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PH Form M1a 1999-2024 free printable template

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Please read instructions at the back before accomplishing this form. M1a Republic of the Philippines PHILIPPINE HEALTH INSURANCE CORPORATION Member s PhilHealth No. MEMBER DATA RECORD FOR EMPLOYED SECTOR PARA SA MGA NAMAMASUKAN August 1999 City State Centre Bldg 709 Shaw Blvd. Pasig City 1. Surname Apelyido Given Name Pangalan Middle Name G* Apelyido 2a* Postal Code 2. Permanent Address Tirahan Number Street Numero at Kalye Barangay Town/City Bayan/Lungsod 3a* Date of Birth Kapanganakan 3....
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How to fill out philhealth m1a form


How to fill out philhealth m1a form:

Begin by entering your personal information, such as your name, address, and date of birth.
Provide your PhilHealth number, if you have one, or leave it blank if you don't.
Indicate your employment status and provide information about your employer, if applicable.
Enter your dependents' details, including their names and PhilHealth numbers, if applicable.
Fill in the spaces for your dependents' relationship to you and their birth dates.
Specify if you are residing in a local or overseas address and provide the necessary details accordingly.
Indicate your chosen PhilHealth accredited health care provider, if any.
Sign and date the form to certify its accuracy.
Submit the completed form to the relevant PhilHealth office or authorized personnel.

Who needs PhilHealth M1A form:

Individuals who are applying for PhilHealth membership for the first time.
Employees who are updating their PhilHealth information or changing their employer.
Individuals who are enrolling their dependents for PhilHealth coverage.
People who have experienced a change in their residential or employment status.
Those who wish to designate a specific PhilHealth accredited health care provider.

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Philhealth M1A Form is a form used by employers to report their contributions to the Philippine Health Insurance Corporation. The form is used to declare the total number of employees, the total amount of contributions, and the number of months covered. It also serves as a proof of payment for the employer’s contributions.
Employers who are required to file the PhilHealth M1A Form are those who are registered with the Philippine Health Insurance Corporation (PhilHealth) and have employees who are required to be covered by the PhilHealth program.
1. Write your name and address at the top of the form. 2. Enter your date of birth and your PhilHealth ID number, if available. 3. Fill in the date on which you became a member of the PhilHealth program. 4. Enter the name, address, and contact information of your employer or sponsor. 5. Enter the dates of the period of coverage for which you are making a claim. 6. Enter the details of the medical services that you are claiming for and the corresponding charges. 7. Sign and date the form. 8. Attach any relevant supporting documents (e.g. bills, doctor’s prescriptions, etc.) 9. Submit the form to the PhilHealth office.
The PhilHealth M1A Form is a form used to collect information about the members of a health plan, their dependents, and other important information related to the health plan. It is used to keep track of members’ information, and to ensure that they are eligible for benefits and services offered by the plan. This form also helps the plan to accurately calculate contributions and benefits that members are eligible for.
The PhilHealth M1A form requires employers to provide information about their employees such as: name, address, gender, date of birth, PhilHealth number, and monthly compensation. Employers must also provide information about the total number of covered and exempted employees, the total amount of contributions due, and the date of remittance or payment.
The deadline to file PhilHealth M1A Form in 2023 is March 31, 2023.
The penalty for the late filing of a Philhealth M1A form is a fine of up to PHP2,000. Additionally, employers may also be liable for administrative sanctions, such as suspension of registration and cancellation of accreditation.
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