PhilHealth Bares New Policy on Benefit Eligibility

Philippine Health Insurance Corporation (PhilHealth) members must have paid at least nine months premium contributions prior to the first day of confinement to avail of the health insurance benefits.

This new policy, which is effective starting October 1 this year, is contained in PhilHealth Circular No. 2017-0021 on Application of Sufficient Regularity of Payment of Premium Contributions to the Required Qualifying Contributions for Eligibility to PhilHealth Benefits issued in August 2017.

PhilHealth 6 Information Officer Dex Jesson Belleza said with this new Circular, members should have at least nine months paid PhilHealth premium contributions within the last 12 months to receive the benefits.

However, Belleza said new-enrolled members whose membership cover less than nine months are only required at least three months within six months contributions prior to the first day of confinement.

Lissette Gelvezon – Lira, also an Information Officer of PhilHealth 6, encouraged members to check and update their membership data record (MDR), one of the supporting documents required by hospitals and other healthcare providers, in the availment of PhilHealth benefits.

“The processing of MDR and PhilHealth ID is free of charge,” reminded Lira amidst reports reaching their office that there are fixers who offer their services for a P200 to P300 fee to speed up the processing of the documents.

As of July 31, this year, according to Lira 94.29 percent of the population in the region are now covered with PhilHealth.

For the last 9 months, PhilHealth 6 has already paid some P5.7 billion benefit claims, of which around P1.6 billion of the amount were paid to illness and medical needs claims of indigents, more than P453,000.00 for sponsored program members, and P1.2B and more than P412,000.00 for senior citizens and lifetime members dependents, respectively.

Lira said these sectors no longer pay for their hospitalization in any government hospital in a ward-type accommodation under the No Balance Billing policy of the agency.

“The government pays for their hospital expenses taken from the Sin Tax funds,” said Lira.

She said PhilHealth 6 is currently joining the Statistical Exhibit at the Ground Floor of Robinsons Place Jaro in this city featuring the significant and updated data of the agency. The exhibit, held in line with the celebration of the 29th National Statistics Month this October, will end on October 26. (JBG/laf/PIA6-Iloilo)