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

Updated: July 29, 2018 — 5:02 pm

65 Comments

Add a Comment
  1. Hi Michelle, eligible ka sana kasi nakabayad ka ng 3 months within the past 6 months, pero ang problem ay malamang delayed ang payment for October 2014. Baka mas nauna yong date of admission ng anak mo kesa sa date of payment ng Philhealth contribution. Ang Philhealth rule is dapat nauna ang Philhealth contribution payment kesa date of admission. Usually kasi pag employed, sa 15th pa kinakaltas, then sa November pa ibinabayad. Tama ka na dapat hindi nagbigay ang employer mo ng certification of Philhealth payment kung hindi pa naman nabayaran. Kung okay sa iyo, sabihin mo na lang sa employer mo na nagbigay sila ng cert of payment noon, kaya na-eligible ka noon. So fault din nila kung bakit sila nag-certify ng payment na hindi naman pala nabayaran pa. Tell your former employer na wala kang pambayad, or tell them that you can pay but at little amounts over a longer period (hulugan), and don’t sign any document (agreement) na hindi mo kayang bayaran. Basta babayaran mo in your own pace, kasi meron silang fault, at hindi mo kakayanin ang biglaan.
    Ito yong explanation sa eligibility.

  2. Hi po. Tanong ko lang po last july 2015 po kasi natanggap ako ng dating employer ko so ang unang hulog ko sa kanila ay august 2015 and then na ospital po yung anak ko ng october katapusan nagtanong ako sa employer ko kung pwede ko na ma avail ang hospitalization ayun pwede na daw kasi sakto na pang 3 mos ko sa oct. Ngayon nagpunta na kami sa hospital may pina fill up na form kay employer at na approve naman ni philhealth kasi 4k lang ang pinabayaran sakin. Nagresign na kasi ako sa kanila nung 2017 at ngayon naman pinatawag nila ako kasi sinulatan daw sila ni philhealth na hindi daw sakop ng 6 mos yung payment ko. Tapos pinapabayaran sa dati kong employer yung 10k na nakaltas sa bill ng anak ko. Pero bat inapprove ng philhealth yun kung di pa ko entitled sa benefits? Dapat sa ospital palang ay na declined na yung application ko. Sana po matulungan nyo ako. Salamat po.

  3. hello Ms. Nora

    Ask ko lng po kabuwanan ko po ngayong september 2019 kaya lng po hindi na po nahuhulugan ang philhealth ko. kung magbayad po ako ngayon ma avail ko po ba ang benefits?

  4. Hi Juanito, kulang ka ng one month. Pero punta ka na sa accounting/billing at ipakita mo Philhealth receipts mo kung qualified. Kung hindi eligible, tanungin mo kung puedeng mag-avail ng Women about to give birth program ang misis mo.

  5. Hi Jesse, ang sad naman na hindi ka nakabayad ng more than 9 months na, kasi ang binibilang ng Philhealth ay yong 9 monthly payments mo within the past 12 months. Sana kung OFW ka, puede kang magbayad ng one year (2,400) at magagamit mo agad. Meron ka bang proof na OFW ka na hindi makikita na seaman ka? Ang seaman kasi under Philhealth ay hindi OFW, kundi employee.

  6. Jesse Tafalla Dones

    hello mam ako po ay seaman cook ako po ay mahigit ng 20yrs na member ng philhealth ngunit hindi na po ako nakapagbayad ng mahigit 9 months, ako po ay magpapaoera sa gallstones makaka avail pa po ba ako ng operation sa mga hospital thanks

  7. Hi po..ask ko lng po kung makaka avail po ako ng philhealth benefits.nanganak po asawa ko this April 09…last hulog ko is December 2018

  8. Hi Cristina, sorry hindi tinatanggap ang late payments from individual members. Pero puede mo pa ring bayaran ang Jan Feb March (one quarter) this March (deadline is last business day of March). Kung first-time ka lang mag-member at never ka pang nag-member in the past, qualified ka kahit 3 months pa lang ang nabayaran mo. Pakuhanin ka lang siguro ng hospital ng cert from Philhealth na new member ka pa lang, so eligible ka.

  9. Hi, nagregister lang ako ngayun March 2019. Maari ko bang bayaran yung last 9 months para ma qualified agad?

    Salamat

  10. Hi Gaz, yes, kasi ang gagamitin mo naman na certification of premium payment ay from the employer. Merong receipt no., amount and date doon sa certification.

  11. Hi ailene, eligible ka noon kasi amg requirement that time is payment of 3 months within the past 6 months. Paid mo ang July Aug Sep (3 months). Included sa counting ang current month na Sept 2014, nasa Philhealth circular yan. Kahit ngayon na 9 months na ang required, included sa counting ang current month. Sabihin mo sa employer mo ang basis: Section 39 of The Revised Implementing Rules and Regulations of the National Health Insurance Act of 2013 (RA 7875) plus yong Philhealth Circular No. 032-2014. Paki-update ako kung okay na.

  12. hi ask ko lang this case is from year 2014, last 2011 to january 2014 employed po ako that time then umalis po ako ng company nung february to june so ung philhealth ko po is di ko na nahulugan , then bumalik ako ng company ko ng july2014 to september 2014 nahulugan po ulet ung philhealth ko then nconfine ung anak ko nung september 2014, so na allowed ako n philhealth na gumAMIT ng philhrealth pero this year my employer told me na pinagbbyad sya ni philhealth ng worth 15 k dahil po di daw ako allowed gumamit ng philhealth that time kase walang hulog ung marc to june ko po , soask ko lang if nreed ko po ba tlgang magbyad???

  13. Hi, possible po bang gamitin ang Philhealth if bayad na ni employer pero hindi pa posted ang payment?

  14. Hi Randolf, puedeng maremedyuhan ang situation mo sa government hospital (meron silang Philhealth membership at point of need), pero sa private hospital, hindi mo magagamit ang Philhealth immediately. Kelangang makaipon ka muna ng 9 monthly payments within the past 12 months. Ask mo ring yong hospital where you plan to have the surgery

  15. Hi! Individual payor po ako registered since feb 2018, ngunit hindi ko nabayaran ang buong taon ng 2018. Now that Im planning to pay for the whole year jan-dec 2019, kelangan ko pong gamitin para sa surgery ng anak ko, magagamit ko na po ba ang philhealth ko anytime? Thank you

  16. mam, hindi po ako nkpgbayad last this year 2018..panu po pag babayaran ko this lahat this january to december 2019 ..kailan po pwede maavail kung sakali lang po..salamat

  17. Hi nconfine ako sa madocs last frday lbg dec14. Ngstart ako sa compny ko apr4,2018, upon discharge ngcash out ako ng 25k dahil ineligible daw ako sa philhealth. Wala nmng sinasabi ang compny nmin about sa 9months paymnt ng philhealth. My mggwa p b ko to have my money refunded? Kc db benefit ng employee ang healthcard?

  18. Hi po pwde na po bang magamit ang phillhealth kung unang bayad ko po nang july,august,sept
    Tpuz po ngayon ko lang ulit mahuhulugan dec po due date ko po kasi is february ang kapanganakan ko???

  19. Hi joane, kung nadeduct naman sa kanya ang July to Sep at hindi lang naremit, fault ng employer. Puedeng ask the employer to pay yong amount na dapat na i-cover ng Philhealth. Or baka naman naremit. Ask the employer to issue a cert of Philhealth payments for any 9 months within Jan to Dec 2018 para magamit ng office mate mo.

  20. Ask ko lang po, na admit yung office mate ko kahapun lng december 4, 2018. maka avail po vah cya sa philhealth nya., kahit ang naremit lng nang employer nya is january-june pa lng?

  21. Hi Jo-Ryl, yes, puede. The best thing to do is go to the hospital or clinic where you will give birth and ask them about Women about to give birth program, para masabi nila kung kelan ka dapat magbayad sa Philhealth.

  22. Hello po, I am 6 months pregnant and I want to know po if makaka avail pa po ba ako ng Philhealth benefits para sa Women about to give birth kapag kukuha ako ngayong January? Wala pa po kasi akong perang ipangbabayad ngayon. ?

  23. Hello po halimbawa po nagbayad aq oct-dec 2017 then jan-june tapos nakaligtaan ko po magbayad ng july to september then na hospital ung baby ko ng november applicabe pa po kaya un??

  24. Hello po..ask ko lang po,pag na operahan po ba ngaun October or November 2018 pwede maka avail ng philhealth kahit na myrun di nabayaran na 1st quarter (Jan-Mar 2018)pero bayad na po April-Dec 2018,un previous year bayad naman po,un 1st quarter lang talaga ng 2018 ang nakaligtaan..

  25. hi po…ngpamenber po ako s philhealth last nov 2017, tapos nung jan-march 1st quarter hindi k p nbyaran pwde ko b magamit philhealth ko naconfine po kasi anak ko last oct. 11,2018. salamat sa sagot

  26. Hi Mica, yes, you’ll be able to use Philhealth. Meron kang at least 9 payments within the past 12 months. July to Nov (5 payments) plus Jan to Apr (4 payments), within the past 12 months (Dec 2017 to Nov 2018) lahat yang payments mo.

  27. Mica danielle de torres

    hello po, philhealth member po ako at buntis po ako manganganak po ako sa november 24 ask ko lng po kung valid po ba ung binayaran ko coverage April 2017-april 2018 and then july-december 2018? sana po masagot nio po ang katanungn ko . salamat po
    ang wala ko pong hulog ay may at june 2018
    kumbaga naligdangan ko po

  28. Hello po, what if member aq ng philhealth and wala pa aq contributions or payment since from the start of registration, then im pregnant and due on May 2019,what should i do to inquire coverage of maternal benefits?? Thanks very much..

  29. Hi Glenda, puede na yong Dec 2017 to Aug 2018 as your premium payment para maging eligible. 9 monthly payments yan within the past 12 months. Hingi ka from your employer ng cert of premium payments from Dec 2017 to August 2018. Ask your hospital or clinic kung saan ka manganganak para sure.

  30. Hi Rei, naka-confine pa ang mother mo? Yes, dapat eligible ang mother mo for Philhealth kasi wala pa namang Oct 1 noong na-admit, which is yong start ng requirement na 9 monthly payments. In September, 3 monthly payments pa ang required

  31. Hello po, na admit po sa ospital mother ko ngayon.
    Nagbayad po ako ng Jan to Mar. 2018 at July to September 2018.
    Kaso D po kami nkpgbayad ng April to June
    Eligible po ba kami?

  32. Hi Jie, yes, pay asap this Sep ang July to Sep, then next month, pay for Oct to Dec. Prepare your payment receipt for Jan to March, July to Sep, Oct to Dec (9 months dapat lahat yan). Yes, puedeng hindi main branch.

  33. Hello po…
    I’m 7 months pregnant po today and ang due date ko is sa December..
    Hindi po ako nakapaghulog simula ng April.. pero I’m planning po hulugan un (July-September) magagamit ko po ba un philhealth ng December kahit may laktaw ako hindi nahulugan..
    and pwede po ba bayaran ito kahit hindi sa main branch?
    Thank you..

  34. Hello po, November po ang due ko nabayaran ko na po ang Jul. 1-Sept 30 (600) pinapabalik nalang po nila ko next month para magbayad ng another 600. Ibig sabihin po ba magagamit ko na ang maternity benefit ko? Thank you po.

  35. Hi Vaness, sorry hindi puedeng gawing dependent ang kapatid sa Philhealth, so hindi mo puedeng gamitin ang Philhealth ng kapatid mo.

  36. Hi Vaness, puede mong gamitin this September kasi accepted pa ang 3 monthly payments (ask the hospital before admission), pero sa October hindi na, kasi 9 monthly payments na ang required. Kung maternity reason ito, puede mong gamitin ang “Women about to give birth program” in October; bayaran mo lang ang one year. Ask the hospital.

  37. Ano po dapat kung gawin para po makaavail ako ng philhealth , sa october ? Pwede ba gamitin ng philhealth ng aking kapatid ,ako po ay 30 years old na at sya po ay may philhealth pwede po ba gamitin ko un?

  38. Hi po example po ang philhealth ko po ay nahulugan lamang this july august september 2018 ,pwede po ba mag confine ako ngayon october ?

  39. Hi Yhel/Mae, pay asap for July Aug and Sep (600 pesos). Then sa hospital, ipakita mo yong resibo mo ng Jan Feb March, at resibo mo ng July August Sep. Ang titingnan nila, meron kang payment for March July and August (3 monthly payments). Kelangan din ang MDR mo. Kung scheduled surgery itong panggagamitan mo, tanungin mo asap ang hospital about your Philhealth prior to surgery para ready ka

  40. Cover pa din po ba ng January to March maam kung hindi na nakapag hulug April to July? Pls reply

  41. Jan feb March po kasi ko nkpag hulug ng (600) Then hndi na po ako nkapag hulug ng April May at June. Mamagmit ko po ba ngayong August yung nabayaran ko po nung Jan to March? Pls reply po. Or kelangan ko pa po magbayad ng July August September para magamit ko ngayong August Maam? Plss po

  42. Okay po maam. So pwede ko pa din po magamit yung nabayaran ko nung January – March 2018 ngayong August po? Kht hindi ako nkpag hulug ng April To July Maam?

  43. Hi Yhel, yes, use your March, July August payment. Until Sep 30, payment of 3 months within the past 6 months pa rin ang requirement. Starting Oct 1, payment of 9 months within the past 12 months na.

  44. Hi maam. Nagbayad ako Jan to March then na stop April to June. Kung mgbabayad ako July to Sept. Mggmit ko ba yun ngayong August?

  45. Hi Jenelyn, puede pang bayaran ang July Aug to Sep (600 pesos), pero nakabayad ka ba ng 6 months within Oct 2017 to June 2018? September ka ba due?

  46. Jenelyn homeres magallanes

    Hello po ako po c jenelyn homeres im 8 months pregnant…pwede po ba ako mag hulog ngayun august23.. sa philhealth.kong halimbawa po na 3 months diko po nahulogan yung phelhealth ko????

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

  48. Thank you po.

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

  50. 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?

  51. 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).

  52. 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.

  53. 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?

  54. 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

  55. 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.

  56. 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

  57. 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.

  58. 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

  59. 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!

  60. 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.

  61. 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.

  62. 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.

  63. 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

Leave a Reply

Your email address will not be published. Required fields are marked *