Question & AnswerQ&A (PhilHealth Circular No. 032-2014)
The provisions are mandated by Republic Act No. 7875 as amended by RA 10606, known as the National Health Insurance Act of 2013.
The Circular covers paying PhilHealth members from the Formal Economy and Informal Economy sectors, excluding land-based Overseas Filipino Workers (OFWs).
A member must have paid premium contributions for at least three (3) months within six (6) months prior to the first day of availment.
No, payments made on the admission date, during confinement period, or after discharge shall NOT be counted as qualifying contributions except as otherwise declared by PhilHealth.
Only monthly payments made prior to the first day of availment will count as qualifying contributions for benefits entitlement.
Exceptions include dependents (children turning 21 enrolling immediately under Informal Sector), spouse opting as a Primary Member, newly hired dependent employees, sponsored members continuing coverage, members with seasonal employment recently terminated, and OFWs who paid within the calendar quarter following last coverage.
It took effect for all admissions starting January 1, 2015.
Children who turned 21 and immediately enrolled under the Informal Sector by paying premiums within the quarter of their birth month are exceptions to payment during admission counting as qualifying contributions.
Yes, specifically those whose sponsor has not signified intention to continue coverage and have paid the first quarter contribution for the year 2014.
Section 12 pertains to entitlement to benefits, which this Circular implements consistently by clarifying the qualifying contributions requirements.