Philhealth Circular No. 0012 (2013)
REITERATION OF GUIDELINES FOR INDIVIDUALLY PAYING PROGRAM (IPP) COVERAGE RELATIVE TO PHILHEALTH ADVISORY ON DEFERMENT OF INDIVIDUAL POLICY CONTRACT (IPC) ISSUANCE
(NAR) VOL. 24 NO. 2 / APRIL - JUNE 2013
[ PHILHEALTH CIRCULAR NO. 0012, S. 2013, June 03, 2013 ]
REITERATION OF GUIDELINES FOR INDIVIDUALLY PAYING PROGRAM (IPP) COVERAGE RELATIVE TO PHILHEALTH ADVISORY ON DEFERMENT OF INDIVIDUAL POLICY CONTRACT (IPC) ISSUANCE
I. RATIONALE AND OBJECTIVE
PhilHealth Advisory No. 03-04-2012 announced the deferment of Individual Policy Contract (IPC) issuance in response to the need for further program enhancements. As such, not all Individually Paying Members (IPMs) have been issued the IPC. In order to guide the frontline offices and avoid confusion in operational approach brought about by new policy developments, the following guidelines are hereby reiterated for uniform implementation.
II. COVERAGE
This Circular applies to the Individually Paying Members of the National Health Insurance Program (NHIP). Excluded are active IPMs under the iGroup Program.
III. IMPLEMENTING GUIDELINES
A. Premium Rate Per PhilHealth Circular No. 57, series of 2012, calendar year 2013 annual premium rate for all IPMs earning Twenty-Five Thousand Pesos and below monthly shall be at One Thousand Eight Hundred Pesos (PhP1,800). Beginning January 1, 2014, the new premium rate of Two Thousand Four Hundred Pesos (PhP2,400) per annum shall be required while premium rate for self-employed professionals and IPMs earning more than Twenty-five Thousand Pesos per month remains at Three Thousand Six Hundred (Php3,600) per annum. Exclusion to the new premium rate rule are all IPMs covered under the May- June 2012 2-year lock-in promo per PC 20, series of 2012. The old rate computation or One Thousand Two Hundred pesos per annum shall be the applicable basis for their second year premium.
B. Varying application for IPC holders and non-IPC holders Policy IPC Holder Non-IPC Holder ApplicationMode of Monthly, Quarterly, Quarterly, Semi-annual, Payment Semi-anual, Annual Annual Quarterly: Last working day of the quarter being paid for Semi-Annual: Last working day of the Deadline of PC 61, s. of 2012 first quarter of the Payment Prior to the applicable period semester being paid for Annual: Last working day of the first quarter of the year being paid for Penalty None None Premium Valid Option 2 Option 1 requirement Years 1. PhP1,800/annum 1 Full payment Remaining computation for CY 2013 at 9 months for IPMs earning P1,800/annum of CY PhP25,000 and below per multiplied by 2013 month the number of computed years fully under the 2. PhP 3,600/annum paid (max 3 P1,800 computation for CY 2013 years) premium and onwards for IPM-rate Professionals and those 2 Remaining earning more than 6 months Twenty-Five Thousand Or Full of CY Pesos per month payment of 2013 P3,600/annum computed 3. Php 2,400/annum multiplied by under the computation for CY 2014 the number of P1,800 and onwards for IPMs years fully premium earning P25,000/month or paid for rate. below Professional Remaining IPMs and CY 2014 those earning computed more than under the PhP25,000 P2,400/ an per month new (max 3 years) premium rate 3 Remaining CY 2014 and CY 2015 computed under P2,400 premium rate per annum Advance For IPMs with 1 year IPC validity, Advance payments Payment CY 2014 and CY 2015 computed applicable for CY 2014 under the PhP P2,400 shall be and onwards shall be premium rate per annum allowed and shall becomputed based on the PhP2,400/annum For IPMs with 2 or 3 years IPC The P1,800 premium validity premium computation computation shall apply shall be based on the current year for CY 2013 only applicable rate. E.g. If IPM (2-yr IPC) pays the CY 2014 premium in CY 2013, it shall be computed under the PhP1,800 rate. IPM with 3-yr IPC may also pay CY 2014 and 2015 computed under the P1,800 premium/annum if paid in CY 2013 C. Benefits Availment i. IPC holders shall enjoy the 3/6 minimum eligibility requirement in all types of confinements except for Case Type Z as provided by PC 61, series of 2012.
ii. IPC holders of 3-year validity contracts shall continue to enjoy automatic availment of Case Type Z.
iii. Case Type Z eligibility requirements for non-holders of 3-year IPC shall be based on new policies to be issued applicable to IPMs.
iv. IPC holders may present their IPC and PhilHealth Official Receipt, if applicable, or the enhanced MDR reflecting Policy Validity period and applicable premium payments to cover minimum eligibility requirements.
v. All PhilHealth Offices and accredited health care providers shall ensure non-disruption of benefits eligibility of IPC holders according to the policies provided under PC 61, s. of 2012.
D. IPC holders paying at Accredited Collecting Agents (ACAs) i. Only IPMs presenting an IPC or registered in the IPC module shall be allowed the monthly premium remittance. Non-IPC holders’ premium schedule shall be maintained as stated in III.B.
ii. IPMs shall be advised by frontline offices to present their IPC when transacting with ACAs.
IV. EFFECTIVITY
This Circular shall take effect immediately. All issuances that are inconsistent with the provisions of this Circular are deemed superseded.
(SGD.) ENRIQUE T. ONA Secretary of Health/Chairman of the Board and OIC-President and Chief Executive OfficerSource: Supreme Court E-Library