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

19 Comments

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  1. macocover po b ung jan-june 2018 if magbabayad ako Yearly for this 2018?bale Jan-Dec po babayarn ko?

  2. Thank you po.

  3. Hi Rose, yes, you’re eligible in December. By Dec, naka-9 months ka na, so tamang-tama for getting qualified.

  4. Hi po.buntis po ako ngaun due date ko is december..nkstart ako hulog s philhealth ko april-june2018, then continue ko n sya ngaun.. Kung itotal eh ang mbbyran ko lng ay 9months.mka-avail p b ako ng philhealth kung skali mnganak ako by december?

  5. Hi Elsa, yes, sorry you were not able to avail of Philhealth. Tama yong hospital kasi dapat merong at least 3 months na nabayaran mo within Dec 2017 to May 2018. Starting Oct 1, hindi na lang 3 months kundi 9 months na, so pay asap for July to Sep then next quarters para by next year, qualified ka na. Pag maternity, merong program where the member pays for one year to be qualified (one time chance only).

  6. Hello po Ms. Nora,
    Ask ko lang po tama po ba ung decision ng hospital?..mejo nalito po kasi ako.
    Na-confined ang asawa ko last May28,2018. Hindi po namin na-avail ang Philhealth kasi i missed to pay Jan-March2018 at April-May2018. Complete ung hulog ko for the past years.
    Thanks po.

  7. Hi po tanong ko lang po kung ano dapat kong gawin pag 4yrs na di nahulugan yung philhealth? Kailangan po ba bayaran ko yung 4yrs na di ko nabayaran para maging active ulit yung philhealth ko?

  8. regular po ako nagbabayad ng monthly contribution ko, if i miss to pay for this quarter lang po (march-june 2018) pwede ko pa din ba magamit ang philhealth ko just in case na magkaroon ng emergency (wag naman po sana)? thank u

  9. Hi Monina, kung sure sana na June ka manganganak, puede na yong April May June payment, pero dahil puede ka ring May, hindi puedeng magamit yong Apr May June payment. Ang remedyo is magbayad ka ng one year in advance under the “Women about to give birth” policy. Tanungin mo yong hospital or clinic kung okay sa kanila itong advance one-year payment.

  10. Hi po,last year lng po ako nagmember ng philhealth,august po ako nag apply at nagbayad po ako january-dec 2017(annual contribution po) buntis po ako ngayon at duedate ko may 22-jaune 3 po,d po ako nakabayad mula jan-april 2018. Eligible po b ko s maternity benefits?Puede ko po ba bayaran ulit ang jan-dec 2018? Thanks

  11. Hi anna, did you mean you paid for April to Sep? Yes, covered ka in Sep. Mabuti at hindi October ang delivery mo, kasi 9 months na ang required starting Oct 1. Up to Sep 30, three previous monthly payments pa rin ang required.

  12. hi po good day! ask ko lang po nag contribute po ako ngayong may para sa 9months po, magagamit ko na po ba ito by sept? kasi po ayun yung due date ko manganak. maraming salamat po

  13. Hi Ms Nora,

    Thank you very much for quick reply. Sa lying-in clinic aku nag ppa check up pero hindi accredited sa Philhealth, she owns that clinic, pero nagppa anak din sya sa govt and private hospitals na pede nmn aku mag request if preferred ko manganak dun hospital if may vacant room lng or else sa lying clinic in aku. Okay, mag inquire nalang muna aku dun sa hospital about women about to give birth” policy or one-year-payment-in-advance.

    Thanks!

  14. Hi Bebe, hindi na tatanggapin ang payments for Jan to March, so by November, kulang ng 1 month yong Apr to November payment, so ask the hospital or clinic where you will give birth if you can use the “women about to give birth” policy na you pay for 1 year in advance, para you can avail in November. Some require that you have your prenatal checkups with them if you use this policy.

  15. Hi Bebe, sorry hindi na tatanggapin ang payments for Jan to March, so bayaran mo na lang ang April to March (12 months), pero before you pay, ask mo muna yong hospital or clinic where you will deliver if you can use the “women about to give birth” policy or one-year-payment-in-advance policy. Requirement na you have your prenatal checkups with them.

  16. Hi Ms. Nora,

    I’m inactive member of philhealth and planning na mag volunteer pay kasi I’m pregnant, first baby and due ko is November 2018, so applicable sakin un 9 within 12 months na? So I need pay 9 months from January – September 2018, or 12 months (January to December)?

    Thank you very much.

  17. ask ko lng po mam nora ang misis ko po ay nagbabayad ng philheath ko ay buwan ng june yun po ay yearly ang pagbabayad as ofw ..kakabasa ko pa lng sa ngaun na kung yearly ang pagbabayad kailangan ay magbayad sa last working days of march..salamat po

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