Question & AnswerQ&A (Republic Act No. 11286)
The purpose of this Circular is to prescribe specific guidelines and procedures for the just, reasonable, and speedy adjudication of claims for reimbursement of hospitalization expenses of active Philippine National Police (PNP) personnel arising from service-connected illnesses and/or injuries.
Active PNP Personnel refers to the Uniformed and Non-Uniformed Personnel of the Philippine National Police.
A Police Operations Casualty is any PNP personnel who is either killed, wounded, or sustained injury due to anti-criminality, counter-insurgency, counter-terrorism, and police community operations, including duties such as law enforcement, crime prevention, ensuring public safety, and rescue operations during calamities.
The maximum reimbursable hospital expenses is six (6) months reckoned from the time it is incurred, regardless of whether the personnel concerned has been separated from the service or whether the injury or sickness has been cured or not.
Claims may be denied if hospitalization expenses incurred during uncomplicated pregnancy and delivery, refusal to transfer to PNP facilities after the crisis period, claims related to intoxication, drunkenness, immoral habits, willful self-injury, negligence, or unlawful aggression, failure to avail of Social Service/PhilHealth assistance, unreasonable expenses beyond prescribed limits, submission of false or altered documents, and claims related to illnesses caused by lifestyle abuse.
TPPD is any impairment of the mind or body rendering the disabled PNP personnel incapable of substantially performing police duties, expected to be long, continued, and indefinite in duration, including irreparable loss of speech, hearing, limbs, or brain injury causing incurable insanity, and persisting beyond two years without fixed healing period unless waived by medical examination.
Approving authorities include the Chief PNP (CPNP) for claims P1 million and above; the TCAF (presumably a PNP directorate) for claims more than P500,000 but less than P1 million; and the TDPRM (Director for Personnel and Records Management) for claims P500,000 and below.
Claims should be filed at the RHE Section for personnel at National Headquarters and National Support Units, or at Regional Health Services for personnel in Police Regional Offices. Claims must be supported by required documents such as Letter of Authorization, Certificate of Duty Status, Medical Certificate, Certificate of Confinement, invoices, and receipts, and filed within 60 days from discharge.
Hospitalization benefits include room and board (P1,500 per day), intensive care unit admission at prevailing rates, professional fees (e.g., maximum P350 per day for ordinary medical cases, P750 for intensive/catastrophic), surgical case fees depending on complexity (minor up to P10,000, intermediate P10,000-P20,000, major P20,000-P60,000), medicines and medical supplies (each up to P35,000), ambulance fee (max P1,000), and laboratory work-ups (max P30,000).
The Adjudication Boards, one at National Headquarters and another at each Police Regional Office, are responsible for the speedy adjudication of hospitalization reimbursement claims. The National Board includes the Director and Deputy Director of Health Service, Chief of PNP General Hospital, and other key officers; it convenes twice a month. The Regional Board is chaired by the Deputy Regional Director for Administration and includes health and legal service chiefs from the region. They review, verify, and recommend claim approvals.