As per PhilHealth Circular No. 06, series of 2001, retroactive payments are not allowed except when a member can show proof of sufficient regularity of premium contributions or payment of nine (9) consecutive months or three consecutive quarters within the last 12 months prior to the missed quarter. If you meet this condition, you shall be given a grace period of one month immediately after the missed quarter to pay retroactively including the current calendar quarter.
For newly enrolled members (with less than 12 months reckoned from date of enrollment), retroactive payment for the missed quarter including the current calendar quarter shall also be allowed within the month immediately following the missed period.
This privilege is granted only once every 12 months.
Overpayments shall be adjusted to cover underpayments (if there's any) or shall be considered as advance payments.
As per PhilHealth Circular No. 34, s-2010, new enrollees who are professionals and are unable to show proof that their estimated monthly family income is Php 25,000 and below shall pay the new premium contribution of Php 600 per quarter effective immediately.
Existing members and new enrollees who are considered ”professional” such as doctors, lawyers, engineers, teachers, nurses, architects, dentists and accountants shall pay Php 900/quarter effective January 1, 2012.
Those whose monthly family income in the last 12 months is Php 25,000 and below shall still pay Php 300/quarter.
Among those who are considered "professionals" are doctors, lawyers, engineers, teachers, nurses, architects, dentists and accountants. For the complete List of Professionals, please visit the PhilHealth website.
PhilHealth does not allow multiple declaration and application of PhilHealth entitlements of both spouses. We advise you to decide who among you will declare and provide for the PhilHealth coverage of your only child as a dependent.
YES, the Implementing Rules and Regulations of RA 7875, as amended by RA 9241, provides for the inclusion to the National Health Insurance Program the citizens of other countries residing and/or working in the Philippines. If the foreign national is employed, he/she shall be registered under the Employed Sector Program. Meanwhile, if he/she is self-employed or merely residing in the country, he/she may enroll as an Individually Paying Member. He/she only needs to accomplish and submit to any PhilHealth office, the PhilHealth Member Registration Form (PMRF) and a photocopy of his/her Alien Certificate of Registration (ACR) issued by the Bureau of Immigration (BI) to prove his/her residency in the country.
For one to become eligible for the benefits, payment of at least three (3) months within the immediate six (6) months prior to the month of confinement shall be required. However, payment of at least nine months within the last 12 months shall be asked of Individually Paying Members availing of the following procedures/packages:
Individually Paying Members and Employed Members will now be required to have at least nine (9) months contributions within twelve (12) months prior to the month of availment for all confinements including availment of outpatient benefits).
If your dependent gets hospitalized and he/she is not listed in your MDR yet, you may submit a clear copy of the following:
Overseas confinements of PhilHealth members, regardless of their membership category, and their dependents are still covered and shall be paid based on Level 3 Hospital benefit rates.
It refers to a confinement or series of confinements for the same illness with intervals of not more than 90 days. In such cases, members are not entitled to another set of benefits/allowances until after 90 days. They can only avail of the unused portion of their benefits and their room and board allowance until their 45-day allowance in a year is exhausted. Each member is entitled to a maximum of 45 days for room and board allowance per calendar year and another 45 days to be shared by all of the dependents.
However, members can avail themselves of a new set of benefits if succeeding confinements are of different illnesses or conditions.
The following are allowed to sign the said form on your behalf:
|Member Status||Authorized person (in order of priority)|
|Member is married||Legal spouse|
|Child 18 years old and above in the absence of spouse.|
|Parent (mother or father) in the absence of spouse and child|
|Member is single||Parent (mother or father)|
|Member is orphaned||Brother/sister/guardian|
|Other individuals as duly Authorized Representative|
Clearly state in the form the reason for signing on behalf of the member, or a certification (on a separate sheet of paper) may also may be issued to this effect, with the full name, complete address and contact number/s of the authorized signatory also indicated.
Provide a photocopy of the authorized signatory's identification card (ID) and/or proof establishing his/her relationship to the member.
Emergency cases as defined by PhilHealth shall be paid.
Claims of members confined in non-accredited hospitals shall not be compensated unless all of the following conditions are met:
Members are sent a benefit payment notice or BPN to report the actual payments made by PhilHealth relative to their confinement/availment. The BPN is sent to the address indicated by the member in his claim form.
Should there be discrepancies in the payments and the actual benefits deducted from your hospital and doctors' bills, you may present your BPN, your copy of the hospital's Statement of Account/Billing Statement, and Official Receipts to your health care provider.
All claims with complete and properly accomplished documents except those under investigation shall be processed and paid within 60 calendar days from receipt thereof.
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