6.19.2019

Can A Foreigner Enroll In PhilHealth?

Can A Foreigner Enroll In PhilHealth?






Table Of Contents


Intro


My recent illness has me thinking again about PhilHealth. I never signed up for it before, but I did get coverage for my wife and daughter. They are both dual citizens of the United States and The Republic of the Philippines. My wife if the primary member and our daughter is her beneficiary. Foreign citizens are still eligible for PhilHealth coverage, but it costs more now.

Previously, I had the option of PhilHealth coverage as a beneficiary of my Filipino spouse. In 2017 that option was removed by new rules for PhilHealth coverage. Before the change our family could have maintained coverage for 2400 PHP per year. That's right, $50 a year. A lot of foreigners had taken advantage of this sweet deal for years.

There are a lot of changes happening with PhilHealth, so in this post I will outline my understanding of what PhilHealth can do for the expat and other foreigners.

Foreign And Expat Enrollment In PhilHealth Is Nothing New


The Revised Implementing Rules and Regulations of the National Health Insurance Act of 2013 (RA 7875 as amended by RA 9241 and 10606) (RIRR NHIAct 2013) Included Foreigners.

This RIRR enabled expats and other foreigners to be covered under PhilHealth Title III:

SECTION 5. Nature and Scope - The Program shall cover the following members and their dependent/s:
b. Members in the Informal Economy – this sector would include but are not limited to the following:
6. Citizens of other countries working and/or residing in the Philippines – foreign citizens with valid working permits and/or Aliens Certificate of Registrations (ACRs) working and/or residing in the Philippines.
    Can you think of any class of foreigners in the Philippines that would not be included in Title 3-5(b)(6)? It looks like all of them and there is also the "include but are not limited to," statement to really make it essentially all of them.

    Foreigners have been able to enroll in PhilHealth for many years, as PhilHealth stated in its faq page back around 2010:
    5. Can a foreign national enroll as an Individually Paying Member?

    YES, the Implementing Rules and Regulations of RA 7875, as amended by RA 9241, provides for the inclusion to the National Health Insurance Program the citizens of other countries residing and/or working in the Philippines. If the foreign national is employed, he/she shall be registered under the Employed Sector Program. Meanwhile, if he/she is self-employed or merely residing in the country, he/she may enroll as an Individually Paying Member. He/she only needs to accomplish and submit to any PhilHealth office, the PhilHealth Member Registration Form (PMRF) and a photocopy of his/her Alien Certificate of Registration (ACR) issued by the Bureau of Immigration (BI) to prove his/her residency in the country.
    The link to the above quote is "http://www.philhealth.gov.ph/members/individually_paying/faqs/membership.htm#m5."  The link is from about ten years ago and it is 404-ed now. 

    PhilHealth's coverage of foreigners was referenced by the NIH website in 2015:
    PhilHealth also allows foreign nationals residing or working in the Philippines to enroll in PhilHealth as individually-paying or employed members, provided that they present an Alien Certificate of Registration.

    PHILHEALTH CIRCULAR NO. 2017-0003 CHANGES COVERAGE FOR FOREIGNERS


    Circular No. 2017-0003 Paragraph VIII Eliminates The Option For A Foreigner To Be A Dependent Of A Filipino

    Specific Provision #1. Foreign nationals are required to enroll as member and shall not be covered as dependent by their Filipino Spouse.
    Prior to Circular No. 2017-0003, Article II Sec.4(f)(1) of RIRR NHIAct 2013 was the specific legal provision that had allowed expats and other foreigners to be included as beneficiaries of their spouse:
    Article II. DEFINITION OF TERMS SEC. 4. Definition of Terms. – For the purpose of this Act, the following terms shall be defined as follows:
    f. Dependent – The legal dependents of a member are:
    1. the legitimate spouse who is not a member;
    Whereas Title 3-5(b)(6) of RIRR NHIAct 2013 made me eligible for PhilHealth on my own standing, Article II Sec.4(f)(1) above gave me the option to be counted as the dependent of my wife and this is exactly what many expats had been doing for many years. Now that option is gone.

    Circular No. 2017-0003 Paragraph III Changes How Other Classes Of Foreigners Are Covered Under PhilHealth

    1. Foreign retirees or former Filipino nationals and their qualified dependents, who are holders of Special Resident Retiree's Visa (SRRV) and granted permanent residency status pursuant to Section 9 (d) of Executive Order No. 1037, dated July 4, 1985.
    2. Citizens of other countries working and/ or residing in the Philippines and holders of valid Alien Certificate of Registration Identity Card (ACR I-Card).
    Sec.5(b)(6) of RIRR 2013 stated that both of these classes of foreigners were already covered by PhilHealth. What changes is not who is covered, but how they are covered.

    Circular No. 2017-0003 Paragraph VII: Premium Increase For Foreign Members 


    The 2400 PHP per annum premium is gone for expats. Now the rate is 15,000 PHP per annum for PRA retirees and 17,000 PHP per annum if you are not a PRA retiree. This is the big change that affected every foreigner who had previously been a dependent of their Filipino spouse.

    Circular No. 2017-0003 Paragraph VII: Benefit Exclusions For Foreign Members

    Some of the items no longer covered for foreigners:
      1. Z Benefit Package
      2. Special privileges of Women About To Give Birth (WATGB)
      3. Reimbursement for all confinements abroad
    Item (a), the Z Benefit, provides package benefits for certain major illnesses, such as kidney disease,  prostate cancer and Coronary Artery Bypass Graft Surgery. I can see how that losing this benefit might be a drawback to some expats who are weighing whether or not to buy in to PhilHealth - but PhilHealth can still be a good value even without it.  

    Item (c) many not matter to most and (b) is mitigated by the fact that most expats are in fact males who are married to Filipinas who would still be covered as citizens (if those Filipino wives had their own PhilHealth coverage NOT as dependents of the foreign spouse).

    These exclusions fall upon all dependents of a foreigner who is the primary member even if those dependents are Filipino citizens.

    IRR NHIA 2013 states that your spouse and children who are Filipino citizens or dual citizens of the Philippines and some other country are already eligible to be covered by the NHIP:
    Article III SEC. 6. Mandatory Coverage. – All citizens of the Philippines shall be covered by the National Health Insurance Program.
    It is up to the individual to weigh the value of each option, but it might be a better value to have a separate PhilHealth coverage for family members who are Filipino citizens if the three exclusions might come into play.

    Circular No. 2017-0003 Paragraph VII Foreign Member Dependent Options

    Circular 2017-0003 provides two options for Qualified Dependent(s) of the covered PRA or non-PRA PhilHealth member:
      1. Filipino spouse and children below 21 years old who is not covered under the NHIP; or

      2. Either the foreign spouse or one (1) of their children below 21 years old who is not a Filipino citizen
    Under option "a" you can choose to forgo separate coverage for your Filipino spouse and children and make them all your dependents. The only case where I can see this making sense is if your Filipino spouse has not yet reacquired citizenship. If they are a citizen, then (depending upon the specific case) it might make more sense to get them their own coverage as a citizen, rather than as a dependent of a foreigner. This way they can still have the Z Benefit.

    Under option "b" you can make either your non-Filipino spouse OR ONE of your non-Filipino children your dependent. You read that correctly - option "a" makes all Filipino family members eligible to be dependents and option "b" provides for only one non-Filipino dependent.

    Circular No. 2017-0003 Lifetime Member Program

    Specific Provision #2. All foreign nationals are qualified to be covered under the Lifetime Member Program of the NHIP once they have reached the age of 60 and have made 120 monthly contributions. However, they are not qualified for the mandatory PhilHealth coverage as provided under the expanded Senior Citizens Act.
    Although Specific Provision #1 states that foreigners can become Lifetime members, there does not seem to be any additional benefit to becoming a Lifetime Member if the member is a foreigner. You are already excluded from the benefits of the Expanded Senior Citizens Act and there is no additional benefit that you are not already receiving as an ordinary member. 

    You may hear that being a Lifetime Member means that you no longer have to pay the premium, but this is not correct. Section 33 of Rule 8 of RA 7875 (as amended by RA 9241 and 10606) makes clear that if you earn over the poverty line you still must pay the required premiums:
    SECTION 33. Lifetime Member with Current Source of Income
    A Lifetime Member who obtains a regular source of income from employment, practice of profession and other means shall resume paying the required monthly premium contribution until finally ceasing to earn, provided that said income is above the poverty threshold.
    And that is for everyone, citizens included. The latest poverty line in approximately 10,000 PHP per month for a family of five. That is little more than $2000 per year for a family of five. I doubt there is a single foreigner in the Philippines that falls below that line much less a foreigner in a family of five. In fact, if you are a foreigner in the Philippines who requires public assistance you are liable to be deported (CA 613 Sec. 29(a)(5) & Sec. 37(a)(6)).

    What Does PhilHealth Coverage Actually Pay For 


    PhilHealth pays fixed case rates that can be found at the PhilHealth case rate search website. I just searched for "appendix." Under that search criteria the first result is code #44960 APPENDECTOMY; FOR RUPTURED APPENDIX W/ ABSCESS OR GENERALIZED PERITONITIS. The case rate is composed of a Health Care Institution Fee of P14,400 and a Professional Fee of P9,600. This means that PhilHealth will pay a maximum benefit of P24,000 for that particular ailment. An appendectomy costs approximately P60,000 to P100,000 or more and there may be other expenses that PhilHealth may or may not cover.

    The Bottom Line


    I have never had PhilHealth coverage. As I mentioned in the beginning of this post my family does have it. Within the last year our daughter was hospitalized with Dengue. The dengue did not become hemorrhagic, but our daughter's illness was complicated with bacterial pneumonia. PhilHealth saved  approximately 25% off of our total hospitalization bill of 45,000PHP. The premium for my wife and daughter (since they are both Philippine citizens) is 2400PHP per year, so that one event saved the equivalent of about five annual premiums. 

    This is approximately what PhilHealth paid:
    Room Accommodation: 60%
    ER Rentals: 79%
    Laboratory-Procedure: 35%
    Pharmacy Meds: 21%
    Physician's Professional Fee: 50%
    I had the same illness with the same complication at that same time, but  I declined to be hospitalized. There was no one else to run errands for my wife and daughter. I did have many tests and a couple of prescriptions. Since I do not have PhilHealth I paid about 10,000PHP out-of-pocket.

    So is PhilHealth worth it? It can be. Medical costs in the Philippines are already lower than in the United States. The 17,000PHP that you pay for a year of coverage in the Philippines (15,000PHP as a PRA retiree) is about what you would pay for a single month of premium cost in the US. A single hospitalization might pay you back your premium plus.

    If you have family that you don't want to take any chances with, then PhilHealth could be a good plan for you. If you are a caveman, like me, and you only go to the hospital when bones are sticking out, then maybe not.

    Ultimately, it's up to you to decide whether PhilHealth is right for your situation. But one thing stands as certain: the days of the 2400PHP annual premiums for foreigners are gone forever.

    If any of the links above for supporting documents are dead, then you may be able to locate the document that you want on our Documents Page.

    2 comments:

    Anonymous said...

    Have had Phil Health for 13 plus years. 10 years 3 months as dependent of wife, next 3 years as individual Phil Health member, 17K per year and now with latest change based on pct. of income (3% of( 1.240000P). My question is at the rate Phil Hlth. keeps changing its' fees (contracts) and for less coverage where will a foreigner be at if he lives a long life?

    Anonymous said...

    All systems are collapsing. We should all be thankful for the times of plenty that we have benefited from.

    Because the party is over.

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