Philhealth lowers eligibility terms

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Sunday, December 29, 2013


TO ENSURE that all members could avail themselves of its benefit coverage, Philhealth will only require at least three monthly contributions within the immediate six months before confinement.

In the past, individually paying members were required to have at least nine monthly contributions within the immediate 12 months prior to the month of availment for select surgical procedures, cancer treatment like chemotherapy or radiotherapy, dialysis and pregnancy related cases.

But as prescribed in the implementing rules and regulations of the National Health Insurance Act of 2013, members, including their dependents, are entitled to Philhealth benefits as long as they have paid premium contributions for at least three months within the six months prior to the first day of availment.

Members are also given an option to pay in full the required premium for the calendar year if ever the three-over-six month requirement is not met. These include employees with no income for particular months, such as those who are on leave without pay or extended leave and members engaged in seasonal employment.

Those who are separated from employment or whose coverage as sponsored member or as overseas Filipino worker (OFW) has ended, including members who missed to pay their premium contributions, may opt to pay for the unpaid months of the applicable year.

To avail outright deduction of Philhealth benefits, premium payments should be made on or before the date of discharge from the hospital.

Published in the Sun.Star Cebu newspaper on December 30, 2013.

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