TFCR Say No!

TFCR (The Filipino Community in Romania) express their opposition to the PhilHealth premium increase for OFWs.

PhilHealth Cataract Package

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PhilHealth Hemodialysis Benefits

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Sulong Laban OFW!!!

A video highlighting OFW's opposition to the planned increase of OFW PhilHealth premiums.

PHILHEALTH NEWS

For less than P3.50 a day, PhilHealth vows enlarged benefits for OFWs

The Philippine Health Insurance Corporation (PhilHealth) has vowed to deliver higher benefit payments and improved services to overseas Filipino workers (OFWs) and their dependents, in return for a contribution of less than P3.50 per day, or P1,200 yearly.

“The required annual contribution stays at P1,200 this year, or less than P3.50 per day, with respect to OFWs. Their adjusted premium of less than P7 daily, or P2,400 per annum, won’t take effect until January next year,” said Dr. Eduardo P. Banzon, PhilHealth President and Chief Executive Officer.

“We are building up our capacity to provide greater value for money to our members – our customers, including OFWs. We are constantly enriching benefits and enhancing services,” Banzon stressed.

“Through enlarged benefit payments, we hope to entice a greater number of OFWs, particularly those already out of the country, to enlist as PhilHealth members,” he said.

Banzon also reiterated that OFWs may avail themselves of the annual premium rate of P1,200 should they opt to pay the full premium contribution for the next two to five years on or before December 31, 2012.

In any case, Banzon urged OFWs to pay their premiums at least for the entire duration of their job contracts abroad.

“This way, the OFW and his or her dependents will have peace of mind. They will be protected the whole time the principal PhilHealth member or family head is abroad,” he added.

At present, PhilHealth covers around 2.52 million OFWs plus 2.48 million of their dependents.

“Whether the contribution is P3.50 or P7 per day, this is really nothing much, considering that OFWs are essentially hedging themselves against unforeseen financial costs associated with sudden sickness in the family,” Banzon said.

“The amount represents a fairly small investment meant to guarantee the OFW and his or her dependents ample financial relief in the event of any ailment in the household, or even a wife’s hospitalization due to childbirth,” he said.

PhilHealth helps pay for room and board, drugs and medicines, laboratory exams, as well as operating room and professional fees for hospital confinements of not less than 24 hours. It is also covering an increasing number of outpatient services, including day surgeries and treatment of tuberculosis.

Qualified dependents of OFWs who are active PhilHealth members are entitled to a separate coverage of up to 45 days confinement per calendar year. However, the 45 days allowance is shared among all dependents.

Eligible dependents include the OFW’s legal spouse who is not a PhilHealth member, or whose membership is inactive; the OFW’s children below 21 years of age, unmarried and unemployed; and the OFW’s parents who are 60 years old and above. (END)


About PhilHealth

PhilHealth is committed to provide every Filipino immediate access to affordable health care, and adequate protection against the risk of incurring medical expenses. PhilHealth delivered over P35 billion in benefits in 2011. Established by the National Health Insurance Act of 1995, PhilHealth now covers more than seven out of every 10 Filipinos. PhilHealth is dedicated to realize President Aquino’s universal health care strategy.

About Dr. Eduardo P. Banzon, M.D., MSc.

Dr. Banzon is the sixth president and chief executive officer of PhilHealth. He is a graduate of the University of the Philippines College of Medicine, and obtained his Master of Science in Health Policy, Planning and Financing at the London School of Economics and the London School of Hygiene and Tropical Medicine. He was one-time senior health specialist at the World Bank, servicing the Philippines and other East Asian countries on health financing, services delivery and regulation. He previously served as clinical associate professor at the UP College of Medicine, and faculty member at the Ateneo Graduate School of Business. He once served as PhilHealth vice president for health finance policy services.

Good Morning Kuya - 2011/04/18

OC: Philhealth, naglagay na ng accredited foreign tie-up

OC: Migrante Int'l, inirereklamo ang premium hike ng Philhealth sa mga OFW

Duties and Responsibilities of a PhilHealth Member

The duties and responsibilities of a PhilHealth member are:

Have in possession at all times your PhilHealth Number Card or Identification Card;

It pays to be prepared in emergency situations such as accidents or illness. Members should always have their PhilHealth ID card or PhilHealth number card ready for presentation at the accredited health care provider to prevent delay in the availment of benefits.

Update your Member Data Record (MDR) for any change in personal information such as change in civil status or addition of a new dependent;

The Member Data Record is a document required during availment of PhilHealth benefits or claiming reimbursement. Members should keep the MDR up-to-date to prevent any inconsistency from being reflected in the MDR. The address in the MDR will be used to send the check payment and any other correspondence that will be issued by PhilHealth. There are instances when health care providers will require that the name reflected in the MDR be the same with their records in order to automatically avail the benefits and others such cases.

Request for a replacement in case of loss of PhilHealth Number Card or Identification Card;

This is in reference to the first discussed responsibility of a PhilHealth member where the PhilHealth Number Card or Identification Card should always be made available as this will be presented to the health care provider when undergoing an emergency admission or surgery. Members should not wait for the need to arise to get a replacement of their lost PhilHealth number card or identification card.

Ensure that you promptly and regularly pay your contributions (for individually paying members and Overseas Workers Program members) to avoid suspension of benefits;

Individually paying members should have a qualifying contributions in order to avail PhilHealth benefits. Moreover, some benefits require nine monthly contributions within a twelve month period prior confinement to avail the benefit, hence, if the member should miss payment for a given quarter or period, this will affect the availment of the benefit. This is the same with OWP members. Although OWP members are covered within their validity period and do not require qualifying contributions, continuous coverage or validity period should be ensured for uninterrupted eligibility for benefits.

For newly hired employees, check if your name is reported by your employer to PhilHealth in the ER2 Form (Report of Employee-Members);

The ER2 form is being submitted by the employers to PhilHealth which is basically a list that certifies the employees of the company. It should also be noted that the date of employment is required information that should be reflected in the ER2. The ER2 will serve as the baseline of the employer in the preparation of their monthly remittance report. Employed members should ensure that their employers have included their names in the ER2 and have properly reported it to PhilHealth as this serves as protection of the employees from employers that are not remitting their premium contributions to PhilHealth.

Ensure that your monthly premium contributions are deducted from your salary and promptly remitted and reported by your employer to PhilHealth;

Every month the employers are submitting a monthly remittance report which includes all employees and corresponding premium contributions that have been deducted. This report is used by PhilHealth to post the contributions to the employees' member accounts. Hence, employees should keep their payslips reflecting premium contribution deductions as this will serve as proof of deduction which may be presented to PhilHealth if a discrepancy in the number of contributions was found.

Report to PhilHealth at once an employer who does not remit premium payments;

Employers are mandated by law to deduct PhilHealth premium contributions and it is also the responsibility of the employer to report the members that have been deducted and how much premium contribution each employee has paid. Hence, if an employee found out that their employer is not remitting their premium payments, PhilHealth should immediately be notified so that they may coordinate with the employer.

Ensure that you have sufficient qualifying contributions to avail of PhilHealth benefits anytime;

Members should not start paying or continue payment when they are expected to use or avail PhilHealth benefits, it should be done regularly.

Secure an updated list of accredited facilities from any PhilHealth office wherein you can avail of benefits;

This is similar to the health management organizations (HMO) where they are providing a list of accredited partners in which the members may be able to go to. It is the responsibility of the member to keep in mind the available health care facilities and hospitals that they may go to in case of illness to prevent denial of PhilHealth benefits.

Others are:

• Submit a properly and completely filled-up PhilHealth Claim Form 1 to the hospital and ensure that all the information you stated in the said form are true and factual;

• Ensure that you properly and completely submit all the necessary documents to the hospital including a copy of your Member Data Record (MDR) to avail of PhilHealth benefits;

• Clarify with providers (hospital/doctor), the appropriate and final benefits deducted upon settlement of bills and charges;

• Ask for a copy of your Statement of Account/Billing Statement from the hospital upon discharge;

• Ask for an Official Receipt (OR) and Waiver from the hospital and doctor for payments made in full;

• Ensure that your claim, if opt for direct filing, is filed at PhilHealth within sixty (60) days from the date of discharge for local confinements and within one hundred eighty (180) days for confinements abroad;

• Be aware of amendments and updates on PhilHealth policies and benefits schedule;

• Seek clarification from any PhilHealth office on any unclear policy or guideline;

• Report at once to PhilHealth any hospital that fails, without valid reason, to accommodate a PhilHealth member who wishes to avail of benefits;

• Report at once to PhilHealth any fraudulent transactions that you know about;

• Observe and comply with PhilHealth rules and regulations as there are offenses in its Implementing Rules and Regulations that a member may be held liable for.

We hope that members are guided accordingly in order to prevent any negative experiences from occurring when transacting with PhilHealth.

Source: http://www.philhealth.gov.ph/forms/others/member_duties.pdf

What is a PhilHealth MDR (Member Data Record)?

Whenever you need to avail of your PhilHealth benefits, you will always be asked to provide the health care institution (hospital) a copy of your MDR to be attached to the claim forms. For those who are new to the term, an MDR, short for the Member Data Record is a system-generated document being issued by PhilHealth as a primary attachment to the Claim Form 1.

What does the MDR contain?

The document contains the member's basic information such as the PhilHealth Identification Number, full name, address (local and/or foreign), civil status, date of birth, contact information and for those employed or under the KaSAPI Program the PhilHealth number, name and address of the employer or organized group is reflected.

Aside from the basic information of the member, a list of valid dependents (with their complete name, birth date and other info) who may avail PhilHealth benefits are also displayed along with payment information for OFW members and the validity or effectivity date for sponsored members.

What is the purpose of the document?

With the release of PhilHealth Circular No. 07 s-2007, the Member Data Record (MDR) was made a primary document for claim applications which aims to:

• Reduce incidents of returned claims due to lacking supporting documents;
• Lessen claims that are doubtful in nature.

In addition to this, prior the implementation of the MDR requirement, members are required to submit supporting documents (e.g. birth certificate of dependent who was confined, marriage contract etc.) to be attached to their claim form in order to avail PhilHealth benefits. Supporting documents are necessary for PhilHealth to establish the relationship of the member and the patient or the person that was confined to prevent unauthorized usage of the member's annual 45-days allowable period. Hence, there is no need for a member with an updated MDR to attach several supporting documents to avail PhilHealth benefits as hospitals may refer to the MDR to establish the relationship of the patient to the member.

What to do if you are not able to get the document?

Although the MDR is a primary document, PhilHealth does not say that a member cannot avail benefits if this document was not provided. For those members that are unable to provide the MDR, the corresponding supporting documents must be attached to the claim forms in order to avail the benefits.

Where do you get this document?

Any PhilHealth Office (with system access) can provide or issue the MDR.

For purposes of consistency and to prevent any problems during availment of benefits, ensure that the MDR is always updated. To update your PhilHealth record refer to this post "How to Update Your Membership Record with PhilHealth".

Ontario, Canada-based OFWs PhilHealth Payment thru Mabini Express, Inc.

A PhilHealth Advisory has been issued informing the public that Overseas Filipino Workers (OFWs) based on Ontario, Canada may pay through the Mabini Express Inc., a tie-up of the Philippine Veterans Bank (PVB) with the following branches:

• Sheppard Centre (subway station)
• Location: 4841 Yonge St. Unit 133, 2nd Flr. North York Ontario (see map)
• Mabini Contact no: 416-222-1178
• Store hours: Mon-Wed (9:30am-7pm), Thu-Fri (9:30am-9m), Sat (9:30am-6pm) and Sun (11:30am-5pm)


• T & T Promenade
• Location: Prominade Circle, Thornhill Ontario M2N5X2 (see map)
• Store hours: Mon-Fri (9am-10pm), Sat-Sun (9am-10pm)


• T & T Milliken (Middlefield & Steels)
• Location: 5661 Steeles Avenue East, Scarborough Ontario M1V 5P6 (see map)
• Store hours: 9am-10pm


• T & T Ottawa (Hunt Club Rd. & Riverside Drive)
• Location: 224 Hunt Club Rd. Ottawa Ontario ON K1V 1C1 (see map)
• Store hours: 9am-10pm

The Official Receipt issued by the Mabini Express Inc. shall serve as your proof of payment for the paid applicable period. You would need to continue paying your premium contributions based on the current premium rate for the year prior end of your effectivity period. Please note that you would need to indicate your PhilHealth Identification Number (PIN). You may refer to the linked Advisory for the image of the official receipt.

Sample PhilHealth Request Letter

Due to numerous requests for a sample request letter that may be used for PhilHealth transactions, we have devised this template for requesting:

• Issuance of PhilHealth ID Card;
• Issuance of Member Data Record (MDR);
• Certificate of Premium Payment (CPP);
• Certification for lost payment receipt.

This is free to download and use, however, note that this template did not come from nor is it mandated or required by PhilHealth. The letter is in PDF format so you may need a PDF reader if your PC doesn't have one installed like Adobe Reader.

You may download the template here or click the image below.

Is PhilHealth coverage mandatory for all Filipinos?

Yes. Put another way, PhilHealth membership is compulsory.

SEC. 6. Coverage. - All citizens of the Philippines shall be covered by the National Health Insurance Program. In accordance with the principles of universality and compulsory coverage enunciated in Section 2 (b) and 2 (1) hereof, implementation of the Program shall, furthermore, be gradual and phased in over a period of not more than fifteen (15) years: Provided, That the Program shall not be made compulsory in certain provinces and cities until the Corporation shall be able to ensure that members in such localities shall have reasonable access to adequate and acceptable health care services. (underlining supplied)

Reference: Art. III, Sec. 6, R.A. 7875 

SECTION 4. Objective – It is the main objective of the NHIP to provide all Filipinos with the mechanism to gain financial access to quality health care services within the first 15 years of its implementation. Coverage of the employed members in the government and private sectors, individually-paying, retirees, and indigent families shall be ensured. (underlining supplied)

Reference: Title III, Rule 1, Sec. 4, IRR of R.A. 7875

Please note though, that membership and eligibility to avail of benefits are two different things. You may be a member, but if you are not paying your PhilHealth contributions with the required frequency, you are not eligible to avail of your PhilHealth benefits.

This applies to everyone who is employed, regardless if it is with the government or the private sector, or Overseas Filipino Workers (OFWs).

Individually Paying Members (IPMs) may or may not choose to register or pay premiums under the IPM program. If they choose not to, they are not eligible for PhilHealth benefits. It is strongly recommended that those qualified as IPMs register and pay their contributions.

Lifetime members need not pay as they are already retired and have already made at least 120 monthly contributions.

The contributions for those belonging to sponsored program are paid for by government or private entities.

For further information on who can enroll or register as a PhilHealth member, read this post.

Who can Enroll or Register as a PhilHealth Member?

This post aims to discuss the different types of membership programs of the National Health Insurance Program. PhilHealth members are divided into five (5) main categories broken down as follows:

• Employed;
• Individually Paying Members (IPM);
• Sponsored Members;
• Lifetime Members;
• Overseas Filipino Workers.

The Employed category are basically those individuals that are employed either in a private or government institution and are therefore further classified into Private/Government. Individuals under this category are enrolled in PhilHealth through the employers in compliance with the law.

Individuals that are classified under the Individually Paying Member (IPM) are those that are directly paying their premium contributions to PhilHealth and belong to either of the cases below. Participation under this scheme is voluntary.

• Professional individuals are those whose professions are included in this list;
• Non-professional individuals which include individual farmers and fisherfolk;
• Individuals who are separated from work;
• Parents not qualified as legal dependents, sponsored members or lifetime members;
• Children not qualified as legal dependents;
• Unemployed individuals not qualified as a sponsored member;
• Citizens of the Philippines residing in other countries;
• Citizens of other countries (foreigners) residing/or working in the Philippines.

Sponsored members are those who are being paid for by local government units, government agencies or private institutions which fall under the implementation of the government subsidy program. Members under this category are usually covered on a yearly basis. Availment of PhilHealth benefits depends on the effectivity or coverage period as reflected in their membership.

Lifetime members generally covers retirees/pensioners who have reached the retiring age as defined by law and have met the required 120 monthly PhilHealth premium contributions. Individuals under this classification no longer need to be paying members in order for them or their dependents to avail of PhilHealth benefits.

Overseas Filipino Workers (Land-based) were previously under the IPM category. Due to the differences in the needs of the members under this category and the efforts with which these were addressed, PhilHealth decided to separate the monitoring and evaluation of those individuals who are working out of the country, hence a separate category was created. OFWs are required to enroll and pay a one-year premium contribution prior to leaving the country and to continue being an active member, OFWs would need to pay continuously to the program after the expiry of the one-year coverage.

Reference: Title III-Section 5 of the Implementing Rules and Regulations of the National Health Insurance Act of 1995

Paid PhilHealth for the first time, can I use it immediately?

No.

Addendum: Unless you're an OFW.

Is Philhealth a mandatory requirement for working abroad?

Yes.

Is it important?

Yes.

Are all OFWs happy about this?

Apparently, no.

Proofs of Payment recognized by PhilHealth and Accredited Health Providers

This post serves to remind  members of the National Health Insurance Program the proofs of payment  recognized by PhilHealth and accredited health care facilities. For one thing, the PhilHealth Premium Payment Slip (PPPS) is NOT recognized as an official receipt. Below is the list of proofs of payment that may be presented to the health care facilities when required.

Individually Paying Members

• For the Remittance-by-Air (payment through mobile phone) facility, printed proof of payment from PhilHealth website or Certificate of Premium Payment issued by PhilHealth;
• Duly validated Bayad Center Payment Form;
• Certificate of Premium Payment issued by PhilHealth (for Organized Groups);
  
• Certificate of Premium Payment issued by PhilHealth (for KaSAPI members);
• Duly validated LBC Bills Express Payment Receipt;
• Duly validated LBC Bills Express Collection System Acknowledgement Receipt;
• MLhuiller Sendout Form (for online transactions);
• MLhuiller Sendout Form Remote Transaction (for offline transactions);
• MI-5;
• PhilHealth Agent's Receipt (PAR);
• PhilHealth Official Receipt (POR).

Overseas Filipino Workers (OFWs)

• Duly validated Remittance Forms of Development Bank of the Philippines tie-up ENJAZ, Philippine Veterans Bank tie-up BTI Money Transfer Pte., Ltd. and iRemit Singapore Pte Ltd.;
• DBP Remittance Center HK Ltd. Official Receipt;
• OEC Receipt of POEA;
• PhilHealth Official Receipt (POR);

Employed Members

• Duly validated LBC Bills Express Payment Receipt;
• Duly validated LBC Bills Express Collection System Acknowledgement Receipt;
• MLhuiller Sendout Form (for online transactions);
• MLhuiller Sendout Form Remote Transaction (for offline transactions);
• ME-5;
• PhilHealth Agent's Receipt (PAR);
• PhilHealth Official Receipt (POR);

This information was taken from the  Advisory of PhilHealth dated April 03, 2011. Click here to view the Advisory and the images of the honored proof of payment. Make sure that the information such as your name, PIN, applicable period of payment, date and amount reflected in your payment receipts are correct.

Avail PhilHealth Benefits for Confinements Abroad

Here are some things you need to know in order to avail PhilHealth benefits for confinements abroad. This is applicable to OFWs, lifetime, individually paying and employed members of the NHIP.

Documentary Requirements

• PhilHealth Claim Form 1 (signed by member or authorized representative);
• Member Data Record (MDR) or supporting documents;
• Proof of applicable premium payments;
• Original official receipts for hospital, doctor, medicines and services (in English);
• Statement of Account with itemized charges (in english) should reflect rates for room and board, medical supplies, laboratory procedures, operating room fee and others;
• Medical Certificate (indicating final diagnosis, confinement period, services rendered in English).

Things you need to know:

• Claim should be filed within 180 days upon discharge in any PhilHealth Regional and Branch Offices;
• You will be paid equivalent to the level 3 hospital benefit rates;
• You may still file for PhilHealth reimbursement even if your employer abroad has a health insurance benefit;
• If you are unavailable to sign or submit your claim application for reimbursement, the person/s below may act as your representative. The members should provide an authorization letter (indicating your name and name of your authorized representative), and a photocopy of two (2) valid IDs of both the member and representative. PhilHealth might require your representative to present the original ID for authentication purposes.
• Spouse;
• Children 18yrs and above;
• Parents for unmarried member;
• Brother / Sister / Guardian;
• Other individuals as duly authorized representative.
• You may verify the status of your claim application by emailing philhealth_hk@philhealth.gov.ph or calling +63 917 5129149 for OFW members or 441-7442 and info@philhealth.gov.ph for non-OFW members. In your inquiry state the following information:
• Patient's complete name;
• Date of confinement;
• Hospital information.
• If you wish to name the cheque to your spouse you would need to submit a Special Power of Attoryney (SPA) or a letter authorizing PhilHealth to use the name of your spouse for the cheque with attached two (2) valid IDs of you and your spouse and Marriage Contract.

For other information visit these links:

• OFW benefits
• FAQs Benefit Availment related
• Individually Paying Member benefits

How to Update Your Membership Record with PhilHealth

In our previous post, we discussed about the instances on when to update our membership record with PhilHealth and its importance. Here we will discuss the procedure and required documents to update your membership record.

Steps in updating your member record:

1. Fill-out the PhilHealth Membership Registration Form (PMRF);
2. Submit the PMRF with attached supporting documents to any PhilHealth Office near you;
3. Validate that the changes requested have been correctly reflected in your newly released Member Data Record (MDR);
4. For correction/change in your name, ensure that you are issued a new PhilHealth ID Card (PIC) reflecting the corrected/updated name.

Accomplishing the PMRF:

• Accurately write your PhilHealth Identification Number (PIN) in the form;
• Put a check mark in the "For Updating" under the PURPOSE;
• Write your name and date of birth. This will be used by PhilHealth to verify the member record retrieved using the PIN. If purpose is for correction of your name, write your correct name;
• Write the necessary information that you would need to update or correct, there is no need to provide all the information in the form. If you are going to update your address, just write in the address portion, to register new dependents, just write your dependent's information and so on;
• Affix your signature and write the date the form was accomplished.

Documents that are normally being required:

• ID card/s issued by a government official authority;
• Birth Certificate for correction on member's/dependent's name or date of birth and/or for declaring of new dependents;
• Marriage Certificate or Contract / Affidavit of Marriage issued by Office of Muslim Affairs to update your civil status, change your last name (for females) and/or to declare your spouse as a dependent.

Other documentary requirements can be found in the second page of the PMRF.