Siguro maraming nagreklamo sa biglaang announcement ng 9-within-12-months, so Philhealth moved the effectivity from January 1, 2018 to October 1, 2018 para members will have time to adjust…na dapat naman.
Ano ang gagawin ng mga na-deny ang Philhealth claims in January 2018 dahil na-apply agad ang 9-within-12 months na rule?
Request for your Philhealth documents from the hospital you were confined in, and file directly at the nearest Philhealth branch.
Effective October 1, 2018
Hindi na kasya ang 3 monthly Philhealth contributions for Philhealth eligibility para sa mga Philhealth members.
Starting January 1, 2018 (extended to October 1, 2018 na), ang requirement na ngayon ng Philhealth para eligible ka sa Philhealth benefits ay nakapagbayad ka ng 9 monthly contributions sa loob ng 12 months BEFORE hospital admission.
Halimbawa, naospital ka sa buwan na ito, magbilang ka ng 12 months pabalik. Isama mo sa pagbilang ang buwan na ito. Para qualified ka sa Philhealth benefits, dapat nakapagbayad ka ng 9 months sa loob ng 12 months na nabilang mo. Kahit aling mga months, kahit merong laktaw, basta merong 9 months sa loob ng 12 months.
Dapat din na nabayaran mo lahat ng 9 monthly contributions BEFORE confinement. Hindi puedeng naospital ka na at may kulang sa bilang, at maghahabol ka ng payment. Hindi tatanggapin ng Philhealth ang contribution payments sa araw mismo ng admission sa ospital, o habang naka-confine. Dapat BEFORE the day of admission.
Ang requirement ba na ito ay para sa lahat ng types of members?
Yes. Ang hindi lang kasali ay yong members na merong Validity Dates ang Philhealth receipt o Philhealth card nila katulad ng mga Sponsored at landbased OFWs.
Tumaas ba ang monthly contribution ng mga Individual Payors?
Hindi. 200 pesos pa rin per month.
Ang tumaas ay yong contributions ng mga Employees at Employers sa private or government, Kasambahay, at Seafarers.
Payment Deadlines for Philhealth contributions by Individual Payors:
Kapag Monthly ka nagbabayad: Payment Deadline is Last Working Day of the Month
Kapag Quarterly ka nagbabayad: Payment Deadline is Last Working Day of the Quarter
Kapag Semi-Annually ka nagbabayad: Payment deadlines are Last Working Day of March and Last Working Day of September
Kapag Yearly ka nagbabayad: Payment Deadline is Last Working Day of March
Ano ba yong sufficient regularity na sinasabi ng Philhealth?
Sufficient regularity of payment of Philhealth premiums. Sinasabi nila na hindi lang daw payment of 3 monthly Philhealth contributions ang kailangan para makakuha ng Philhealth benefit. Kailangan din daw na merong proof na regular na nagbabayad ng Philhealth contributions ang member.
Nag-refer sila sa Section 12 of Republic Act No. 7875 as amended by RA 10606, known as the National Health Insurance Act of 2013:
“A member whose premium contributions for at least three (3) months have been paid within six (6) months prior to the first day of availment, including those of the dependents, shall be entitled to the benefits of the Program: Provided, that such member can show that contributions have been made with sufficient regularity: Provided, further, that the member is not currently subject to legal penalties…”
Philhealth Circular No. 2016-025
Schedule of Premium Contributions for the Members in the Informal Economy
Philhealth Circular No. 2017-0021
Application of Sufficient Regularity of Payment of Premium Contributions to the Required Qualifying Contributions for
Eligibility to Philhealth Benefits