Wednesday, April 18, 2007 Philhealth rolls out new rules
THE Philippine Health Insurance Corp. (PhilHealth) adjusted the eligibility requirement of individually-paying members when availing themselves of certain reimbursable procedures.
Beginning April 1, confinements of individually paying members and their dependents for hemodialysis and peritoneal dialysis, chemotherapy administration, radiation oncology services and all elective or planned surgeries now require at least nine monthly contributions within the immediate 12-month period before the month of confinement.
Procedures
For instance, if an individually paying member or his dependent is confined any time in April for any of the procedures, PhilHealth requires that at least nine months within April 2006 to March 2007 has been paid in order for such member or dependent to avail himself of PhilHealth benefits.
Payment
Pursuant to the sufficient regularity of payment rule, if an individually paying member failed to pay one-quarter premium, his eligibility to avail himself of PhilHealth benefits will be suspended beginning on the second month after the missed quarterly period.
Exempted from this new eligibility requirement are members enrolled under the Kasapi Organized Group Program and individually paying members undergoing emergency dialysis services during hospital confinements.
