Question & AnswerQ&A (PHIC PHILHEALTH CIRCULAR NO. 25)
An Individually Paying Member (IPM) must have paid at least three (3) monthly premium contributions within the immediate six (6) months prior to the first day of availment to be eligible for Medicare benefits.
The suspension of eligibility to benefits for IPMs who fail to pay their premium contributions starts on the second month of the quarter following the missed or unpaid period.
IPMs are required to submit as proof of payment and eligibility any of the following: a machine validated MI-5, machine printed receipt, Government Official Receipt, or bank receipt representing at least three monthly contributions within the immediate six (6) months prior to the month of availment.
The Circular takes effect immediately and covers all claims filed by IPMs starting February 2, 2001.
Yes, the suspension of eligibility to benefits applies to IPMs and their dependents.
Section 46-b entitled "Entitlement to Benefits" is referenced, which mandates the payment of at least three monthly premium contributions within six months prior to availment.
Claims filed during the suspension period starting on the second month after the unpaid period shall be suspended and need not be referred to the Claims Review Unit for consideration.
No, all other provisions of PhilHealth Circular No. 09, s. 2001 that are consistent with this new Circular remain in full force and effect.
Francisco T. Duque III, M.D., M.SC., President and CEO, signed the circular.
It defines the time frame within which IPMs must have paid their three monthly premium contributions to be considered eligible to avail of Medicare benefits.