Scope of Coverage
- Applies to all Household Employers and Kasambahays as defined in RA 10361 and its IRR.
Duties of Household Employers
- Required to complete and submit:
- Household Employer Unified Registration Form (PPS-HEUR1).
- Household Employer Unified Report Form (PPS-HEUR2).
- Kasambahay Unified Registration Form (PPS-KURF) if Kasambahay not yet registered.
- Must pay and remit monthly PhilHealth premiums on or before due dates.
- Failure to remit premiums makes the employer liable for reimbursing claims and subject to penalties.
Registration Procedures
- Registration must be done through Local Health Insurance Offices or equivalent PhilHealth, SSS, or Pag-IBIG offices.
- Submission of PPS-HEUR1, PPS-HEUR2, and PPS-KURF forms is mandatory.
- Mandatory fields in PPS-HEUR1 include detailed personal and contact information and certification.
- Personal submission requires no supporting documents; authorized representatives must provide authorizations and valid IDs.
- PhilHealth issues a unique PhilHealth Employer Number (PEN) linked to the employer’s PhilHealth ID.
- Kasambahays get unique PhilHealth Identification Numbers (PINs), ID cards, and Member Data Records.
- Employers receive Employer Data Records and Master List of Kasambahays.
- Must report separation within 30 days using PPS-HEUR2.
- Updates to employer information require submission of PPS-HEUR1.
Premium Contribution
- Premiums are solely paid by the Household Employer, except if Kasambahay’s salary is at least Php5,000, then a proportionate share is paid by Kasambahay.
- Contribution schedule is based on salary brackets ranging from Php0 to Php35,000+ with specific employer and employee shares.
Payment of Premium Contributions
- Contributions due on or before the 25th day of the month following the coverage month.
- Payments can be made ahead but not exceeding two years.
- Only cash payments in Philippine pesos accepted.
- Payments made at Local Health Insurance Offices via Individual Kasambahay Payment Scheme.
- Requires PhilHealth Payment Slip with precise details signed by the employer.
- PhilHealth Official Receipt issued indicating payment under the Kasambahay’s name and PIN, including employer details.
Benefits and Entitlements of Kasambahays
- Entitled to in-patient hospital care, including case rate packages and catastrophic illness coverage.
- Eligible for outpatient and special benefit packages.
- No Balance Billing (NBB) privilege at accredited government and select private health care institutions.
- Kasambahays aged 60 and above qualify for the TSeKaP primary care benefit package, including consultations, preventive services, diagnostic tests, and medicines.
- Coverage starts at enrollment and payment of premiums and lasts continuously while premiums are paid.
Repealing Clause
- All inconsistent issuances are repealed, amended, or modified accordingly.
Effectivity Clause
- Circular effective fifteen days after publication in a newspaper of general circulation.
- Circular to be deposited with the Office of National Administrative Register at the University of the Philippines Law Center.