QuestionsQuestions (PHILHEALTH CIRCULAR NO. 48, S. 1999)
It provides guidance on the implementation of the PhilHealth indigent program, specifically that qualified indigent PhilHealth members and their dependents enrolled in the NHIP are eligible to avail of Medicare benefits.
Qualified PhilHealth indigent members and their dependents who are officially enrolled in the National Health Insurance Program (NHIP).
Yes. The Circular states that accredited PhilHealth providers are automatically entitled to participate and, as such, it is also their responsibility to render services to these newly enrolled indigent members.
At PhilHealth Central Office (3rd Floor, JOCFER Building, Commonwealth Avenue, Quezon City) or at the PhilHealth Regional Health Insurance Office in the provider’s area.
They contain pertinent information such as the effectivity and validity of coverage and the names of their legal dependents.
The Circular indicates dependents are defined similarly to Program I, meaning the definition in Program I should be used by reference.
The Circular clarifies that accredited PhilHealth providers are automatically entitled to participate in the Indigent Sector Component of NHIP.
The Circular cites Section 4(a)(iv), Rule I; Section 23, Rule IV; and Sections 44(d) and 49, Rule VIII of the Implementing Rules and Regulations of the National Health Insurance Act of 1995, plus Section 2.1, Part II (Warranties of Accreditation) of the provider’s accreditation application.
It refers to the benefits package under NHIP available to indigent members; the Circular further notes that the benefit package is attached for claims.
It indicates that providers and concerned parties must follow the procedures and requirements (e.g., rendering services and filing claims as directed) without deviation.
Providers should verify coverage details such as effectivity and validity shown on the cards and recognize the listed legal dependents for service and claim processing.
It serves as the attached reference for what benefits apply to indigent members, guiding which services should be claimed and how claims should be processed.
It links accreditation to participation in the Indigent Sector Component and explicitly states that providers must render services to the newly enrolled indigent members.
The Circular points to Section 2.1, Part II (Warranties of Accreditation) in the provider’s accreditation application as one cited basis for entitlement and responsibilities.
While the Circular itself does not enumerate penalties, non-compliance with the Circular’s explicit responsibility to render services may result in administrative or program-related sanctions under PhilHealth rules and accreditation warranties.
It requires claims pertaining to the indigent members and their dependents to be filed, and it references the dependents’ names on the identification cards.