PhilHealth Forms: PMRF, Claim Forms 1 to 4
Philippine Health Insurance Corporation · forms
Quick answer
PhilHealth publishes the PMRF for membership registration and the PMRF-FN for foreign nationals. Claims run on Claim Forms 1 to 4 plus a Claim Signature Form, and inpatient claims need Claim Form 1 with a copy of your MDR or a PhilHealth Benefit Eligibility Form.
Last verified
Where these figures come from
About these figures: the numbers below come from PhilHealth's official published sources: PhilHealth | Downloads, forms (https://www.philhealth.gov.ph/downloads/, retrieved 2026-09-01); PhilHealth | Benefits (https://www.philhealth.gov.ph/benefits/, retrieved 2026-09-01); PhilHealth | Members, registration procedures (https://www.philhealth.gov.ph/members/, retrieved 2026-09-01). Agencies change fees and rates without notice, so confirm with PhilHealth before you rely on them. Last verified: 2026-09-01.
PhilHealth’s Downloads page is organised by what you are trying to do. This is the member-facing half of it.
Membership forms
| Form | Full name | Who uses it |
|---|---|---|
| PMRF | PhilHealth Member Registration Form | The standard registration route |
| PMRF-FN | PhilHealth Member Registration Form for Foreign Nationals | Foreign nationals |
A newly hired employee without a PIN fills out two (2) copies of the PMRF and submits them to the employer’s HR department, then awaits the Member Data Record and PhilHealth ID card. The registration guide covers the route.
Claim forms
| Form | What it carries | Revision |
|---|---|---|
| Claim Signature Form | Signatures | Revised September 2018 |
| Claim Form 1 | Member and Patient Information | Revised September 2018 |
| Claim Form 2 | Provider Information | Revised September 2018 |
| Claim Form 3 | Patient’s Clinical Record | - |
| Claim Form 4 | Clinical Summary | - |
PhilHealth also publishes Claim Form 1 Guidelines, Claim Form 2 Guidelines, Claim Form 4 Guidelines and a set of Claim Form Reminders.
What a hospital actually needs from you
| # | Document |
|---|---|
| 1 | A copy of the Member Data Record, or a PhilHealth Benefit Eligibility Form (PBEF) |
| 2 | A duly accomplished PhilHealth Claim Form 1 |
Of the five claim forms, only Claim Form 1 is the member’s. Forms 2, 3 and 4 are the provider’s. The MDR guide covers printing the record.
Payment forms
| Form | Detail |
|---|---|
| PPPS | PhilHealth Premium Payment Slip, published for Accredited Collecting Agents |
| SPA | The Statement of Premium Account, generated in the SPA Generator rather than downloaded |
Self-paying members pay against an SPA, and the payment must match the SPA amount exactly. The payment guide covers it.
Benefit-specific forms
| Programme | Forms published |
|---|---|
| Maternity Care Benefits | Annex C, Antenatal Care Record; Annex E, Post Partum Care Record |
| Dialysis | Dialysis Database Registration Form; Certification on Diagnosis and Management of CKD Stage 5; Hemodialysis Benefits Package Agreement Form |
| E-Claims | Software Certification Application Form (SCAF); Non-Disclosure Agreement (NDA); Software Certification Agreement (SCA); eClaims Cloud Storage Technical Specifications; PCSS Application Form; Account and Cipher Key Request Form; HCI Engagement Registration Form |
The E-Claims set is for software providers and health facilities, not members.
Provider accreditation forms
The Downloads page also carries the Konsulta accreditation annexes: Annex A on facility standards, Annex B.1 a health human resource survey tool, Annex B.2 a checklist of drugs, Annex B.3 a checklist of laboratories and diagnostic services, Annex C on procedures and documentary requirements, Annexes D.1 and D.2 on service delivery support, and Annex E, a non-disclosure agreement.
The Konsulta guide explains why those are the only Konsulta documents left, and the YAKAP guide covers the member-facing programme.
What none of them cost
PhilHealth publishes no fee for any of its forms on the pages read for this guide. They are published as downloads. No figure is stated here.
For contrast, these are the fees other agencies attach to their own forms and documents.
| Document | Published fee | Where it is covered |
|---|---|---|
| PhilHealth PMRF | No fee published | This page |
| BIR Form 1905 for a TIN Card | Free first issue; ₱100.00 replacement | TIN ID |
| BIR business registration, Form 1901 | ₱30.00 documentary stamp tax | TIN registration |
| PSA civil registry document | ₱130.00, or ₱185.00 for a CENOMAR | PSA birth certificate |
| DFA passport application | ₱950.00 regular, ₱1,200.00 expedite | New passport |
| LTO APL form transactions | ₱250.00 for a student permit | Student permit |
| NBI clearance | ₱160.00 including the ₱30.00 e-payment fee | NBI clearance requirements |
What the forms sit on
| Figure | |
|---|---|
| Premium rate | 5.0% of monthly income |
| Income floor | ₱10,000.00 |
| Income ceiling | ₱100,000.00 |
| Monthly premium range | ₱500.00 to ₱5,000.00 |
| Annual deadline | December 31, grace to January 31 |
| Interest after that | Compounded monthly, not exceeding 1.5% |
| Overseas claim window | 180 days from discharge |
What this page does not cover
PhilHealth does not publish, on the pages read for this guide, filing instructions for Claim Form 3, a deadline for submitting a domestic claim, a form for adding or removing a dependent, a replacement form for a lost ID card, or which forms may be submitted electronically. None of those are stated here.
Related
The registration guide covers the PMRF, the MDR guide the document that accompanies Claim Form 1, and the case rates guide how the claim is paid.
Frequently asked questions
- Which form registers me with PhilHealth?
- The PMRF, the PhilHealth Member Registration Form. Foreign nationals use the PMRF-FN, the PhilHealth Member Registration Form for Foreign Nationals. Both are published on PhilHealth's Downloads page.
- How many copies of the PMRF do I need?
- Two. PhilHealth's registration procedure for a newly hired employee without a PIN is to fill out two copies of the PMRF and submit them to the employer's HR department.
- What are the claim forms?
- Claim Form 1 for Member and Patient Information, revised September 2018; Claim Form 2 for Provider Information, revised September 2018; Claim Form 3 for the Patient's Clinical Record; and Claim Form 4 for the Clinical Summary. There is also a Claim Signature Form, revised September 2018. PhilHealth publishes guidelines for Claim Forms 1, 2 and 4 and a set of Claim Form Reminders.
- Which form does a hospital need from me?
- Claim Form 1, plus a copy of your Member Data Record or a PhilHealth Benefit Eligibility Form. That is PhilHealth's published documentary requirement for inpatient benefits.
- Is there a form for paying premiums?
- The PPPS, the PhilHealth Premium Payment Slip, published for Accredited Collecting Agents. Self-paying members pay against a Statement of Premium Account generated in the SPA Generator.
- Are there forms for maternity care?
- PhilHealth publishes Annex C, the Antenatal Care Record, and Annex E, the Post Partum Care Record, under Maternity Care Benefits on its Downloads page.
- What about dialysis?
- The Downloads page carries a Dialysis Database Registration Form, a Certification on Diagnosis and Management of CKD Stage 5, and a Hemodialysis Benefits Package Agreement Form.
- Do the forms cost anything?
- PhilHealth does not publish a fee for any of its forms on the pages read for this guide, and they are published as downloads. No figure is stated here.
Sources
- PhilHealth | Downloads, forms, retrieved
- PhilHealth | Benefits, retrieved
- PhilHealth | Members, registration procedures, retrieved