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Philhealth: Report of Employee - Members Name of Employer/Firm: Employer No: Address: E-Mail Address

This document is an employee reporting form for PhilHealth, the Philippine national health insurance program. It contains instructions for employers to report newly hired employees to PhilHealth in order to enroll the employees in the national health insurance program. Employers must fill out the form in duplicate, providing employee names, positions, salaries, and other identifying information. The form also contains instructions on how to properly fill out and submit the form to PhilHealth.

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558 views3 pages

Philhealth: Report of Employee - Members Name of Employer/Firm: Employer No: Address: E-Mail Address

This document is an employee reporting form for PhilHealth, the Philippine national health insurance program. It contains instructions for employers to report newly hired employees to PhilHealth in order to enroll the employees in the national health insurance program. Employers must fill out the form in duplicate, providing employee names, positions, salaries, and other identifying information. The form also contains instructions on how to properly fill out and submit the form to PhilHealth.

Uploaded by

malou
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLS, PDF, TXT or read online on Scribd
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PLEASE READ INSTRUCTIONS AT THE BACK BEFORE ACCOMPLISHING THIS FORM.

PHILHEALTH
REPORT OF EMPLOYEE - MEMBERS (CHECK APPLICABLE BOX) INITIAL LIST (Attach to PhilHealth Form Er1) SUBSEQUENT LIST
Er2
NAME OF EMPLOYER/FIRM: Employer No:
ADDRESS: E-MAIL ADDRESS:
(DO NOT FILL)
PHILHEALTH/SSS/GSIS NAME OF EMPLOYEE POSITION SALARY DATE OF EFF. DATE OF PREVIOUS EMPLOYER
NUMBER EMPLOYMENT COVERAGE ( IF ANY )
Surname Given name Middle name

TOTAL NO. LISTED ABOVE: CERTIFIED CORRECT:


One (1)

Human Resource Management Officer II


PAGE_1__ OF __1__SHEETS SIGNATURE OVER PRINTED NAME
TO BE ACCOMPLISHED IN DUPLICATE.
Note: This form can be reproduced but not for sale.
INSTRUCTIONS

1. An employer who is not yet registered with PhilHealth will submit this form in two (2) copies together with the "Employer Data
Record ", in two (2) copies also.

2. An employer already registered with PhilHealth will submit this form in two (2) copies to PhilHealth to report (a) newly hired
employee(s). The PhilHealth Number of the employee (which was shown to the Employer) should be written in the first column
of this form.

3. ALL COLUMNS SHALL BE FILLED CORRECTLY, except the column with the heading "EFF. DATE OF COVERAGE".

4. IT IS IMPORTANT THAT YOU INDICATE YOUR REGISTERED NAME AND EMPLOYER NUMBER IN YOUR REMITTANCE
(PhilHealth Form RF1) ACCURATELY. OTHERWISE, YOUR PAYMENTS CAN NOT BE CREDITED TO YOUR ACCOUNT.

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