QuestionsQuestions (PHIC PHILHEALTH CIRCULAR NO. 02, S. 2005)
It applies to all PhilHealth members and dependents who are 60 years old and above, and to all accredited PhilHealth institutional health facilities and health care professionals.
Medical and dental services (including diagnostic and laboratory fees) provided to senior citizens confined in service wards of government facilities shall be provided for free, as long as they are medically necessary and in accordance with available Clinical Practice Guidelines or Hospital Treatment Protocols.
They are granted a 20% discount on medical and dental services, including diagnostic and laboratory fees, if medically necessary and in accordance with Clinical Practice Guidelines or Hospital Treatment Protocols.
A 20% discount is granted to senior citizens for medical and dental services, including diagnostic and laboratory fees (e.g., x-rays, CT scans, blood tests), and for specialized treatment rooms/equipment such as hemodialysis and radiotherapy.
Yes. Professional fees of attending health care professionals in private hospitals and medical facilities for medical, surgical, and dental services to senior citizens are granted a 20% discount.
PhilHealth reimbursement shall first be applied to PhilHealth-covered services (drugs/medicines, laboratories, and supplies) that are not subsidized by the government facility. Official Receipts must be attached to the claims application for reimbursement.
After the first deduction, any remaining PhilHealth benefits (including professional fees, if any balance remains) shall be applied to the cost of services/items that are subsidized by the facility and covered by PhilHealth—subject to benefit limits.
Payment may be made to the requesting party (member/hospital) if the expenses being claimed were not included in the earlier submitted claim and there are available benefit balances. No adjustment is allowed without a corresponding request and necessary documentation.
The health facility must first deduct the amount representing the 20% senior citizen discount from total hospital charges. Only the remaining 80% (or portion chargeable correspondingly to PhilHealth) is then subject to PhilHealth reimbursement and co-payment rules.
First deduct the 20% senior citizen discount from the applicable professional fees. Only the remaining 80% (or portion thereof) is chargeable to PhilHealth, then PhilHealth benefit coverage is deducted, leaving the co-payment for the senior citizen.
The original Official Receipt (OR) must be attached to the PhilHealth claim for professional fees.
The difference shall be paid to the member, provided that the original OR is attached.
The OR must indicate the 20% senior citizen discount and the PhilHealth expected reimbursement or counterpart explicitly written, and the OR should reflect the total charges, the discount, and the PhilHealth reimbursement/net amounts.
They must post hospital room rates, laboratory/diagnostic fees, medicine prices, professional fees for private patients, and other fees/rates in conspicuous places; submit the price lists as attachments in initial/renewal accreditation applications; issue ORs for every paid service/item with stated usual rates and discounted price; and set up grievance mechanisms and disciplinary/reportorial procedures related to refusal to grant proper discounts.
Non-compliance is considered breach of warranties and may result in non-approval or non-renewal of accreditation or other sanctions provided in the implementing rules and regulations of Republic Act 7875, as amended, and RA 9257.
They must post a schedule of professional fees in a conspicuous place in their office, and issue an OR indicating the 20% senior citizen discount and PhilHealth expected reimbursement/counterpart; their OR copies for covered services must be made available to PhilHealth upon request.
It takes effect 15 days after publication.