Title
PhilHealth Kasambahay Registration and Coverage
Law
Philhealth Circular No. 016-2015
Decision Date
Jun 22, 2015
Household employers are mandated to register with PhilHealth and ensure their domestic workers, or kasambahays, are enrolled in the National Health Insurance Program, covering premium contributions and providing access to health benefits.
registration
domestic workers
kasambahay

Legal basis and governing mandates

  • Rule V, Section 3 of the Implementing Rules and Regulations (IRR) of Republic Act No. 10361 requires that a household employer who employs a Kasambahay shall register and enroll the Kasambahay as the household employer’s employee with the SSS, PhilHealth, and Pag-IBIG.
  • Section 21, Rule IV of the IRR of Republic Act No. 7875, as amended (the National Health Insurance Act of 2013), requires that employers register Kasambahays with PhilHealth and pay the corresponding PhilHealth premium contributions for services rendered until the date of separation to sustain PhilHealth membership.
  • The Circular requires implementation of the Kasambahay Unified Registration System (KURS) through PhilHealth-Pag-IBIG-SSS Joint Memorandum Order No. 001, s. 2013.
  • Premium contribution computation is tied to the latest PhilHealth premium schedule for the employed sector under the formal economy, referenced as Pursuant to PhilHealth Circular No. 027, s. 2013.

Coverage and covered parties

  • The Circular applies to all Household Employers and their Kasambahays as defined under R.A. 10361 and its IRR.
  • Coverage includes Kasambahays and their qualified dependents as PhilHealth members under the NHIP.
  • Membership coverage applies within the formal economy framework through enrollment and issued PhilHealth identifiers.

Registration system and forms

  • All individuals engaging the services of Kasambahay/s must register with PhilHealth as a Household Employer by submitting the following forms:
    • Household Employer Unified Registration Form (PPS-HEUR1) (PPS-HEUR1).
    • Household Employer Unified Report Form (PPS-HEUR2) (PPS-HEUR2).
    • Kasambahay Unified Registration Form (PPS-KURF) (PPS-KURF) if the Kasambahay is not yet enrolled with PhilHealth, SSS, or Pag-IBIG Fund, to be attached to the accomplished PPS-HEUR2.
  • Forms must be submitted to any Local Health Insurance Office (LHIO) of PhilHealth or to any service office of Pag-IBIG and SSS.
  • To properly accomplish PPS-HEUR1, the Household Employer must fill in the following mandatory fields:
    • Last Name, First Name, Suffix (Sr./Jr.), Middle Name of Household Employer.
    • Date of Birth; Sex; and Tax Identification Number, if available.
    • Address; Contact Number (Landline and/or Mobile/Cellphone); email address; and
    • Signature of Household Employer certifying the correctness of the supplied information.
  • No supporting document is required when the Household Employer submits personally.
  • If submitted through an authorized representative, submission must include:
    • Letter of Authorization from the Household Employer.
    • Valid ID of the Household Employer.
    • Valid ID of the Authorized Representative.
  • Upon registration, PhilHealth assigns a unique and permanent PhilHealth Employer Number (PEN) linked to the Household Employer’s own PhilHealth Identification Number (PIN).
  • Registration and reporting of Kasambahays must be done by submitting duly accomplished PPS-KURF to be attached to PPS-HEUR2.
  • Once registered and reported, Kasambahays receive:
    • a unique and permanent PIN,
    • a PhilHealth ID Card, and
    • a Member Data Record (MDR) as members under the Formal Economy.
  • The Household Employer is provided with:
    • an Employer Data Record (EDR), and
    • a Master List of the Kasambahay/s under employment.

Duties and reporting timelines

  • Household Employers must execute and submit:
    • PPS-HEUR1,
    • PPS-HEUR2, and
    • PPS-KURF when the Kasambahay is not yet enrolled with PhilHealth, SSS, or in Pag-IBIG Fund, to be attached to PPS-HEUR2.
  • The Household Employer must pay and remit the prescribed monthly premium contribution for the Kasambahay on or before the prescribed due date.
  • Failure to remit required premium contributions makes the Household Employer liable for reimbursement of payment for a properly filed claim if the Kasambahay or the Kasambahay’s dependent/s avail of PhilHealth benefits, without prejudice to imposition of other penalties.
  • Within thirty (30) days from the date of separation of the Kasambahay, the Household Employer must submit a duly accomplished PPS-HEUR2 to PhilHealth indicating the date of separation, among others.
  • The Household Employer must update records (including changes in address or contact information) by submitting a duly accomplished PPS-HEUR1 to any PhilHealth Office.

Premium shares and contribution schedule

  • Premium contributions of Kasambahays are shouldered solely by the Household Employer, under the Circular’s framework.

  • If the Kasambahay receives a monthly salary of five thousand pesos (Php5,000.00) or above, the Kasambahay pays a proportionate share.

  • The premium contribution schedule for Kasambahays (employed sector under the formal economy) sets monthly contributions by salary bracket as follows:

  • Salary 0–4,999.00:

    • Personal Share: None
    • Employer Share: 200.00
    • Total Monthly Premium: 200.00

  • Salary 5,000.00–8,999.99:

    • Personal Share: 100.00
    • Employer Share: 100.00
    • Total Monthly Premium: 200.00

  • Salary 9,000.00–9,999.99:

    • Personal Share: 112.50
    • Employer Share: 112.50
    • Total Monthly Premium: 225.00

  • Salary 10,000.00–10,999.99:

    • Personal Share: 125.00
    • Employer Share: 125.50
    • Total Monthly Premium: 250.00

  • Salary 11,000.00–11,999.99:

    • Personal Share: 137.50
    • Employer Share: 137.50
    • Total Monthly Premium: 275.00

  • Salary 12,000.00–12,999.99:

    • Personal Share: 150.00
    • Employer Share: 150.00
    • Total Monthly Premium: 300.00

  • Salary 13,000.00–13,999.99:

    • Personal Share: 162.50
    • Employer Share: 162.50
    • Total Monthly Premium: 325.00

  • Salary 14,000.00–14,999.99:

    • Personal Share: 175.00
    • Employer Share: 175.00
    • Total Monthly Premium: 350.00

  • Salary 15,000.00–15,999.99:

    • Personal Share: 187.50
    • Employer Share: 187.50
    • Total Monthly Premium: 375.00

  • Salary 35,000.00 and up:

    • Personal Share: 437.40
    • Employer Share: 437.50
    • Total Monthly Premium: 875.00

Premium payment rules and due dates

  • The Household Employer must pay or remit premium contributions on or before the twenty-fifth (25th) calendar day of the month following the applicable month for which payment is due.
  • If the due date falls on a Saturday or Sunday, or on a declared regular/special or non-working holiday, payment must be made on the next working day.
  • A Household Employer may opt to pay monthly premium contributions in advance but not to exceed two (2) calendar years.
  • PhilHealth accepts premium contributions only in CASH and in Philippine currency.
  • Premium contributions must be paid or remitted at any LHIO through the Individual Kasambahay Payment Scheme.
  • Under the Individual Kasambahay Payment Scheme, the Household Employer must submit a duly accomplished PhilHealth Payment Slip (PPS) for each Kasambahay, stating:
    • Kasambahay PIN and name.
    • Household Employer PEN and name.
    • Applicable period or month/s being paid for.
    • Amount to be paid.
  • The PPS must be signed by the Household Employer certifying the correctness of the details.
  • Premium payment is acknowledged through a PhilHealth Official Receipt (POR) under the Kasambahay’s name and PIN.
  • The POR must show the Household Employer PEN and name marked as “Paid for by a [Household Employer/PEN]”.

Benefits entitlement and coverage duration

  • As PhilHealth members, Kasambahays and qualified dependents are entitled to:
    • inpatient hospital care benefits including all case rate packages and catastrophic illnesses in the Case Type Z Benefit Package,
    • outpatient and other special benefit packages under the NHIP.
  • Kasambahays are entitled to the No Balance Billing (NBB) privilege when admitted in an accredited government healthcare institution, or in an accredited private healthcare institution for selected cases, consistent with PhilHealth Circular No. 003, s. 2014.
  • Kasambays aged sixty (60) years old and above are eligible to avail of Tamang Serbisyo para sa Kalusugan ng Pamilya (TSeKaP), a primary care benefit package that includes:
    • consultations with primary care doctors,
    • preventive and promotive services,
    • selected diagnostic tests upon physician recommendation, and
    • select medicines for specific primary illnesses.
  • Coverage of Kasambahays and their dependents starts from the time of enrollment and payment of premium contributions.
  • Coverage remains valid for as long as premium contributions are regularly paid.

Repeal and administrative effect

  • All other issuances inconsistent with the Circular are treated as repealed, amended, or modified accordingly.

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