Amendments to Bohol Public Works Projects

Address gaps in health insurance coverage for both financially capable and incapable Filipinos.
Include unregistered, inactive, and poor members under the National Health Insurance Program (NHIP).
Achieve 100% availment rate for the poor.

Covers all unregistered Filipinos, especially financially incapable individuals seeking care at government facilities.

Point of Service (POS Program): Program for covering all Filipinos, especially indigents and inactive members in NHIP.
POS Patient: Patient classified financially incapable by DOH standards.
Financially Capable: Self-earning individuals such as professionals, entrepreneurs, artists, and similar occupations.
National Government Facility (NGF): Health facilities owned by national government agencies.
Local Government Owned Facilities: Hospitals/facilities managed by Local Government Units (LGUs).
Medical Social Welfare Officer (MSWO)/Social Welfare Development Officer (SWDO): DOH-trained social workers conducting financial capability assessments.

Eligible patients are unregistered or inactive PhilHealth members assessed as financially incapable by MSWO/SWDO.
Must be Filipino citizens admitted to government facilities or referred to private HCIs after assessment.
Financially capable patients are assessed and enrolled based on capacity, with premium payment obligation.

NGFs, LGUs, and other government hospitals can participate upon compliance with requirements:
- Submission of specified application forms.
- Provision of IT infrastructure including dedicated computer and internet.
- Designation and training of staff for POS system operation and assessments.
- Availability of licensed MSWO/SWDO trained by DOH.
Existing users comply only with updated training requirements.

Unregistered POS Patients must fill out PhilHealth Member Registration Form (PMRF).
Registration via POS System within 72 hours of admission or before discharge.
Issuance of Certificate of Assessment signed by MSWO/SWDO.
Contingency plans for system downtime include submission of PMRF via email, fax, or alternative agreed methods.
Weekend or off-hour admissions assessed and registered on next working day.
Special provisions for women about to give birth, minors, orphaned, abandoned, and mentally-ill patients.
Assignment of PIN by PhilHealth upon registration; inclusion of PIN in claim forms.

Financially incapable POS Patients enjoy immediate benefits:
- In-patient/out-patient All Case Rates.
- Z Benefits (e.g., dialysis).
- No Balance Billing policy applies.
Financially capable patients must pay annual premium to avail benefits including Z Benefits.
Subsequent benefit availments under system downtime require certification from PhilHealth.
Coverage allowed in private facilities upon proper government referral or special conditions (e.g., immunized dengue patients, emergency cases, calamity victims).

Only claims with POS registration and PIN accepted.
PMRF, registration slip, and certificate of assessment required for initial claim.
Government HCIs not using eClaims may file manually; electronic claims require digital submission of MSWO/SWDO certificate.
Compliance with all existing claim rules and requirements mandated.

Quarterly endorsement of POS indigent patients to DSWD for inclusion in Listahanan as qualifying indigents for future coverage.

PhilHealth tasked to create mechanisms to monitor benefit utilization and program effectiveness.

Annual premiums for Sponsored Members under POS are funded by the General Appropriations.

Full transition from Point of Care (POC) Enrollment Program to POS as of July 1, 2018.
Deactivation of POC-ORE system from that date.
Patients enrolled prior to July 1, 2018 remain entitled to benefits until December 31, 2018.

Circular retroactively effective from January 1, 2018.
Filed with the National Administrative Register at the University of the Philippines Law Center.