What is PhilHealth and Why It Matters
The Philippine Health Insurance Corporation — known as PhilHealth — administers the National Health Insurance Program under Republic Act 11223, also called the Universal Health Care Act. Every Filipino worker in the formal sector is required by law to contribute monthly premiums. In exchange, PhilHealth pays a significant portion of hospital and medical bills when you or your registered dependents need care — reducing the out-of-pocket cost that would otherwise fall entirely on you.
Understanding how PhilHealth works Philippines is essential for every worker because contributions are deducted from your payslip every month regardless of whether you actively use the benefits. Knowing what you are entitled to — and how to claim it — means you get the full value of every peso deducted. Many Filipino workers pay PhilHealth contributions for years without ever successfully claiming a benefit, simply because they did not know the process. This guide covers exactly that.
Last updated: January 2026 · RA 11223 (Universal Health Care Act) · PhilHealth premium contribution schedule
Who is Required to Contribute
PhilHealth membership is mandatory for all employed workers in the private and government sectors, self-employed individuals, and overseas Filipino workers. Employers are legally required to register all employees with PhilHealth within 30 days of hiring and to remit contributions monthly. For employed members the premium is split equally between you and your employer — 2.5% each — and your share is deducted automatically from your salary.
Self-employed, freelance, and voluntary members shoulder the full 5% premium themselves and are responsible for registering and paying directly. OFWs are also required contributors — land-based OFWs pay the full 5% on their declared income. Senior citizens, indigent Filipinos, and persons with disabilities are covered as indirect contributors, meaning the government pays their premiums on their behalf through the National Health Insurance Fund.
| Member Type | Rate | Who Pays |
|---|---|---|
| Private / government employee | 5% | Split — 2.5% employee, 2.5% employer |
| Self-employed / voluntary | 5% | Full — member pays all |
| OFW (land-based) | 5% | Full — member pays all |
| Senior citizen / indigent / PWD | — | Government sponsored |
How Your PhilHealth Premium is Computed
Your monthly PhilHealth premium is 5% of your monthly basic salary. The computation applies to your basic salary only — allowances, overtime, bonuses and commissions are excluded. PhilHealth sets an income floor of ₱10,000 and an income ceiling of ₱100,000. If your basic salary is below ₱10,000, your premium is computed on ₱10,000 giving a minimum total premium of ₱500. If your salary exceeds ₱100,000, your premium is capped at ₱5,000 total regardless of how much more you earn.
For employed members, the ₱5,000 maximum is split equally — you pay ₱2,500 and your employer pays ₱2,500. The employee share is the only deduction that appears on your payslip. Your employer’s matching contribution is paid separately and does not reduce your take-home pay. To compute your exact monthly deduction: multiply your basic salary by 0.025. For a salary of ₱35,000, your monthly PhilHealth deduction is ₱875.
What Benefits PhilHealth Covers
PhilHealth pays a defined benefit package for covered medical services. For inpatient care, PhilHealth covers room and board, laboratory tests, medicines included in the benefit package, professional fees for attending physicians, and surgical procedures. The amount PhilHealth pays is based on its Case Rate system — a fixed payment per diagnosis regardless of the actual bill. If your hospital bill exceeds the case rate, the difference is your out-of-pocket responsibility.
Outpatient coverage is available through the Konsulta package — a primary care benefit that gives active members free consultations, selected laboratory tests, and medicines at PhilHealth-accredited Konsulta providers. Maternity benefits cover normal delivery, caesarean section, and newborn care packages. There are also Z-Benefit packages for catastrophic illnesses including certain cancers, end-stage renal disease, and other high-cost conditions where PhilHealth covers the full cost of treatment at accredited facilities.
| Benefit Type | Coverage |
|---|---|
| Inpatient / hospitalization | Case rate payment per diagnosis — room, labs, medicines, surgeon fees |
| Maternity | Normal delivery, C-section, newborn care packages |
| Konsulta (outpatient) | Free primary consultations, selected labs and medicines |
| Z-Benefits | Full coverage for catastrophic illnesses at accredited centers |
| Mental health | Selected mental health services included in PhilHealth’s benefit packages |
Dependents Coverage — Who is Included
One of the most underused aspects of PhilHealth is dependents coverage. As an active contributing member you can register your qualified dependents at no additional premium cost. Qualified dependents are your legal spouse, unmarried and unemployed children under 21 years of age — including legally adopted and stepchildren — and parents over 60 years old who are not PhilHealth members themselves. Each dependent is entitled to the same inpatient and outpatient benefits as the primary member.
To register dependents, log in to the PhilHealth Member Portal and update your member data record. You can also visit any PhilHealth office with your PhilHealth ID, proof of relationship — such as a birth certificate or marriage certificate — and a valid ID. Under the Universal Health Care Act, every Filipino is a PhilHealth member in their own right, so a dependent who is not declared is still entitled to PhilHealth benefits through their own membership. Even so, it is good practice to keep your qualified dependents declared and updated on your member data record, since dependent records are still used by PhilHealth and help claims go through smoothly.
How to Claim PhilHealth Benefits
Claiming PhilHealth benefits for hospitalization does not require you to do anything in advance — the process is handled by the hospital on your behalf. When you are admitted to a PhilHealth-accredited hospital, inform the admissions desk that you are a PhilHealth member and present your PhilHealth ID or PhilHealth Identification Number. The hospital files the claim directly with PhilHealth and deducts the benefit from your total bill before presenting you with the balance.
Under the Universal Health Care Act, every Filipino has immediate eligibility to avail of PhilHealth benefits — so you are entitled to coverage even if you have missed or lapsed contributions. The old rule requiring at least three monthly contributions within the previous six months is no longer a barrier to claiming. The main requirement at the point of care is that the hospital is PhilHealth-accredited. For employed members, your employer remits your premium, so your coverage stays active while you are employed; self-employed and voluntary members are still legally required to pay their premiums and may be asked to settle unpaid amounts. For elective procedures you can confirm your member details in advance through the PhilHealth Member Portal. For emergency admissions PhilHealth also has provisions for claims at non-accredited facilities in certain circumstances, though that process requires direct filing after discharge.
How to Verify Your PhilHealth Contributions
You can check your posted contributions at any time through the official PhilHealth Member Portal at philhealth.gov.ph. Log in using your PhilHealth Identification Number and registered email address. Under Member Records select Contribution Inquiry to see your monthly contribution history. Each row shows the month covered, the amount remitted, and whether it was posted by your employer or paid directly.
If you see a gap for a month where PhilHealth was deducted from your payslip, your employer may not have remitted your payment. Keep your payslips as evidence. You can report non-remittance to PhilHealth directly — employers who fail to remit contributions face interest and surcharges on the unremitted amount and potential legal action. Your benefit eligibility is protected even in cases of employer non-remittance — the liability stays with the employer, not with you as the worker.
Frequently Asked Questions
How many months of contributions do I need to claim benefits?
Under the Universal Health Care Act, all Filipinos have immediate eligibility for PhilHealth benefits regardless of the number of contributions paid — the older requirement of three monthly contributions within the last six months no longer gates access to benefits, including maternity. For employed members, coverage is active as long as your employer is remitting. Self-employed and voluntary members remain legally obligated to pay their premiums and may be required to settle unpaid contributions, but a gap in payments does not remove your entitlement to benefits at the point of care. For the Konsulta outpatient package, you should be registered at a Konsulta-accredited provider.
Can I use PhilHealth at any hospital?
Only at PhilHealth-accredited hospitals and clinics. You can search for accredited facilities through the PhilHealth website. Using a non-accredited facility means PhilHealth will not pay any portion of your bill. For non-emergency situations always confirm accreditation before choosing where to seek treatment. Most major public and private hospitals in the Philippines are accredited.
What is the No Balance Billing policy?
No Balance Billing — also referred to as the no co-payment policy — means that for basic or ward accommodation in government and public hospitals, members are not charged amounts beyond what PhilHealth covers. The Universal Health Care Act broadened this protection so that it is no longer limited only to indigent members and senior citizens. If you choose a private room, a private hospital, or an upgraded accommodation tier, co-payments and out-of-pocket costs can still apply. Always confirm the accommodation tier and any expected charges with the hospital’s billing office.
What happens to my PhilHealth coverage when I resign?
Under the Universal Health Care Act you remain a PhilHealth member for life — resigning does not end your membership. To keep contributing after you leave a job, you can register as a self-paying voluntary direct contributor and pay your premiums yourself. If you find new employment, your new employer is required to enroll you and resume remitting your contributions. Gaps in your contribution history do not erase your record, and you keep your immediate eligibility for benefits — but direct contributors are still expected to pay the premiums they owe.
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📋 Rates verified — Official sources: philhealth.gov.ph · RA 11223 (Universal Health Care Act)
⚠️ This page is for informational purposes only and does not constitute financial or legal advice. KnowMyGovt is not affiliated with PhilHealth nor the Philippine government. Always verify with official government sources at philhealth.gov.ph.
