Philhealth Eligibility Back to 9 Over 12 Months

9 Monthly Contributions na
ang requirement for Philhealth eligibility!

 

Effective October 1, 2018
required na ang payment of 9 monthly contributions within the past 12 months para maka-avail ng Philhealth coverage.

So dapat tuluy-tuloy na ang pagbayad ng Philhealth contributions para laging eligible sa Philhealth coverage.
Pay your premiums every month, or every quarter, or every 6 months, or every year.

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.

Paano magbilang ng 9 months?

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 meron kang nabayaran na 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. Remember, kasama sa bilang ang buwan na na-admit ka sa hospital.

Dapat din na nabayaran mo lahat ng 9 monthly contributions BEFORE start of 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 Philhealth eligibility requirement ba na ito ay para sa lahat ng types of members?

Yes. Applicable sa Employed, Self-Employed, Voluntary, Non-Working Spouse, at Seaman.

Ang hindi lang kasali sa 9-within-12 rule ay yong members na ang kanilang Philhealth receipt or ID or Philhealth card ay merong Validity Dates, katulad ng mga Sponsored, Indigent at land-based 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. Ang proof na regular kang nagbabayad is nabayaran mo ang Philhealth contributions or premiums for at least 9 months within the past 12 months (the month of hospital admission is included in the counting of 12 months).

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…”

References:

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

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