The Finance of Healthcare (Part 1): PhilHealth
Last week, I was hospitalised due to a lung infection. Hospitalisation is one of the things that scare me the most because of its impact on my health and finances. Not only was I worried about getting treated and recovering, I was worried about the income lost with every day that I spent in the hospital. Aside from that, I was also worried about the costs of hospitalisation.
In this series of articles, I will be talking about the financial aspect of healthcare. I already mentioned the two ways through which health problems impact our finances: 1) cost of healthcare and 2) lost income. In Part 1, I will be talking about the cost of healthcare and how PhilHealth covers this, protecting us from the financial burden of hospitalisation.
PhilHealth, or the Philippine Health Insurance Corporation, is a government-owned and controlled corporation that administers the National Health Insurance Program, the government’s universal healthcare insurance program. Its mandate is to provide socialised healthcare for all Filipinos, including the employed, self-employed, indigents, overseas workers, and retirees.
For financial consultants/insurance agents like me, healthcare is a considerable cost. Unlike employees, most of the people in our industry are considered “self-employed” individuals. This means that we have to pay for our own PhilHealth premiums. I was in the middle of transitioning from the “Employed” to the “Individually Paying” category when I got sick. Luckily, this is something that can now be done online at http://www.philhealth.gov.ph/services. By electronically registering as an “Individually Paying” member, I was able to generate a new member data record form and a PhilHealth Identification Card.
If you have recently resigned from your employment for whatever reason (to start your own business, to become a freelancer, to pursue further studies) and you want to continue your PhilHealth coverage, or if you have never been employed and want to be covered by PhilHealth, you may apply to become a PhilHealth member through their website.
After registering, the next step is to pay for your premium. For Individually Paying members, the premium computation for the first year is simple. If the average monthly salary for the last 12 months prior to changing categories is 25,000 and below, the quarterly premium is 300. If this is above 25,000, the quarterly premium is 600.
You can pay your premiums at any PhilHealth branch or you can pay through any of their accredited collecting agents. Many banks are authorised to collect premiums on behalf of PhilHealth, including major banks such as BPI, BDO, Metrobank, PNB, and RCBC. You can also pay at some LBC branches. For a full list of collecting agents, check http://www.philhealth.gov.ph/partners/collecting/
What are the benefits of being a PhilHealth member? PhilHealth members get a considerable reduction in hospitalisation costs. Even if you don’t have a private health maintenance organisation (HMO), the savings that you will achieve with a PhilHealth membership are considerable. Additionally, private HMOs require that you first be a PhilHealth membership before they can accept your application for coverage.
I enumerate below some of the inpatient benefits up to the maximum ceiling per category:
- Up to 1,100 per day for room and board (maximum of 45 days per hospitalisation)
- Up to 40,000 in dugs and medicine per single period of confinement
- Up to 30,000 in laboratory and X-ray fees
- Up to 8,000 in doctor’s (specialists) fees
For some illnesses, PhilHealth pays benefits on a case rate (lump sum) basis. For example, for the treatment of moderate-risk pneumonia, PhilHealth will pay the healthcare provider 15,000 in lump sum, with the balance shouldered by the member or the private HMO. This means there is no need to compute how much of each hospitalisation cost category will be subsidised by PhilHealth.
For a comprehensive list of benefits, visit http://www.philhealth.gov.ph/members/individually_paying/coverage.html.
I cannot emphasise enough how important it is to get a PhilHealth membership. For those who are employed, this is already a mandatory salary deduction but for those of us who are self-employed, this is only voluntary. But I think the savings are worth the effort. Had I paid 600 of my quarterly dues on time, I would have save 15,000 from my medical bill of around 33,000. That’s a lot! Sayang. Hindsight is always 20/20, but then again better late than never. Today, I paid my quarterly dues. Just in case.
In Part 2, I will be talking about some of the health maintenance organisations or HMOs that I have been looking into, those private health insurance companies that supplement the benefits provided by PhilHealth.