Philippines Health Insurance
The complete guide!

How does the state health insurance system work?

The Philippines’ Universal Health Coverage Bill, in conjunction with the WHO, aims at providing comprehensive, universal health coverage for all Filipino citizens. It is the result of the continued development of public healthcare in the country, based on existing UHC models such as the UK’s NHS and the Chinese devolved health insurance scheme, and makes The Philippines a leader in this regard in the region, along with Thailand and Singapore.

PhilHealth, The Philippines’ public health system, is funded by the government (it is a corporation attached to the Department of Health), and by employer/employee national health contributions. Although everyone is technically entitled to healthcare that is free at the point of delivery, not all medical procedures are covered in reality, and some out-of-pocket expenses must be made, limiting access to treatment for some low-income Filipino citizens.

There are concerns that funding will become too overstretched and that PhilHealth will extend its services through the use of private health cover and provision, meaning that the private sector will ultimately come to dominate Filipino healthcare.

Most of the country’s hospitals are privately run and are of a high standard: The Philippines is a major exporter of medical personnel and is also a destination for medical tourism. Although treatment can be expensive for many Filipinos, it is competitively priced in comparison to some Western nations, such as the USA.

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Who is eligible for state healthcare?

All Filipinos are covered by the national health system. Until recently, foreigners were not eligible to join the scheme, but PhilHealth has now been extended to apply to expat workers. There are two categories of recipients: those who are paying national insurance contributions and those who are unable to do so, such as the unemployed or people on low incomes. In the latter case, the government will subsidise healthcare.

Migrant workers may be eligible for TSeKaP (Tamang Serbisyo para sa Kalusugan ng Pamilya), a primary care benefits package.

How do you apply to join the state health insurance system?

Your employer should sign you up with PhilHealth, but check that this has been done and that they are paying their share of contributions. You will usually need to pay around nine months’ worth of contributions before you become eligible for coverage under PhilHealth. However, check with PhilHealth to make sure this applies to you, as the number of contributions that you need to pay may vary depending on your job and where you live.

You will need to submit the following documentation to the local health insurance office:

  • a valid Alien Certificate of Registration Identity Card (ACR I-Card) issued by the Bureau of Immigration
  • a PhilHealth Member Registration Form (PMRF) for Foreign Nationals

Once you are registered you will then be sent a PhilHealth ID card and number, which you must take with you to medical appointments. You can also use this for other purposes, such as opening a bank account.

You can also register to make voluntary contributions into the system via your PhilHealth ID number.

You will have to co-pay some treatment costs: usually the difference between what your healthcare provider charges and the amount covered by PhilHealth. You may also want to sign up with an HMO (Health Maintenance Organisations: medical insurance groups providing health services for a fixed annual fee), as a top up for your PhilHealth cover. Check with your employer to see if this is already part of your insurance package.

What is covered by the state health insurance system?

The range of inpatient care to which Filipinos are entitled will be extended to you as an expat, along with a number of benefit packages, but there are some exclusions, mainly in the area of maternity:

  • Z Benefit packages (for catastrophic diseases)
  • reimbursement for all confinements abroad
  • benefits for women about to give birth

Some primary care is covered, but this may be restricted to low-income cases. Outpatient treatment for malaria and TB will be covered, plus some non-emergency day surgeries, blood transfusions, radiotherapy and dialysis, and cataract operations.

TSeKaP covers a further range of treatments, including mammograms and blood pressure checks.

Are retirees covered by state medical insurance?

Yes, you may be covered by PhilHealth as a foreign retiree. Under a Memorandum of Understanding (MoU) in 2015 between the Philippine Health Insurance Corporation (PhilHealth) and the Philippine Retirement Authority (PRA), if you are a qualified foreign retiree registered with the PRA you will be able to enroll under the Informal Economy member category.

You will need to take the following documentation to the PRA Head Office in Makati City or one of its local bureaus:

  • PhilHealth Member Registration Form for Foreign Nationals
  • Special Resident Retiree’s Visa (SRRV)
  • your permanent residency documentation

As a retiree your treatment should be free at the point of delivery.

Are students covered by state medical insurance?

You will need to check your eligibility for national insurance cover with PhilHealth. If you are not eligible you will need to take out private cover and may be able to sign up for a policy specifically designed for international students. Consult with your educational provider to see if they recommend any specific private cover.

Will your family be covered by your insurance?

Yes, your dependents will be co-insured under the national scheme.

Is dental treatment covered by state health insurance?

Basic dental care is covered under PhilHealth, but you may wish to opt for private dental provision or pay out-of-pocket costs for more complex procedures, such as crowns.

What are the contribution rates for state health insurance?

The annual premium contribution rate is paid half each by employer and employee, up to a maximum of 3% of your gross income. For example, as an expat you would on average pay around P17,000.00 ($334), or P15,000.00 ($295) if you are a retiree. You can pay contributions quarterly, semi-annually or annually.

Why buy private health insurance?

Healthcare provision in The Philippines is of variable quality: it is of a high standard in the cities but often limited and difficult to access in rural areas. The public system also suffers from overcrowding and long waiting times, and from a shortage of medical staff as so many graduates choose to go abroad to work. The government is attempting to address this by encouraging recently qualified graduates to work in rural areas.

Given the limitations of the system, many expats therefore choose to opt for private cover, to ensure speed of access in addition to better facilities.

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What is covered by private health insurance?

Private insurance will cover a full range of both primary and secondary care, along with any elective treatments such as cosmetic surgery. Given that The Philippines is a high risk health area, you may want to check your policy for coverage for medical evacuation or specific treatment for catastrophic illness.

How much does private health insurance cost?

This will depend on factors such as your age and any pre-existing conditions, and the kind of package you opt for; a more expensive insurance package will give you more a extensive range of treatment and facilities. As so many variables have an effect on the cost of international private medical insurance in China, it becomes very difficult to give accurate estimates without knowing the full details of the coverage required. However, as a very rough guide, using a standard profile of a 40-year-old British male with no deductibles, no co-insurance, a middle-tier plan, all modules included and worldwide coverage excluding the US, a ballpark price of around £4,000/$5,000 might be expected. Were coverage to be expanded to include the US then the premium could increase to almost double that amount

Which companies offer private health insurance?

Many of the large international health providers cover The Philippines, including:

  • Allianz
  • Cigna Global
  • Foyer Global
  • Pacific Prime

Glossary of health insurance terms

Philippine Health Insurance Corporation (PhilHealth) - the Filipino national healthcare system

Tamang Serbisyo para sa Kalusugan ng Pamilya (TSeKaP) – a primary care benefits package

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