Question & AnswerQ&A (PHILHEALTH CIRCULAR NO. 28, S. 2010)
The main purpose is to mandate the automatic enrollment of retiring employees who meet certain conditions into the Lifetime Member Program (LMP) of PhilHealth, ensuring their continued health insurance coverage after retirement.
The retiring employee must have reached the legal age of retirement and must have paid at least 120 monthly PhilHealth contributions.
The employer, specifically through its Human Resource Management Office or authorized representative, is responsible for facilitating the enrollment of the retiring employees into the LMP.
Enrollment must be facilitated at least three (3) months prior to the employee’s date of retirement, and the application should be filed as soon as the employee’s retirement application has been approved by the employer.
The required documents include: two copies of the duly accomplished PhilHealth Member Registration Form (PMRF), two 1x1 recent photographs, certified copies of the employee's birth certificate or two alternative documents, approved retirement applications, and either employer certification of contribution history for private sector employees or service record and employer certification of contributions for government employees.
Contributions made with previous employers or under other PhilHealth program categories are included in the computation to reach the required 120 monthly contributions, provided that proof of payment or certification with official receipt numbers is submitted.
The employee must continue their membership coverage as an Individually Paying Member until reaching the legal age of retirement, after which they can enroll in the Lifetime Member Program.
They must ensure that the retiring member receives their Lifetime Member ID card and Member Data Record (MDR) on or before the last day of their service.
Section 12(b), Article III of Republic Act 7875 provides the legal basis stating members who have reached retirement age and paid at least 120 monthly contributions need not pay anymore to be entitled to PhilHealth benefits.
The Circular took effect fifteen (15) days after its publication in a newspaper of general circulation.