What is Sufficient Regularity of Premium Payment?

Sufficient Regularity is defined as "payment of premium contribution of at least nine (9) months within the twelve (12) month period immediately prior to the month of availment" as cited in Section 3-iii of the Revised Implementing Rules and Regulations of PhilHealth. Now what does this mean for us NHIP members particularly since the release of PhilHealth Circular No. 25 s-2010?

• Who are covered by PhilHealth Circular No. 25 s-2010?
NHIP members under the Individually Paying Program and Employed members are covered in this circular. Availment of members belonging to the sponsored program and OFWs will still be based on their effectivity period defined by the date of coverage or payment. OFWs are covered for one year starting with the date of their payment while sponsored members have their corresponding one year NHIP coverage period. Lifetime members no longer have this eligibility criteria as they are no longer considered as paying members of the NHIP.

• What does this have to do with availment of benefits?
This now indicates that before the date of your or your dependent's admission, you should have nine (9) months contribution within a twelve (12) month period. Members covered in this Circular that do not meet this requirement will not be able to avail of PhilHealth benefits.
• How does this relate to our payment of premium contributions?

• Premium payment paid on or during the confinement period will be credited to the succeeding applicable period. Example, if the date of confinement/availment is on March 13, 2011 then payment for the first quarter (1st Qtr) should be made before March 13, 2011 so that the amount shall be credited to the first quarter. If payment was made on March 13 or during the confinement period, the payment will immediately apply to the 2nd Quarter. In short, pay your premium contribution before the date of your or your dependent's admission.

• For payments under the rules of sufficient regularity, payment should be made on the last day prior to confinement or availment of benefits in order to be considered or credited to the quarter being paid. This simply means no retroactive payments on the start, during or after the confinement/availment date will be allowed previously permitted under Section 7 of PhilHealth Circular No. 24 s-2003.

• All benefits shall be covered under this eligibility criteria including treatment or out-patient benefits.

The nine (9) over twelve (12) months contribution eligibility criteria shall take effect starting on July 2011 admission / treatment date. For additional information or clarification you may refer to the PhilHealth Circular No. 25 s-2010 or you may coordinate / inquire with PhilHealth's call center or the nearest PhilHealth office.