Law Summary
Reimbursement of Professional Fees
- PhilHealth commits to reimbursing professional fees for services provided by accredited health professionals.
- This Circular specifically clarifies how professional fee reimbursements should be indicated in Claim Form 2 under the fee-for-service payment mechanism.
Clarification on Indicating Professional Fees in Claim Form 2
- Health care professionals must indicate one of the following in the boxes for total actual professional fees (PF) or amount paid by members:
- "zero" or "0"
- "complimentary"
- "PhilHealth benefit"
- "No PF"
- "co / company"
- These terms may appear either as words or as amounts.
- When indicated properly, PhilHealth will reimburse the professional fee directly to the concerned health care professional.
Reimbursement Upon Indication of PhilHealth Benefit
- Professional fees shall also be reimbursed if the health care professional indicates "complimentary" or "PhilHealth benefit" either in words or amount in the box for PhilHealth benefit.
Effectivity and Coverage
- The effectivity and coverage of this Circular align with those of PhilHealth Circular No. 9, s. 2013.
Publication and Registration
- The Circular is to be published in a newspaper of general circulation.
- It is to be deposited with the National Administrative Register at the University of the Philippines Law Centre for official record and accessibility.