Public Officers Health Insurance Scheme

 
 
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Please fill up the form below to enroll yourself in the National Healthcare Insurance Scheme. This form is meant for all public officers, union workers, parliamentarians, or members of any statutory board of Papua New Guinea aged over 16 years and below 65 years.

The submission of this form serves as my acceptance of the Public Officers Group Healthcare Insurance Scheme and consent to provide PHA authority for premium deduction from my salary payroll following the date of my enrolment, and for PHA, its affiliates and service providers to process my personal data for these purposes and as described in the Privacy Policy below.

Name *
Name
Date of Birth *
Date of Birth
Please indicate your Salary Range. This information will be kept private and confidential.
Plan A (4.5% deduction for regular employees and 5% deduction for executive grades and above) Plan B (3% deduction for regular employees and 4% deduction for executive grades and above) Plan C (fixed premium of 20 Kina per fortnight for all employees)
Please fill up and submit the Family Cover Rider Form attached below and send to PHA within 30 days. Eligible spouse: The legally married spouse of the Employee, aged over 16 and below 65 years and is not separated or divorced from the Employee; Eligible child: The natural or legally adopted children of the Employee, new-born and up till below 18 years old; or new-born and up till 25 years old who are in continuous full-time education, unmarried and dependent on the Employee for support. For those who want to include more children, please contact PHA at support@pha.com.pg.

The personal data collected by PHA includes all personal data provided in this form, or in any document provided, or to be provided to us by you or your insured persons or from other sources, for the purpose of this insurance application or transaction. It includes all personal data for us to evaluate or administer this application or transaction. For example, if you are applying for an insurance policy, in addition to the personal data provided in the application form, the personal data will also include any subsequent information we collect on health or financial situation, or any information that is necessary for us to decide whether to insure and on what terms to insure, such as test results, medical examination results, and health records from medical practitioners or other insurance companies. You may not alter any of the wording in this ‘Personal Data Collection Statement’. Any attempt to do so will be of no effect.