QuestionsQuestions (PhilHealth Circular No. 006-2015)
Republic Act (RA) No. 10645 mandates mandatory PhilHealth coverage for all senior citizens. It amended RA No. 7432 (as amended by RA No. 9257 and further amended by RA No. 9994), known as the Expanded Senior Citizen Act of 2010.
A senior citizen is any Filipino citizen who is a resident of the Philippines and aged 60 years or above. Dual citizens may also qualify if they can prove Filipino citizenship and have at least six (6) months of residency in the Philippines.
It refers to a senior citizen who, among others, is not yet issued a PhilHealth Identification Number (PIN), has no qualifying contributions as a member without qualifying contributions, is not identified as indigent in Listahanan/NHTS-PR, is not a Sponsored Member, is not yet qualified as a Lifetime member, and may include a qualified dependent already declared in PhilHealth membership database.
A new membership category called “Senior Citizen” was created to provide coverage to senior citizens who are not currently covered under the National Health Insurance Program (NHIP).
Senior citizens are primarily enrolled in coordination with the Office for Senior Citizens Affairs (OSCA) or any office designated by the Office of the Mayor in the locality where they reside.
The list must include: full name; birthdate; sex; full name of legal spouse and/or qualified dependents (if any); and complete address details (unit/room/floor, building name, lot/block/house/building no., street, subdivision/village, barangay, city/municipality, and province).
A duly accomplished PhilHealth Member Registration Form (PMRF), a 1x1 photo taken within the last six (6) months, and a Senior Citizen Identification Card issued by OSCA or any acceptable proof of senior citizen status (e.g., passport, birth certificate, voter’s ID, SSS/GSIS ID, etc., or alternative documents subject to PhilHealth validation).
The circular allows: certificate from NCWDP; DSWD or Local DSWD certification; Barangay certification; or an affidavit from two (2) disinterested persons certifying age and identity, subject to PhilHealth validation.
PhilHealth LHIOs issue the PhilHealth Identification Card (PIC) and the Member Data Record (MDR) of the enrolled Senior Citizen member.
Yes. A Senior Citizen member may declare as qualified dependents: (1) legitimate spouse not enrolled under NHIP; (2) children legitimate or illegitimate below 21 years old, unmarried, unemployed; (3) a child 21 years old or above suffering from congenital or disabling conditions rendering totally dependent; and (4) foster child as defined in RA 10165 (Foster Care Act of 2012).
Premium contributions are sourced from the proceeds of RA No. 10351, commonly known as the Sin Tax Law.
A Senior Citizen member is entitled to 45 days of confinement coverage every calendar year. Qualified dependents share among themselves another 45 days of confinement every calendar year.
Qualified dependents are entitled to the program benefits until the end of the calendar year only; thereafter, the dependents shall enroll as principal member(s).
The circular lists inpatient hospital care; day/ambulatory services; Z-benefits (catastrophic cases); TB-DOTS package; animal bite package; malaria package; outpatient HIV/AIDS treatment package; blood transfusion package; maternity and newborn care package; normal spontaneous delivery package; pre-natal care package; benefits for voluntary contraceptive surgical procedures; and starting January 2015, the Primary Care Benefit Package (Tsekap), among others. It also mentions No Balance Billing policy for eligible confinement in accredited government facilities.
Enrollment is allowed during confinement or after the benefits are availed, provided the required documents for enrollment are attached to the claims document submitted by the health care provider.
The senior citizen must present the PIC to accredited providers; however, absence of the PIC shall not prejudice rights if a valid ID or document proving identity and age is presented.
They have 60 calendar days from the effectivity of the circular to directly file benefit claims with any PhilHealth office having jurisdiction over the hospital/provider where they were confined.
It takes effect fifteen (15) days after publication in at least two (2) newspapers of general circulation, and then it must be deposited with the National Administrative Register (UP Law Center).