Tripartite Manifest of the PMA, PHAP, PHA on PhilHealth Circular 011-2011

Letter of PMA, PHAP, PHA to PhilHealth re: No Balance Billing

Availing PhilHealth Benefits for Direct Filing of Claims

Eligibility for Direct Filing:

• You have paid the hospital and doctor's fee in full (without PhilHealth benefit);
• You have the required number of premium payment (for employed and individually paying members) or date of availment is within your membership coverage (for sponsored and ofw members). Lifetime members are eligible to avail PhilHealth benefits and need not pay premiums;
• The hospital/facility is accredited from the time of confinement/admission;
• The doctor is accredited from the time of confinement/admission.

Documents Required to Submit:

• Fully accomplished and original PhilHealth Claim Form 1;
• An updated Member Data Record (MDR) or required supporting documents;
• Waiver from the Hospital and Doctor/s specifying fees are paid in full;
• Official Receipts from drugs/medicines (purchased within confinement period), laboratory procedures, surgical procedures, hospital bills and doctor's fee;
• Fully accomplished and original PhilHealth Claim Form 2 (to be provided by the hospital/facility);
• Fully accomplished and original PhilHealth Claim Form 3 for confinement in primary hospitals or availment of maternity benefit;
• Operative record (if applicable);
• Hospital Statement of Accounts which contains breakdown of charges;
• Authorization or Special Power of Attorney (SPA) for transactions made through an authorized representative (immediate family member).

The Hospital may request for you to submit all receipts to prepare the PhilHealth Claim Form 2. Just provide them a photocopy of the documents they would need and do not give the original. Be sure to go back to the hospital to retrieve the Claim Forms and then submit the form and corresponding required attachments to the PhilHealth Office assigned to the area of the hospital. This should also be filed within 60 days from date of discharge. Ensure that the PhilHealth Claim Form 2 waiver portion for full payment is accomplished by the Hospital. You will need this to be reimbursed.

For inquiries on the status of your claim, you may call PhilHealth's call center or the PhilHealth Office - Claims Department.

Issuance of PhilHealth ID Cards and MDR to Employed Members

An official advisory has been released by PhilHealth informing the public that transactions for members belonging to the Private and Government Sectors should be facilitated by their respective Human Resource Departments (HRD).

Employees that are not yet registered with PhilHealth and those without PhilHealth Identification Numbers (PIN) should submit a fully accomplished PhilHealth Membership Registration Form (PMRF) with attached supporting documents:

• Clear copy of employee's birth certificate/baptismal certificate or one (1) valid ID;
• Clear copy of legal supporting documents of declared dependent/s such as birth certificate, marriage certificate and others as necessary.

Submit all the requirement to the HRD of the company you are in. They will in turn submit the documents together with the ER2 (Employer-Employee List) to PhilHealth. PhilHealth in turn will process your documents and forward your PhilHealth ID Card (PIC) and Member Data Record (MDR) to your office's HRD for distribution.

New employees whether newly employed or transferred who are existing PhilHealth members would just need to inform their current employer of their PhilHealth Identification Number (PIN) for the preparation of the Monthly Employer's Remittance Report (RF-1).

Source: PhilHealth Advisory No. 08-01-2011

One Dream. One Card.

Privileges Covered Under the I-PhilHealthy Card

In our previous post, we have not mentioned the details on the privileges that an I-PhilHealthy Card holder may get. This is because the privileges will expand as PhilHealth continues partnering with other private establishments to offer the members additional services through their tie-ups.

This post will enumerate the existing tie-up establishments and the corresponding privileges that they are offering to active PhilHealth members.

The I-PhilHealthy Card may be used in any of the following establishments:

• Watsons Personal Care Stores Phils. Inc.
• 15% discount for unbranded generic medicine products (both OTCs and prescription medicines);
• 10% discount on Watson's branded cosmetics;
• 10% discount on compliance packs;
• 5% discount on medical devices;
• 50-60% discount on Qualifirst products (*no minimum purchase required);
• Php380.00 flu vaccine (includes administration).
• Fresenius / FMC Renal Care Corp
• Reduced price of Php4,000.00 from Php6,700.00 for hemodialysis (in 18 outlets in Luzon and Visayas).
• PQ Healthshield
• 20% discount on vaccines.
• Rose Pharmacy Inc.
• 15% discount for unbranded generic medicines (both OTCs and prescription medicines);
• 5% discount for medical supplies and devices;
• 50-60% discount on Qualifirst branded generic drugs/medicines.
• South Star Drugstore
• 15% discount for unbranded generic medicine products;
• 5% discount for medical supplies and devices;
• 50-60% discount on Qualifirst branded generic drugs/medicines.
• Vivian Sarabia Optical Corp. (available at SM City North EDSA, Cubao, Megamall and Mall of Asia)
• Free eye exam;
• 20% discount for lenses and frames
• JNW Drug Testing Inc.
• 10% discount on drug testing services (at J & W sites)

Aside from the list of establishments where the I-PhilHealthy Cards may be used, below are the other partners that are helping in the implementation of the project.

• Qualifirst Health Inc.
• 50-60% discount on Qualifirst branded generic drugs/medicines through Watson's Personal Care, Rose Pharmacy and South Star Drugstores at no minimum purchase requirement.
• GlaxoSmith Kline (GSK)
• Provides Php380.00 flu vaccine (includes administration)
• Globe
• Provides text blasts;
• Use of LEDs in NCR;
• G-Cash premium payment.
• Smart Communications
• Provides text blasts;
• Inclusion in the SHINE project.
• United Laboratories, Inc.
• Shoulder the cost of Senior Citizen's Card.
• SM outlets
• Provides registration and collection services available in 307 sites nationwide.
• Bayad Centers
• Provides registration and collection services available in 1,067 sites nationwide.
• Prime IT Source
• Provides mobile and onsite registration services by schedule.
• e-Soluzione
• Provides e-premium cards;
• Mobile phone registration services;
• Dependent's ID Card;
• PhilHealth Sabado (remittance-by-air).
• All Cards Plastic Philippines
• I-PhilHealthy Cards for principal members.
• 1abx
• Provides point-of-sale (POS) machines for all merchants and phased-in implementation for providers.

Watch out for more partnering establishments to be included in this post.

PhilHealth Case Payment - The Hemodialysis Package

Another package offered under the Case Payment Scheme is the Hemodialysis Package for a total of Php4,000.00 with Php500.00 professional fee for every treatment inclusive in the package.

Coverage of Hemodialysis

• Covers all outpatient hemodialysis procedures with RVS code 90935;
• Includes payment per session for:
• Facility use and hemodialysis machine;
• Drugs and medicines (0.9% sodium chloride, heparin, bicarbonate or acetate hemodialysis solution, e-cart drugs and epoetin alfa or beta);
• Supplies and others (fistula kits, blood tubing set, dialyzet. syringe, and gauze).

Excluded in the package will be paid for through the fee-for-service scheme such as:

• Hemodialysis performed during hospital confinement;
• Other renal replacement therapy (e.g., CAPD, automated peritoneal dialysis);
• Emergency dialysis procedure for Acute Renal Failure (e.g., ARF secondary lo leptospirosis);
• Creadon of fistula for hemodialysis.

Source: PhilHealth Circular No. 011-B-2011

PhilHealth President Rey Aquino on Headstart

Getting the Fully Loaded PhilHealth Card with Privileges

It's all in the news. PhilHealth has recently launched its new PhilHealth card launched last September 5, 2011 at SM MOA. This card is packed with privileges in the form of discounts and other incentives offered by partner establishments. The new card known as the I-PhilHealthy Card is the first project under the Public Private Partnership Scheme that will be implemented by PhilHealth. Under this scheme, PhilHealth may engage in partnerships with private establishments or merchants which are interested in offering their services or providing product discounts and other incentives to PhilHealth members. Through this, PhilHealth members need not be confined, admitted or undergo surgery to avail PhilHealth benefits as they are able to avail the privileges offered by partner merchants.

Aside from the added value of the I-PhilHealthy Card, PhilHealth has also used this opportunity to facilitate and provide an easier means of enticing and getting new members into the program through the services of partner registration sites. With this, PhilHealth has enhanced public accessibility through the increase in the registration sites and collection windows towards the goal of universal coverage.

The PhilHealth ID Card and the I-PhilHealthy Card

The difference between the PhilHealth ID Card and the I-PhilHealthy Card is not only on the material used for the card. As shown in the illustrations of the card, the PhilHealth ID card can be considered a valid ID card due to the presence of the cardholder's picture not present in the I-PhilHealthy Card. The I-PhilHealthy Card is similar to the old card released by PhilHealth known as the PhilHealth Number Card (PNC) which only contains the PhilHealth Identification Number (PIN) and the name of the member. The I-PhilHealthy card is made up of PVC material, has a magnetic stripe and displays additional information such as the date of birth and sex of the cardholder.

Will the I-PhilHealthy Card replace the PhilHealth ID Card? The answer is no, PhilHealth will still be issuing the PhilHealth ID Card to its members who will request for it and both cards can be used in availing PhilHealth benefits. The I-PhilHealthy card is optional, meaning it is the choice of the member to obtain the card to avail the added value of being a PhilHealth member. Moreover, obtaining a PhilHealth ID Card is issued free of charge and applying for an I-PhilHealthy Card will have entail a minimal cost that will be borne by the member.

Who can avail of the I-PhilHealthy Card?

• Non-PhilHealth members. Individuals interested in becoming a PhilHealth member may obtain an I-PhilHealthy Card upon registration and a one (1) quarter payment of premium contribution. Employed individuals who have not yet been issued their PhilHealth number may also obtain the card through registration with PhilHealth;

• Existing members. Existing members (those who already have their PhilHealth numbers) in any category (private and government employees, OFWs, individually paying members, sponsored members and lifetime members) may obtain an I-PhilHealthy Card. Sponsored members should likewise apply for the card within the validity of their PhilHealth membership. Lifetime members shall be issued a "PhilHealth Gold Card" as provided by Unilab having the same privileges as that of the I-PhilHealthy Card.

• Dependents. All valid declared dependents may also obtain their own card. It should be noted that the available/offered privileges and discounts can only be enjoyed by the principal members, however, the dependent card can be presented to accredited health care facilities when availing PhilHealth benefits. A different material will be used for a dependent's I-PhilHealthy card which is somewhat similar to the material used in LRT and MRT cards.

Where to register/obtain the I-PhilHealthy Card?

• All SM outlets;
• All CIS Bayad Centers;
• Mobile and onsite registration through partnership with Prime IT Source.

The I-PhilHealthy Card is not available in any PhilHealth office, hence, you would need to go to any of the above registration sites.

As for mobile and onsite registration, members enrolled through this registration scheme will immediately be issued their corresponding I-PhilHealthy Card and members will be introduced to the National Health Insurance Program (NHIP) through the Information and Education Campaign being conducted. You may coordinate with your local barangays for the schedule of the PhilHealth onsite registration. We will also try to post or tweet the schedule if available. Moreover, you can request for an onsite registration by coordinating with the Marketing and Collection Department (MCD) or the International & Local Cooperation Department (ILCD) of PhilHealth Central Office or through the PhilHealth Regional offices.

In addition, for existing PhilHealth members, the registration sites above will not process any amendment or changes to your membership record such as correction in your name or date of birth or change in civil status. They shall only be processing addition of your declared dependents. You would need to go to any PhilHealth office for this. Hence, if there are any discrepancy found in the information you have provided upon application and the information provided by PhilHealth, your transaction cannot be processed by the registration site. You would need to first correct or update your record with PhilHealth. So to prevent this from happening, ensure that you have an updated PhilHealth record before you apply for the I-PhilHealthy Card.

The SM outlets and CIS Bayad Centers are also accepting collections or payments of your premium contributions particularly for individually paying members. They shall be accepting card and registration applications starting on September 16, 2011 within NCR and the rest of the branches will follow. You may ask directly with the SM and Bayad Centers nearest you for their exact implementation schedule.

What documents are needed to apply for an I-PhilHealthy card?

• Non-PhilHealth member. Unemployed and employed members not yet registered with PhilHealth (those without PhilHealth numbers) will be required to submit a fully accomplished PhilHealth Membership Registration Form (PMRF) with attached supporting documents for the principal member and declared dependents. Required documents are listed in the 2nd page or back page of the PMRF. For employed non-PhilHealth members, attach an ER2 to be provided by your employer;

• Existing Members. Existing members should submit an accomplished PMRF (write your PhilHealth number, name and date of birth along with the information of your dependents that will be issued their dependent card) with attached supporting documents for newly declared dependents. You can read our post on who can be declared or recognized as a valid dependent. For employed or individually paying members, photocopy of existing PhilHealth ID Card (PIC) or PhilHealth Number Card (PNC). In lieu of the PhilHealth card you may submit a photocopy of any valid ID. For OFWs, bring photocopy of your existing PhilHealth ID Card or e-receipt, a Member Data Record (MDR). OFWs may also apply for the card through authorized representatives (next of kin), just in case provide an authorization letter. For members under the lifetime membership program (pensioners, retirees and others), bring a photocopy of your Lifetime Membership Program Card. For sponsored members, bring photocopy of your PhilHealth ID Card (with effectivity);

Bring the original documents and IDs to be presented to the registration sites, however, you will only be required to submit the photocopies / xerox copies.

How much will be the cost for the Card?

• Non-PhilHealth member. New registrants shall pay a total of Php360.00 when applying in SM outlets (distributed as Php50.00 for registration and card fees, Php300.00 for one quarter payment and Php10.00 collecting fee) or Php358.00 in CIS Bayad Centers (comprising of Php50.00 for registration and card fees, Php300 for one quarter payment and Php8.00 collection fee);

• Existing member. Existing members with active coverage or payments only needs to pay the Php50.00 registration and card fees. However, inactive or non-paying PhilHealth members may also pay their premium contributions in the registration sites plus the corresponding collection fee;

• Dependents. When the principal member applies for the card, two (2) of his/her dependents will be issued their own I-PhilHealthy Card free of charge. The member may opt to provide all his/her declared dependents with their individual card in excess of the two free dependent cards for a corresponding fee. We will be posting the fee once the official advisory comes out.

How to use the I-PhilHealthy Card

There is no need to activate the card and the member is eligible to avail the privileges as long as the member is actively or regularly paying the corresponding premium contributions. The I-PhilHealthy Card of the principal member can be used to avail privileges in the form of discounts or incentives offered in any partner merchants.

Discounts offered is not on top of the 20% Senior Citizens Discount, hence Lifetime Members should choose which discount to use when transacting with the partner establishments.

The partner merchants may require you to present a valid ID when availing the privileges to ensure your identity.

Who are the partner merchants / Where can you use the I-PhilHealthy Card (a separate post will be provided to list all services and privileges being offered)

• Qualifirst Health Inc.;
• GlaxoSmith Kline;
• United Laboratories, Inc.;
• Watsons Personal Care stores;
• Fresenius/ FMC Renal Care Corp.;
• PQ Health Shield;
• Rose Pharmacy Inc.;
• South Star Drugstore;
• Vivian Sarabia Optical Corp.;
• J&W Drug Testing, Inc.;
• SM outlets;
• CIS Bayad Centers;
• Prime IT Source;
• e-Soluzione;
• 1abx;
• All Cards Plastic Philippines;
• and more to come...

Mechanics in Applying for an I-PhilHealthy Card

• The member will go to any registration site and submit the needed documents;
• The Partner Registration Facility (PRF) shall verify the completeness of the documents;
• The PRF shall encode all needed information from the PMRF into the system;
• The PRF will ask you to confirm correctness of encoded / retrieved information. For existing members, you will be informed to coordinate with PhilHealth if there is any discrepancy found in your record. The discrepancy should first be resolved in order to be issued an I-PhilHealthy Card;
• Once member information is confirmed the PRF will generate a PhilHealth number and encode the two dependents, generate a PhilHealth number for the dependents for the issuance of their own free dependent cards. You may ask the PRF to encode more than two dependents for issuance of the PIN and dependent card at a given cost;
• The PRF will provide a claim stub for the claiming of the I-PhilHealthy Card. The stub also contains the date when the card can be picked-up which is at least two (2) weeks from the date of your application. The I-PhilHealthy Card can be claimed at the site where you have registered or lodged an application;
• The PRF will forward unclaimed cards after one year of issuance to corresponding PhilHealth branches. Hence you would need to coordinate with the PhilHealth Office to claim your I-PhilHealthy Card. Call any PhilHealth office near your area on what branch you can claim the card. PhilHealth might also mail the card based on the address in your membership record.

Replacement of Lost / Stolen Card

• Submit an Affidavit of Loss, a request letter for replacement and the documentary requirements for existing members. You will be required to pay for the Php 50.00 registration and card fee and may claim the replacement card at the registration site you have filed your request.

In our personal opinion, since the I-PhilHealthy Card might not be considered a valid ID card by other institutions or establishments due to the unavailability of the cardholder's picture, it is therefore recommended that you hold onto or request for a PhilHealth ID Card. This is especially recommended for those individuals who do not own an ID card since they will need one for transacting with PhilHealth or encashing of check payment issued by PhilHealth (for directly filed claims).

As PhilHealth has not yet released an official advisory or Circular on these, the information contained here will be updated based on the final information release from PhilHealth. So keep checking back on this post for updates.

New PhilHealth Card

For info on the new I-PhilHealthy Card, read our post here.