STARTING January 1, 2018, members of the Philippine Health Insurance Corporation (PhilHealth) must have sufficient regularity of premium contributions to ensure that they are able to avail themselves of social health insurance benefits in accredited health care institutions.
Through Circular 2017-0021 published last October 27, PhilHealth emphasized that eligibility to benefits means that a member must have made at least three (3) months’ contribution within the immediate six (6) months prior to the first day of confinement. In addition, a member must also have sufficient regularity of premium contribution, and should not be subject to legal penalties.
This is articulated in Section 12 of Republic Act 7875 or the National Health Insurance Act as amended by RA 10606 which was passed in 2013.
As contained in PhilHealth Board Resolution No. 2097, s.2016 sufficient regularity of payment means that a member must have paid at least six (6) months’contributions preceding the three (3) months qualifying contributions within the immediate 12-month period prior to the first day of confinement.
“In other words, a member must always have updated premium contributions to ensure eligibility to benefits availment,” said Dr. Celestina Ma. Jude P. de la Serna, Interim/Officer-in-charge, PhilHealth President and Chief Executive Officer. “While PhilHealth has the obligation to provide financial access to quality medical care services, our members are also responsible for making sure that their premium payments to the National Health Insurance Program (NHIP) are updated,” she said.
Through special provisions, however, PhilHealth Circular 2017-0021 provides exemptions in the application of the said policy for certain membership types.
For instance, newly-enrolled members whose membership to the NHIP covers less than nine (9) months from the initial date of registration, shall only be required payment of at least three (3) months within six (6) months prior to the first day of confinement.
In addition, women about to give birth must pay the annual premium contribution prior to discharge from the accredited hospital to immediately avail themselves of maternity care benefits.
On the other hand, Sponsored members and Overseas Filipino Workers (OFWs) with expired coverage may shift membership to the Informal Economy within the three (3) months’ grace period following the month of expiration of coverage of their membership validity. Employed members, including seasonal employees who have been recently separated from work may also shift to the Informal Economy within the three (3) months’ grace period.
To avail themselves of the PhilHealth benefits, they should pay at least three (3) months’ premium contributions prior to hospital discharge and must show proof of sufficient regularity of premium contributions.
The Circular, which may be downloaded from www.philhealth.gov.ph/circulars/2017, defines and clarifies the application of sufficient regularity of PhilHealth premium payments and establishes the required number of contributions for eligibility to PhilHealth benefits of members from the Formal and Informal Economy, including migrant workers, members of organized groups and sponsored members.
Premium contributions may be paid through any of PhilHealth’s accredited banks or non-bank partners nationwide and overseas. (END)
(Reference: Dr. Israel Francis A. Pargas, Head Executive Assistant and Concurrent OIC-Vice President for Corporate Affairs Group, Tel. 0917-8089399)