QuestionsQuestions (PNP MEMORANDUM CIRCULAR NO. 2011-11)
It prescribes specific guidelines and procedures for the just, reasonable, and speedy adjudication of claims for reimbursement of hospitalization expenses of active PNP personnel arising from service-connected illnesses and/or injuries.
It is an additional privilege, not a right, and must be exercised in the best lights and always subject to availability of funds.
“Active PNP Personnel” means both Uniformed and Non-Uniformed Personnel of the PNP.
Hospitalization is the rendering of medical attendance after admission in any PNP Medical Facility (including PNP General Hospital) and government/private health care institutions; medical attendance includes professional services, nursing care, radiologic exams, lab work-ups, and dispensing of medicines/supplies.
It refers to PNP personnel killed, wounded, or injured by reason of anti-criminality, counter-insurgency, counter-terrorism, and police community operations, including enforcement of laws, crime prevention/control/investigation, ensuring public safety/internal security, protection of lives/liberties/properties, arrest and assisting prosecution, search and seizure operations, and rescue operations during calamities.
The maximum reimbursable hospital expenses is six (6) months reckoned from the time they are incurred, regardless of whether the personnel is separated or the sickness/injury is cured.
Three hundred sixty-five (365) days after which the personnel shall be thoroughly evaluated for fitness to remain in the active service.
Non-emergency cases generally require a Letter of Authorization (LOA) from the PNP Health Service Facility before treatment/confinement. Emergency cases require presenting PNP ID prior to treatment/confinement, and notifying PNP Health Service within 24 hours for LOA verification; after the emergency, documents are signed for reimbursement and transfer is made to PNP facilities when feasible.
Room and board is fixed at P1,500.00/day. Medical case professional fees are capped at P350.00/day for ordinary cases and P750.00/day for intensive/catastrophic cases; medicines are capped at P35,000.00 and medical supplies at P35,000.00; ambulance fee max is P1,000.00; laboratory work-ups max is P30,000.00.
For non-battle casualties: ordinary non-urgent medical cases cannot exceed P60,000.00; surgical cases cannot exceed P100,000.00.
Intensive and catastrophic cases cannot exceed P350,000.00.
Expenses incurred during uncomplicated pregnancy and delivery (Normal Spontaneous Delivery) are denied.
Denial may apply if the illness/injury is due to intoxication/drunkenness, use of prohibited drugs, excessive substance consumption, or various immoral habits leading to STDAs; also if caused by willful intention to injure/kill oneself/another or by notorious negligence (AWOL), or if provoked by the claimant in unlawful aggression.
Claims may be filed either during confinement or upon discharge, but in no case exceeding sixty (60) days from discharge. Documentary requirements include LOA (for non-emergency), certificate of duty status, medical certificate by the attending physician; hospital requirements include certificate of confinement and original invoices/official receipts inclusive of confinement days.
NHQ ERHE Adjudication Board: convenes twice monthly or as needed; adjudicates certain NHQ/hq-support-unit claims in DOH-accredited hospitals and recommends approval within four working days; reviews regional recommendations and renders adjudication report for final approval for higher ceiling claims; also determines legal heirs for deceased personnel. PRO ERHE Adjudication Board: convenes twice monthly or as needed; adjudicates claims for PRO-assigned personnel within four days and recommends approval to the Regional Director, forwarding cases exceeding allowable reimbursable amounts or high-value battle casualties to NHQ for final disposition.
The concerned PNP personnel or his/her heirs shall bear the cost of the medical and/or hospitalization services rendered.
Any PNP personnel or representative who commits fraud, collusion, falsification, misrepresentation, or any anomaly for the purpose of securing entitlement under the Circular is subject to criminal and administrative action deemed appropriate by the investigating body.