Question & AnswerQ&A (PHILHEALTH CIRCULAR NO. 25, S. 2010)
A member must have paid premium contributions for at least three (3) months within the six (6) months prior to the first day of his or her or their dependent's availment.
The member must have paid at least nine (9) months of premium contributions within the twelve (12) months immediately preceding the month of availment.
It means paying premium contributions of at least nine (9) months within a twelve-month period immediately prior to the month of availment.
Yes, members under the Sponsored Program, Lifetime (Non-Paying) Program, and the Overseas Workers Programs (OWP) are exempted from this requirement.
Premium contributions paid during confinement or on the day of confinement are not considered for that confinement but only for future or prospective confinements.
The member will not be entitled to PhilHealth benefits for that confinement since meeting this condition is mandatory for benefit availment.
The Circular refers to penalties provided under RA 7875 as amended by RA 9241; members currently subject to these legal penalties are disqualified from availing benefits.
This policy became effective for all reimbursements with admission or outpatient treatment dates starting July 1, 2011.
The reckoning date for premium payment is the last day before the start of confinement. Payments made after the confinement date are not considered for the present confinement.
Republic Act 7875 (National Health Insurance Act), as amended by Republic Act 9241, together with its Implementing Rules and Regulations governs the requirements for PhilHealth benefit availment.