Question & AnswerQ&A (PHIC PHILHEALTH CIRCULAR NO. 02, S. 2005)
The circular applies to all PhilHealth members and dependents who are 60 years old and above, as well as to all accredited PhilHealth institutional health facilities and health care professionals. It provides guidelines for benefits availment and additional accreditation rules.
Senior citizens confined in government service wards shall receive free medical and dental services, including diagnostic and laboratory fees, if medically necessary per Clinical Practice Guidelines or Hospital Treatment Protocols. Those in pay sections receive a 20% discount on these services.
Senior citizens confined in private hospitals and medical facilities receive a 20% discount on medical and dental services, including diagnostics and use of specialized treatment rooms and equipment. Professional fees of attending health care professionals also get 20% discount.
PhilHealth reimbursements are first applied to non-subsidized services and items with official receipts attached. Remaining benefits are then applied to subsidized services and professional fees if benefits remain, ensuring proper deduction and reimbursement.
The health facility must first deduct the 20% senior citizen discount from total charges. PhilHealth reimbursement is applied only to the remaining 80% or portion thereof, with the senior citizen paying the balance as co-payment.
They must first deduct the 20% discount from the professional fees, then apply PhilHealth reimbursement to the remaining balance. Official receipts showing the discount and expected PhilHealth reimbursement must be issued.
They must post prices conspicuously, submit price lists upon accreditation or renewal, issue official receipts showing usual rates and discounted prices, set up grievance mechanisms for senior citizens, and have disciplinary procedures for non-compliance with discount rules.
Accredited professionals must post their schedule of fees conspicuously and issue official receipts indicating the 20% senior citizen discount and PhilHealth expected reimbursement. Receipts must be available to PhilHealth upon request.
Non-compliance may be considered a breach of warranties, which could lead to non-approval or non-renewal of accreditation or other sanctions as provided under the implementing rules of RA 7875, as amended, and RA 9257.
These guidelines took effect 15 days after publication, specifically adopted on February 8, 2005.