Coverage of the Circular
- Applies to paying PhilHealth members from both Formal Economy and Informal Economy sectors.
- Explicitly excludes land-based Overseas Filipino Workers (OFWs).
Premium Payment Requirements for Benefits Entitlement
- Entitlement requires premium payment for at least three months within the six-month period before the first day of availment.
- The six-month qualifying period includes the month of confinement.
- Payments made on the admission date, during confinement, or after discharge generally do not count as qualifying contributions unless otherwise declared by PhilHealth.
Exemptions Regarding Payment During Admission Period
- Extended deadlines within applicable quarters allow longer payment periods for members.
- Only payments made before the first day of availment count towards the three months’ qualification.
- Exceptions where payments during confinement count as qualifying contributions:
- Dependent children who turned 21 years old, enrolled immediately in the Informal Sector, and paid premiums within the birth month quarter.
- Spouse who opts to enroll as a Primary Member or was previously a dependent of a deceased primary member.
- Newly hired employees who are dependents.
- Sponsored Members whose sponsors have not continued coverage for CY 2014 but paid the required first quarter contribution.
- Members with seasonal employment who recently terminated and settled unpaid months within the separation quarter.
- OFWs who ended coverage, will no longer work as OFWs, and paid premiums in the quarter following last coverage.
Effectivity of the Circular
- Effective for all admissions starting January 1, 2015.
- Issued for information and guidance by PhilHealth President and CEO Alexander A. Padilla.