Question & AnswerQ&A (PHILHEALTH CIRCULAR NO. 2018-0008)
The primary purpose is to ensure coverage of all Filipinos, especially those financially incapable and inactive members, under the National Health Insurance Program using the POS enrolment to facilitate immediate coverage and benefits during medical care in government facilities.
A POS Patient is a Filipino citizen assessed as financially incapable according to the DOH classification on indigence, including minors whose parent or guardian is financially incapable, and is admitted or referred by a government facility.
Financially Capable individuals are those who earn their livelihood independently outside employer-employee relationships such as professionals, entrepreneurs, artists, and other self-earning individuals.
NGFs include health facilities owned by national government agencies such as DOH-retained hospitals, PNP hospitals, DND hospitals, and corporate-specialty hospitals.
They must submit the PhilHealth Online Access Form and NDA, have a dedicated computer and reliable internet, assign IT and trained staff for POS operations, and have licensed MSWO or SWDO trained by DOH on the assessment tool.
POS Patients must be registered through the POS System within 72 hours from the date of admission or prior to discharge.
They are entitled to in-patient and out-patient benefits under All Case Rates, Z Benefits, and the No Balance Billing policy within the validity period after registration.
Yes, but they must pay the prescribed annual premium to be eligible for inpatient/outpatient benefits and Z benefits based on existing rules.
A duly accomplished PhilHealth Member Registration Form can be sent to PhilHealth through email, fax, or other agreed means for PIN assignment within 72 hours of admission, and registration completed upon return of system availability.
They assess the financial capability of patients using the DOH prescribed tool, interview unregistered or inactive members, conduct registration activities, and issue certificates of assessment for eligibility.