PhilHealth has four categories of enrollees encompassing nearly the entire population:
- Formal sector
- The individual paying program (IPP) for those not eligible for the other three categories.
PhilHealth beneficiaries have access to a nearly comprehensive package of services, including inpatient care, catastrophic coverage, ambulatory surgeries, deliveries, and outpatient treatment for malaria and tuberculosis. Those identified as indigent and OFW are also entitled to outpatient primary care.
Funding for different population categories varies, with the majority of insurance reform financed through general taxation. Specifically:
- Formal sector: Employers and employees split in half the required premium
- Indigents: local governments contribute (on average) 25% of the premium and national government contribute (on average) 75% of the premium
- Retirees: Lifetime free membership for those who are 60 years old and older and have paid 10 years worth of premiums during employment in the formal sector
- Non-poor, Overseas Filipino Workers (OFWs), and others not eligible for other three categories: Premiums paid by individuals, referred to as the individual paying program (IPP)
- KASAPI members are allowed to pay PhilHealth premiums in small amounts regularly through their organizations.
All premiums are pooled nationally and in effect, there is cross-subsidization across districts. Premiums for formal sector are set by law to be up to 3% of the monthly income. However, the current level is 2.5%, applied up to the first 30,000 pesos of income (i.e., all people earning up to or more than 30,000 pesos pay the same premium, while people with salaries under 30,000 pesos pay less). The premium for both the poor and the informal sector is 1,200 pesos annually. The rate for the OFWs is 1,200 pesos.
One of the critical measures for the government to undertake to achieve universal coverage is the massive expansion of PhilHealth members among indigents and informal workers. With the relatively low and unstable coverage rate for informal workers, KaSAPI (Sigurado at Abot-Kaya sa PhilHealth Insurance) was conceptualized. The project was launched as program of PhilHealth that aims to reach out and enroll more informal sector by partnering with big organized group with more than 1,000 members.