Manila, Philippines – The Philippine Health Insurance, Inc. (PhilHealth), announces new rules for eligibility of admission benefits.
In its official page, the state-run social health insurance said that starting October 1, 2018, members should have paid at least a total of nine (9) months premium contributions within the immediate twelve (12) month prior to the first day of confinement, to become eligible for PhilHealth benefits. The twelve-month period is inclusive of the confinement month.
The policy was previously set for implementation last January, however, PhilHealth postponed the execution of the directive to provide its members with ample time to update their premium contributions in order to ensure themselves and their dependents of uninterrupted social health insurance coverage.
The new sufficient regularity of payment (SRP) rule is contained in PhilHealth Circular No. 2017-0021 which states that, “…to establish sufficient regularity of payment, members should have paid six (6) months contributions preceding the three (3) months qualifying contributions within the twelve (12)-month period prior to the first day of confinement…”
How do you know if you will be eligible of PhilHealth benefits? Below are illustration of how is eligibility determined.
Example No. 2 – Confinement date is December 15-17. Premium payment for Jul-Sept. was made prior to the first day of confinement.
Example No. 3 – Confinement date is June 20-22. Payment for Feb, May and June was made prior to the first day of confinement. However, with no sufficient regularity of premium contribution, patient is ineligible to avail of benefits.
Example No. 4 – Confinement date is June 20-22. Payment for June was made on June 23, after discharge. While the patient has sufficient regularity of premium contributions, non-compliance to payment of 3 months within 6 months prior to the first day of confinement has resulted to suspension of benefit entitlement for this particular admission.
PhilHealth urges members to update their premium contributions to ensure uninterrupted health insurance coverage for the principal and his beneficiaries.
Source: PhilHealth.gov.ph (opens a PDF file)