QuestionsQuestions (PhilHealth Circular No. 033-2014)
RA 10645 amended Section 5, sub-paragraph (h)(2) of RA 7432 (as amended), providing that all senior citizens shall be covered by PhilHealth’s national health insurance program; funds for enrolling those not yet covered shall come from PhilHealth’s National Health Insurance Fund sourced from the proceeds of RA 10351.
A Filipino citizen who is a resident of the Philippines and aged 60 years or above; it may apply to dual citizens aged 60 or above if they can prove Filipino citizenship and have at least six (6) months residency in the Philippines (per IRR of RA 9994).
A senior citizen not yet issued a PhilHealth Identification Number (PIN), or who has no qualifying contributions as a member in the formal/informal economy, is not identified as indigent under NHTS-PR/Listahan, not a sponsored member, not yet qualified as a lifetime member, and not merely a declared qualified dependent unless already recorded in PhilHealth’s membership database.
A new category called “Senior Citizen,” created to provide coverage to senior citizens who are not currently covered under the NHIP.
Enrollment is primarily coordinated with the OSCA (Office for Senior Citizens Affairs) or a designated office of the Mayor in the locality of residence; OSCA maintains and regularly updates the quarterly list of senior citizens and may submit it to the Local Health Insurance Office (LHIO) for enrollment.
Full name, birthdate, sex, and complete address breakdown including unit/room/floor, building name, lot/block/house/building no., street, subdivision/village, barangay, city/municipality, and province.
It should be submitted electronically (e.g., Microsoft Excel/Access, text file, or other acceptable format), and the electronic file must be password protected.
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 other proof of senior status such as various government IDs, documents, or—if unavailable—certificates/affidavits subject to PhilHealth validation.
Certificate from NCWDP; DSWD or Local DSWD certification; barangay certification; or an affidavit from two (2) disinterested persons certifying age and identity, all subject to PhilHealth validation.
The LHIO shall not accept registration of senior citizens represented by individuals unauthorized, not identified, or not tapped by PhilHealth, DSWD, or the LGUs facilitating enrollment.
Yes. If the dependent is a senior citizen (e.g., a spouse already 60+), the dependent shall be enrolled separately as a “Senior Citizen” member of the NHIP.
Premiums for Senior Citizen members shall be sourced from proceeds of RA 10351 (Sin Tax Law). PhilHealth will bill the Department of Budget and Management through the Department of Health annually for payment of premium contributions.
The premium rate for Senior Citizen members shall not be less than the premium prescribed for Indigent members of the NHIP; PhilHealth retains the right to determine an actuarially feasible premium rate to sustain identified benefits.
Inpatient hospital care; day/ambulatory services; Z-benefits for catastrophic cases; TB-DOTS; animal bite; malaria; outpatient HIV/AIDS treatment; blood transfusion; maternity and newborn care; normal spontaneous delivery; antenatal care; and benefits for voluntary contraceptive surgical procedures.
A senior citizen should present the PhilHealth Identification Card to any PhilHealth-accredited provider or, in absence of the PIC, present a valid ID showing senior citizen status. Absence of the PIC does not prejudice rights as long as a valid ID or document proving identity and age is presented.
Enrollment is allowed during confinement or after benefits are availed if the required documents for enrollment (Section V.9) are attached to the claims document submitted by the health care provider.
They are given 60 calendar days from the Circular’s effectivity to directly file their benefit claims with the PhilHealth office having jurisdiction over the health care provider/hospital where they were confined, together with specified enrollment/claim documents and required forms.
It takes effect fifteen (15) days after publication in at least two (2) newspapers of general circulation, and it is deposited thereafter with the National Administrative Register at the University of the Philippines Law Center.