Suspension of Eligibility Due to Non-Payment
- Eligibility of IPMs to avail of Medicare benefits is suspended if premiums are not paid for a prescribed period (quarter, semester, or year).
- Suspension commences on the second month of the quarter following the missed or unpaid premium period.
Proof of Payment Required for Benefit Availment
- IPMs must submit valid proof of payment for at least three (3) monthly contributions within the immediate six (6) months prior to the month of availment.
- Acceptable proofs include:
- Machine validated MI-5 form
- Machine printed receipt
- Government Official Receipt
- Bank receipt
Implementation and Coverage of Suspension
- The suspension rules are effective immediately as of August 9, 2001.
- They apply to all claims filed starting February 2, 2001.
- Claims under these rules need not be referred to the Claims Review Unit.
Continuity of Other Related Provisions
- All other provisions consistent with this Circular, as stated in PhilHealth Circular No. 09, series 2001, remain effective and enforceable.
Purpose and Scope
- The Circular clarifies and operationalizes eligibility, suspension, and documentation requirements for Medicare benefits of IPMs and their dependents under the National Health Insurance Act of 1995.
- It ensures compliance with Section 46-b of the Revised Implementing Rules and Regulations.
Legal Authority
- Issued and adopted by the President and CEO of PhilHealth, Francisco T. Duque III, M.D., M.Sc., on August 9, 2001.
- Draws authority from the Revised Implementing Rules and Regulations of the National Health Insurance Act of 1995.