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PhilHealth Insurance Corporation Downloads




Philhealth Forms Downloadable
Individual Paying Member (IPM)OFW/Overseas MemberEmployed Member
Php 450.00/quarterPhp 2,400/yearDepends on Salary Rates


Download PHILHEALTH Circular No. 11 Series of 2012:


CATEGORIESForm Name/ DescriptionDOWNLOADS
MembershipMembership Registration Form
CLAIMS(CF 1) Membership and Patient Information
(CF 2) Provider Information
(CF 3) Patient's Claim Form Guidelines
Employers(ER 1) Employer Data Record
(ER 2) Report of Employee-Members
(ER 3) Employer Data Amendment Form
(RF 1) Employer's Remittance Report
Accreditation
(Institutional)
(PDR) Provider Data Record
(MMHR) Monthly Mandatory Hospital Report
(SOI) Statement of Intent for Hospital,
ASC and FSDC
(SOI) Statement of Intent for OPB, MCP and DOTS
Providers
Accreditation
(Performance
Commitments)
(ANNEX A) Performance Commitment For Health
Care Provider
(ANNEX B) Performance Commitment For Health
System Provider
(ANNEX C) Performance Commitment For
PCB Providers
Accreditation
(Professional)
(PAF) Professionals Accreditation Form with Warranties
for Accreditation and Checklist of Requirements
Accreditation
(Collection Agents)
(CAAF) Collecting Agents Accredition Form
for Accreditation and Checklist of Requirements
Primary Care
Benefit 1
Manual Procedures for Providers
PCB Annexes A1-A5 (Excel File
Payment(PPPS) PhilHealth Premium Payment Slip



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