LearnersMaterial PhilHealth
LearnersMaterial PhilHealth
LearnersMaterial PhilHealth
Grade 10 Health
LEARNERS MATERIAL ON
THE PHILIPPINE HEALTH
INSURANCE CORPORATION
(PHILHEALTH)
and the
Social Health Insurance Academy | Philippine Health Insurance Corporation Department of Education
Grade 10 / HEALTH LEARNERS MATERIAL ON PHILHEALTH
Quarter I
CONSUMER HEALTH
The Philippine Health Insurance Corporation (PhilHealth)
Introduction
Illnesses do not only pose harm to ones health Read and ponder through the topics and
but also affect the finances of an individual and follow it up and with each activity, you will gain
the entire family. knowledge and deeper understanding about the
role of PhilHealth in upholding the health care
Do you have any idea how your parents manage
of our nation. At the end of the lesson, a transfer
the health care expenses of your family?
activity will allow you to apply your learning and
How about the different sectors of our society your appreciation about PhilHealth.
specially those who belong to the lower income
Are you ready to learn? Dig into the lesson and be
segment? How are they able to cope with the
a champion of PhilHealth!
financial demands of ill health and sickness
specially if there is surge of illnesses and diseases
that easily spread and are costly?
Social Health Insurance Academy | Philippine Health Insurance Corporation Department of Education
Grade 10 / HEALTH LEARNERS MATERIAL ON PHILHEALTH
LEARNING COMPETENCIES
At the end of the lesson, you are expected to:
1. State what PhilHealth is about
2. Explain the meaning of the PhilHealth Vision
Bawat Pilipino, Miyembro, Bawat Miyembro, Protektado, Kalusugan ng Lahat, Segurado
3. Discuss how PhilHealth provides financial risk protection to Filipinos
4. Conduct an activity that will promote the message of PhilHealth
Look for 10 of the many illnesses and procedures that PhilHealth pays for as case rates.
A S T H M A X Y Z Q A M
M P N E U M O N I A K Q
E S P D I A L Y S I S X
R T A E X A I R A L A M
S R R Q N Q Y W S U J A
C O C X Z D D Z Q B X T
O K H Z M S E A I D S E
V E I A F A N C I S G R
A A T K G L G T T Q L N
S G I B W D U O L O X I
E E S L T U E P K H M T
C A T A R A C T Z G J Y
Social Health Insurance Academy | Philippine Health Insurance Corporation Department of Education
Grade 10 / HEALTH LEARNERS MATERIAL ON PHILHEALTH
TIME TO READ
The Philippine Health
Insurance Corporation
(PhilHealth)
The Philippine Health Insurance Corporation
(PhilHealth) is a Government Owned and Social Solidarity can be likened to the Filipino tradition of Bayanihan
where there is a spirit of communal unity and cooperation
Controlled Corporation (GOCC) created through
the National Health Insurance (NHI) Act of 1995
or Republic Act 7875. It is the administrator of the
Social Solidarity in Health
National Health Insurance Program (NHIP) which The National Health Insurance Program is guided
was established to provide health insurance by community spirit. There is social solidarity
coverage for all Filipinos and ensure affordable, in health care -- people support each other by
acceptable, available and accessible health care contributing financial resources to a pool that
services for all citizens of the Philippines. will pay for everyones cost of carei. There is risk-
sharing among income groups, age groups and
PhilHealths battle cry for the financial health care persons of differing health status and residing in
protection of Filipino families can be summarized different geographic areas. This is exemplified in
through its vision statement: PhilHealth as members who are:
How does PhilHealth provide financial health care protection to all Filipinos? Let us go through each line of the PhilHealth vision
statement and discover it.
i
Tamang Sagot (TS) PhilHealths Frequently Asked Questions. PhilHealth. May 2012
Social Health Insurance Academy | Philippine Health Insurance Corporation Department of Education
Grade 10 / HEALTH LEARNERS MATERIAL ON PHILHEALTH
Once enrolled under PhilHealth, a member must declare his or her legal dependents so they can also be
given the same health care protection as that of the principal member.
Social Health Insurance Academy | Philippine Health Insurance Corporation Department of Education
Grade 10 / HEALTH LEARNERS MATERIAL ON PHILHEALTH
Dependent: Parents
parents with permanent Dependent: Children with Disability
disability irrespective of age 21 years old and above with total
disability (congenital/acquired)
Students like you are qualified as dependent children of your parents. By the time you reach the age of
21 or become employed, you need to enroll with PhilHealth to become a member.
go to www.philhealth.gov.ph
Membership application can also be done through the eRegistration module in the
PhilHealth website
A copy of the PMRF can be downloaded online
You may search for PhilHealth offices near your area
Social Health Insurance Academy | Philippine Health Insurance Corporation Department of Education
Grade 10 / HEALTH LEARNERS MATERIAL ON PHILHEALTH
PhilHealth pays benefits per case rate. There is a fixed rate or amount for each illnesses/case which
PhilHealth provides as benefits for its members.
(Refer to Annex C for the example of PhilHealth benefits)
Social Health Insurance Academy | Philippine Health Insurance Corporation Department of Education
Grade 10 / HEALTH LEARNERS MATERIAL ON PHILHEALTH
ii
Dr. Eduardo P. Banzon. Bawat Miyembro. Protektado. Business Mirror. May 8, 2012
Social Health Insurance Academy | Philippine Health Insurance Corporation Department of Education
Grade 10 / HEALTH LEARNERS MATERIAL ON PHILHEALTH
INSTRUCTIONS:
Please put a check (a ) on the space beside the Yes/No/and other items for your selected answer.
3. Has anyone in your family been confined in a hospital over the last 6 months?
___Yes ___ No (if no, please proceed to question no. 4)
If yes, please identify who
Are you aware how your parents or any family member paid the hospital bill?
___ Yes ___ No
If yes, how? (check all items that apply)
___ out of their own pocket
___ through private insurance or Health Maintenance Organization (HMO)
___ through PhilHealth
___ borrowed money from relatives and friends
___ through Philippine Charity Sweepstakes Office (PCSO)
___ Politicians
___ Others, please specify
4. Do you think students like you should know how your parents manage the health care finances
of your family?
___ Yes ___ No
Why?
Social Health Insurance Academy | Philippine Health Insurance Corporation Department of Education
Grade 10 / HEALTH LEARNERS MATERIAL ON PHILHEALTH
Social Health Insurance Academy | Philippine Health Insurance Corporation Department of Education
Grade 10 / HEALTH LEARNERS MATERIAL ON PHILHEALTH
In the WHAT TO PROCESS phase, you will answer and perform activities which will
help you process and improve your understanding about PhilHealth. At the end
of the phase, you will be assessed again to check your processing skills about the
concepts and information learned.
Answer this: How does PhilHealth ensure financial risk protection of PhilHealth members?
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Social Health Insurance Academy | Philippine Health Insurance Corporation Department of Education
Grade 10 / HEALTH LEARNERS MATERIAL ON PHILHEALTH
In the WHAT TO REFLECT AND UNDERSTAND phase, you will do activities that will
assess your deeper knowledge and understanding of the topics learned. At the end of
the phase, you will be assessed again to check your reflection and understanding about
the concepts and information learned.
Social Health Insurance Academy | Philippine Health Insurance Corporation Department of Education
Grade 10 / HEALTH LEARNERS MATERIAL ON PHILHEALTH
In WHAT TO TRANSFER phase, you will apply what you have learned through activities
that will enable you to communicate the significance of NHIP in the lives of Filipinos
and their very own family members. At the end of the phase, you will be assessed again
to check your knowledge, skills and attitudes.
Social Health Insurance Academy | Philippine Health Insurance Corporation Department of Education
Grade 10 / HEALTH LEARNERS MATERIAL ON PHILHEALTH
Summary
On top of the governments thrust to ensure financial risk protection for every Filipino citizen is the
Philippine Health Insurance Corporation (PhilHealth) which administers the National Health Insurance
Program (NHIP). Through its universal coverage mandate, it seeks to provide every Filipino with a social
health insurance coverage. Its membership programs cover all sectors of our society Filipinos from all
walks of life with the provision of comprehensive health care benefits that are responsive to the health-
care needs throughout the various stages of life.
PhilHealth membership programs are categorized according to various sectors of our society: Formal
Economy, Informal Economy, Sponsored Members, Indigent Members, Lifetime Program and Senior
Citizens. Range of benefits that PhilHealth cover includes Inpatient Benefits, Outpatient Benefits, Primary
Care Benefits, Z Benefits, MDG Benefits and other Special Benefit packages. These benefits are paid
through the Case Rate mechanism where there is a pre-determined fixed amount of benefit for each
type of illness and procedure.
PhilHealth is able to provide Financial Risk Protection for PhilHealth members because it ensures
provision of health insurance for unforeseen medical care needs through its network of health care
professionals and health care institutions where quality medical services can be availed of whenever
needed.
The National Health Insurance Program is guided by community spirit. There is risk-sharing among
income groups, age groups and persons of differing health status and residing in different geographic
areas. With this, people support each other by contributing financial resources to a pool that will pay for
everyones cost of care. This can be compared to the Filipino tradition of Bayanihan where there is a spirit
of communal unity and cooperation.
PhilHealths battle cry for the health care protection of Filipino families can be summarized through its
vision statement:
Bawat Pilipino, Miyembro
Bawat Miyembro, Protektado
Kalusugan ng Lahat, Segurado
References:
1. Dr. Eduardo P. Banzon. Bawat Miyembro. Protektado. Business Mirror. May 8, 2012
2. Tamang Sagot (TS) PhilHealths Frequently Asked Questions. PhilHealth. May 2012
3. http://listahanan.dswd.gov.ph/about-us/
4. The Implementing Rules and Regulations of the National Health Insurance Act of (R.A. 7875) as
amended by RA. 9241
Social Health Insurance Academy | Philippine Health Insurance Corporation Department of Education
Grade 10 / HEALTH LEARNERS MATERIAL ON PHILHEALTH
Glossary of Terms:
Department of Social Welfare and The executive department of the Philippine Government
Development (DSWD) responsible for the protection of the social welfare rights of
Filipinos and to promote social development
National Health Insurance Act or The law that instituted the National Health Insurance
Republic Act. No. 7875 Program for All Filipinos and establishing The Philippine
Health Insurance Corporation in Feb. 14, 1995. It was later on
amended by R.A. 9241 in 2004 and the latest R.A. 10606 in
2013
National Health Insurance Program The compulsory health insurance program of the
(NHIP) government established under R.A. 7875 or the National
Health Insurance Act. It seeks to provide universal health
coverage and ensure affordable, acceptable, available
and accessible health care services for all citizens of the
Philippines
National Household Targeting System An information management system that identifies who
for Poverty Reduction (NHTS-PR) and where the poor are in the country. The system makes
available to national government agencies and other
social protection stakeholders a database of poor families
as reference in identifying potential beneficiaries of social
protection programs. The National Household Targeting
Office (NHTO) of the Department of Social Welfare and
Development (DSWD) spearheads the implementation of
this projectiii.
iii
http://listahanan.dswd.gov.ph/about-us/
Social Health Insurance Academy | Philippine Health Insurance Corporation Department of Education
Grade 10 / HEALTH LEARNERS MATERIAL ON PHILHEALTH
Annexes
Annex A: PhilHealth Member Registration Form (PMRF)
Social Health Insurance Academy | Philippine Health Insurance Corporation Department of Education
Grade 10 / HEALTH LEARNERS MATERIAL ON PHILHEALTH
Social Health Insurance Academy | Philippine Health Insurance Corporation Department of Education
Grade 10 / HEALTH LEARNERS MATERIAL ON PHILHEALTH
Social Health Insurance Academy | Philippine Health Insurance Corporation Department of Education
Grade 10 / HEALTH LEARNERS MATERIAL ON PHILHEALTH
Group
Criteria Points Comments
Score
Content
The message was clearly depicted in the 5
groups work
Creativity
5
The group work was presented creatively
Collaboration
The group collaborated with each other and 5
each contributed equally to the presentation
Total points 20
Social Health Insurance Academy | Philippine Health Insurance Corporation Department of Education
action center www.philhealth.gov.ph
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