rules and Regulations of the National Health Insurance Act of2013, the following are included as qualified dependents:

a. Children who are twenty-one (21) years old or above but suffering from congenital disability, eitherphysical or mental, or any disability acquired that renders them totally dependent on the member for support.

b. Parents with permanent disability regardless of age that renders them totally dependent on the member

for subsistence.

8. For MEMBERSHIP CATEGORY, put a mark[] in the appropriate box and specify details as necessary.9. The member or guardian (if member is a minor) should certify that the information provided are true and

correct by affixing his/her signature over the printed name in the space provided for. If unable to write,please affix the right thumbmark in the space provided.

"ANNEXA

LETI'ER OF COMMITMENT

Date

MR. _

Regional Vice PresidentPhilHealth Regional Office _

Dear Regional Vice-President ,

It the undersigned. in my capacity as head/representative of (Name of National GovernmentAgency lNGAl/Local Government Unit (L.GU) hereby declare that (Name of NGAlLGtDcommits and continuously commits to participate under the National Health Insurance Program(NHIP) as partner (agency/unit) for the implementation of the Group Enrollment Program andto undertake the following necessary steps to ensure successful implementation of the saidProgram:

1. Cause for the immediate registration/enrollment of its PBCs/JOs under the NHIP;2. Collect from the directly hired PBCs /JOs the prescribed Philhea1th premiums;

3. Remit to Philhea1th the total premium amount due on or before the prescribed deadlinebased on the preferred (monthly/quarterly / semi-annual/annual) mode of payment;

4. Assist and support PhilheaIth in the conduct of information dissemination and educationcampaigns to its members through the "Alaga Ka",

Moreover, we as an (agency/unit) understands that a failure on our part to remit the totalrequired premiums within the prescribed deadline can result in the automatic suspension ofbenefit entitlement of our directly hired PBCs/JOs in accordance with the existing NHIP rules,guidelines and procedures.

Thank you a.nd best regards.

Very truly yours, Con forme:

Name and Position of the Representative Regional Vice-PresidentPhilippine Health Insurance Corporation