Philhealth to require 9-month contribution to avail of benefits

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Saturday, January 8, 2011


MEMBERS of the Philippine Health Insurance Corporation (Philhealth) must have nine months' premium contributions within the 12-month period immediately prior to the month of availment to be able to avail themselves of medical care benefits in accredited facilities.

Circular 25-2010 states that effective July 1, 2011, Philhealth will require employed and individually-paying members (IPMs) to comply with this eligibility requirement to avail of their benefits. The new policy applies to availments through hospital confinements, surgical and pregnancy-related procedures, and when availing themselves of outpatient coverage for day surgeries, chemotherapy and radiotherapy, among others.

Philhealth president and CEO Dr. Rey Aquino said that “Philhealth needs to implement stern policies for the protection of the members…(and that) through this new policy, we can safeguard the funds from possible abuse."

He added that if the month prior to a member's availment is unpaid and it is needed to complete the nine month-requirement, the premium must be paid before the availment. "If a member pays his premium on or after his availment day, the said payment shall no longer be considered for the said availment but for future ones."

As per the Implementing Rules and Regulation of Republic Act (RA) 7875 or the National Health Insurance Program as amended, sufficient regularity of premium payment is the payment of contribution of at least nine months within the 12-month period immediately prior to the month of availment.

"We are preventing the earlier practice of some members contributing only to the program when they need to avail of the benefits. This is unfair to those who are paying their premiums religiously. If this practice continues, the national health insurance fund will be threatened," Aquino was quoted as saying.

The Circular reiterated that in addition to the premium requirement, all Philhealth members may enjoy their benefits provided that no legal actions are filed against them as defined in RA 7875, as amended.

The new policy will not affect Philhealth members under the Overseas Workers and Sponsored Programs since their coverage is within the validity period as stated in their Member Data Record (MDR) or ID cards. Lifetime members, on the other hand, are already covered for life without the need to pay any additional premium.

To date, there are about 318,853 private and 14,776 government employers registered with Philhealth. The monthly premium of employees is based on a contribution schedule ranging from P50 for those receiving salaries of P4,999.99 and below, to as much as P375 for those whose salary base is P30,000 and above. The employers provide an equal amount as their counterpart to the monthly premium.

Philhealth provides substantial subsidies for hospital room and board allowances, drugs and medicines, X-ray and other laboratory exams, operating room fees and professional fees for qualified availments at any of the 1,366 PhilHealth-accredited hospitals nationwide. (Cheryl G. Cruz)

Published in the Sun.Star Bacolod newspaper on January 08, 2011.

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