List of PhilHealth Beneficiaries Qualifications for Additional Coverage
PHILHEALTH BENEFICIARIES – Here are the qualifications for eligibility as dependents of a PhilHealth member for coverage without additional premiums.
In the Philippines, the people have two (2) major choices when it comes to health insurance — either to be insured under insurance policies offered by private companies or be insured under the state-run health insurance institution, the PhilHealth.
The Philippine Health Insurance Corporation or more popularly called PhilHealth has millions of members in the country. Those who may apply for membership to the state-run health insurance institution includes the following:
- government employees
- private employees of both local and foreign business organizations, corporations, partnerships, and institutions
- all workers rendering service
- owners of micro enterprises
- owners of small, medium, and large enterprises
- household helpers
- family drivers
Members of the Philippine Health Insurance Corp. remit premiums to keep their accounts active and updated. The rate is based on the PhilHealth Monthly Contribution Rates 2023 set by the state-run health insurance agency.
The members with active and updated accounts are qualified to the PhilHealth benefits. The benefit offers includes both in-patient and out-patient benefits for qualified members.
- PhilHealth Inpatient Benefits Coverage & Guidelines for Claim
- PhilHealth Benefit for Outpatient Surgeries: Coverage & Guidelines for Claim
- PhilHealth Benefit for Radiotherapy: Coverage & Guidelines for Claim
- PhilHealth Benefit for Hemodialysis – Here’s the Case Rate & Coverage of Claim
Aside from the members, there are also PhilHealth beneficiaries or the dependents of the member. They are also entitled to coverage without additional premiums.
Here are the PhilHealth beneficiaries of a member:
- Legitimate spouse who is not a member
- child or children below 21 years old, single and unemployed
- legitimate, legitimated, acknowledged and illegitimate, adopted or stepchild or stepchildren
- children who are twenty-one (21) years old or above but suffering from congenital disability
- Foster child as defined in Republic Act 10165 otherwise known as the Foster Care Act of 2012
- parents who are at least 60 years old and not members of PhilHealth and whose monthly income is lower than an amount to be determined by PhilHealth in accordance with the guiding principles set forth in the NHI Act of 2013
- parents with permanent disability regardless of age as determined by PhilHealth
According to the state-run health insurance agency, the PhilHealth beneficiaries are entitled to a separate coverage of up to 45 days annually. The said 45-day coverage will be shared among all the dependents of a PhilHealth member.
To ensure the qualification of your dependents under your PhilHealth membership, their names must be listed under your Member Data Record (MDR).