Question & AnswerQ&A (PHILHEALTH CIRCULAR NO. 0032, S. 2013)
The primary objective is to ensure all Filipinos, especially the poor and vulnerable populations, are covered by PhilHealth through enrollment at their point of care in government health institutions to enhance universal health coverage.
The program is anchored under Republic Act 7875 as amended by Republic Act 10606, known as The National Health Insurance Act of 2013.
Non-members assessed as Class C-3 or D, and members not covered due to lack of qualifying contribution but classified as Class C-3 or D shall be considered Sponsored Program Members.
No, patients availing outpatient services such as Cataract Surgery or Hemodialysis are not enrolled; however, Hospital-Sponsored Members may avail these services if hospitalized subsequently.
All DOH-retained hospitals are mandated to implement the program. Local Government Unit hospitals may participate subject to PhilHealth approval, and other government hospitals can join upon PhilHealth’s approval.
The Health Care Institution (hospital) shall act as the premium sponsor and shall not ask patients for any premium payment.
The premium amount is Php 2,400 annually, which is the same as for Sponsored Program Members.
Coverage starts on the first day of the confinement month and ends on the last day of the same calendar year.
They are entitled to immediate availment of inpatient and outpatient NHIP benefits (except Primary Care Benefit 1) including No Balance Billing.
PhilHealth shall process claims within 30 days upon receipt of complete claim documents, and claims shall not be returned for membership or eligibility issues.
PhilHealth submits enrolled Hospital-Sponsored Members to DSWD for validation. Validated poor members are included in the National Household Targeting System for continued coverage under the Sponsored Program.
Yes, any inconsistent provisions in previous issuances are amended, modified, or repealed by this circular.
It took effect fifteen (15) days after publication in a newspaper of general circulation and was deposited with the National Administrative Register at the UP Law Center.