National Health Insurance Programme
Basic Information
Country
Geographic area
Population group
Poor households
Programme Details
Programme objectives
Ensure that all Filipinos are guaranteed equitable access to quality and affordable health care goods and services, and protected against financial risks.
Programme components
NHIP presents different membership modalities: members in the formal economy; members in the informal economy; indigent members; sponsored members; citizens living abroad; senior citizens; and lifetime members.
PhilHealth. n.d. Members. Philippine Health Insurance Corporation website. <https://www.philhealth.gov.ph/members/>. Accessed 16 May 2018>.
Start date
1995
PhilHealth. 2013. The Revised Implementing Rules and Regulations of the National Health Insurance Act of 2013 (RA 7875 as amended by RA 9241 and 10606). Manila: Philippine Health Insurance Corporation. <https://www.philhealth.gov.ph/about_us/IRR_NHIAct_2013.pdf>. Accessed 16 May 2018.
Coverage
All Filipinos are automatically covered. The program covers the premium of a range of individuals who cannot pay the premium. In 2021, the total number of 'indirect contributors' accounts for 36,355,966 individuals, including 23,809,743 indigents, 11,077,579 senior citizens, and 1,468,644 under sponsored programme.
(i) Department of Health, Philippines. (2021). Philippines Health Insurance Corporation Annual Report: Malasakit at Pag-asa sa Panahon ng Pandemya. Available at: https://www.philhealth.gov.ph/about_us/annual_report/AR2021.pdf. Accessed on 20 September 2023
(ii) Department of Health, Philippines. (2018). Implementing Rules and Regulations of the Universal Health Care Act (Republic Act No. 11223). Available at: https://www.philhealth.gov.ph/about_us/UHC-IRR_Signed.pdf. Accessed on 20 September 2023
Programme expenditure
USD3.95 billion for UHC financing in 2021
Asian Development Bank. (2021). Build Universal Health Care Program (Subprogram 1): Report and Recommendation of the President. Retrieved from https://www.adb.org/sites/default/files/project-documents/55105/55105-001-rrp-en.pdf. Accessed on 20 September 2023
Targeting and eligiblity
Targeting methods
Targeted areas
Target groups
Poor and near-poor populations.
Eligibility criteria
All Filipinos including poor and near-poor populations. Beneficiaries for the indigent modality have been identified via the National Household Targeting System for Poverty Reduction (NHTSPR) since 2010. They comprise the poorest 25 per cent of the population.
(i) PIDS. 2017. “Who benefits from the government health insurance subsidy for the poor?” Policy Notes, No. 2017-05. . Accessed 16 May 2018.
(ii) PhilHealth. n.d. Indigent Members. Philippine Health Insurance Corporation website. . Accessed 18 May 2018.
(iii) Philhealth. (2021). Strategic Plan for 2021-2023: Changing Gears: Moving Philhealth on High Speed.
Available online at https://www.philhealth.gov.ph/about_us/transparency/PhilHealthStratplan2021-23.pdf. Accessed on 20 September 2023
Coverage and other information
Type of benefits
Amount of benefits
Health insurance coverage for primary care, catastrophic procedures, and even emerging diseases are all covered under this plan. Access to both inpatient and outpatient services at PhilHealth-accredited facilities. The plan also includes special packages like Z benefits, which contribute towards the costs of specific health issues such as acute types of cancer. Additionally, there is an SDG-related package that offers a variety of benefits for cases such as Malaria, Outpatient HIV-AIDS Package, and Animal Bite Treatment Package.
Philhealth., (2023): Benefits. Available online at https://www.philhealth.gov.ph/benefits/.,
Accessed on 20 September 2023
Benefit recipients
Beneficiaries themselves and their dependents.
PhilHealth. 2013. The Revised Implementing Rules and Regulations of the National Health Insurance Act of 2013 (RA 7875 as amended by RA 9241 and 10606). Manila: Philippine Health Insurance Corporation. <https://www.philhealth.gov.ph/about_us/IRR_NHIAct_2013.pdf>. Accessed 16 May 2018.
Minimum and maximum duration of benefits (if any)
Programme guidelines state that in case of death of a household member, their dependents should continue to benefit from the programme for the remaining coverage period or until the end of the current year, whichever comes first.
PhilHealth. 2013. The Revised Implementing Rules and Regulations of the National Health Insurance Act of 2013 (RA 7875 as amended by RA 9241 and 10606). Manila: Philippine Health Insurance Corporation. <https://www.philhealth.gov.ph/about_us/IRR_NHIAct_2013.pdf>. Accessed 16 May 2018.
Monitoring and evaluation mechanisms and frequency
PhilHealth produces annual reports and semestral status updates on the programme as well as annual procurement plan reports.
PhilHealth. n.d. About us. Philippine Health Insurance Corporation website. <https://www.philhealth.gov.ph/about_us/>. Accessed 18 May 2018.
Legal Framework
REPUBLIC ACT No. 7875, known as National Health Insurance Act of 1995
REPUBLIC ACT No. 7875, Congress of Philippines, 1995, https://www.philhealth.gov.ph/about_us/ra7875.pdf
Accessed on 20 September 2023
