Purpose and operational rationale
- The PhilHealth ID Card serves as a member’s passport for the availment of Medicare benefits.
- The PhilHealth ID Card bears proof of program coverage for the year that commences on the 1st or 16th day of the month.
- The ID Card is generally released to an indigent member upon payment of the LGU premium counterpart by the premium sponsor/donor.
- Collection of the LGU premium counterpart contribution is observed to remain low due to lenient implementation of existing guidelines, and the Corporation issues stricter release rules to address the issue.
Key definitions and classifications
- Grace Period refers to the 30 calendar days after expiration of membership validity for the LGU to remit their premium counterpart.
- Non-delinquent LGUs and/or Donors are those with no outstanding balance or those that have at least paid 75% of the total LGU premium counterpart of previous year.
- Delinquent LGUs and/or Donors are those with more than 25% balance on the previous year’s total LGU premium counterpart.
- LGU Premium Counterpart refers to premium subsidy for indigent members that may be paid by:
- an LGU solely; or
- a Donor on behalf of the LGU; or
- shared by LGUs (barangay, municipal, provincial) or with other donors (private, legislators, and national government agencies).
- Mode of Remittance refers to the LGU/Donor’s preferred mode of paying the premium counterpart quarterly, semi-annual, or annual.
Coverage: Sponsored Program ID releases
- The Order governs the release of PhilHealth ID Cards for the Sponsored Program.
- Release rules apply to LGUs and/or Donors classified as Non-delinquent or Delinquent based on prior year premium payment status.
- Release rules also apply to membership initial implementation, renewal of membership enrollment, expansion of membership enrollment, and enrollment through legislative sponsorship.
- Separate release requirements apply to LGUs with OPB implementation.
- Release and effectivity rules apply when ID Cards are released beyond the applicable grace period.
Initial implementation requirements
- For LGUs initially implementing the Sponsored Program, the Corporation requires payment of LGU premium counterpart contributions based on the LGU/Donor’s preferred mode of remittance.
- If LGUs/Donors insist on release of the IDs prior to payment, they must submit:
- a Certificate of Budget Allocation; and
- a notarized Promissory Note for payment of at least one (1) quarter premium counterpart.
- Payment under the notarized Promissory Note for prior-to-payment release must be made within 30 days after the release of IDs.
Renewal of membership enrollment
IDs must be released at least fifteen (15) days prior to expiration of the previous year’s membership coverage.
To support timely encoding and ID generation, the Local Social Welfare Development Officer (LSWDO) submits and certifies only:
- the list of indigent members to be replaced, and
- their replacement indigent family.
Indigent families not reflected on the LSWDO list are automatically renewed.
For renewal, LGUs/Donors must remit the LGU premium counterpart contribution prior to renewal.
If prior remittance is not possible due to unavailability of funds, on-going re-negotiation with the local chief executives (LCEs), and/or delay in processing of disbursement vouchers (DVs), ID release follows the applicable delinquency classification:
For “Non-Delinquent” LGUs and/or Donors, ID release requires:
- Certificate of Budget Allocation; and
- notarized Promissory Note for payment of the first quarter premium counterpart of current year within the grace period.
For “Delinquent” LGUs and/or Donors, ID release requires:
- full payment of the balance of previous year’s account and submission of the certified true copy of the Official Receipt as proof of payment;
- Certificate of Budget Allocation; and
- notarized Promissory Note for payment of the first quarter premium counterpart of current year within the grace period.
If the LGU/Donor fails to remit premium counterpart within the grace period stated in the notarized Promissory Note, the Corporation shall suspend the provision of Medicare benefits in the territorial jurisdiction of the delinquent party.
Expansion of membership enrollment
- For “Non-Delinquent” LGUs and/or Donors, ID release for expansion requires:
- Certificate of Budget Allocation; and
- notarized Promissory Note for payment of at least one (1) quarter premium counterpart within the 30 days grace period after the release of IDs.
- For “Delinquent” LGUs and/or Donors, ID release for expansion requires:
- Certificate of Budget Allocation; and
- payment of at least one (1) quarter premium counterpart.
Legislative sponsorship enrollment
- IDs of enrolled indigent families are released upon submission of:
- a copy of the Legislator’s proposal for allocation of a portion of the Priority Development Assistance Fund (PDAF) duly approved by the House Committee on Appropriation; or
- a copy of the Special Allotment Release Order (SARO).
- The concerned Unit/Division/Group of PhilHealth coordinates with the Office of the Legislator and the Department of Budget and Management for release of the Notice of Cash Allotment (NCA) of the concerned Legislator.
OPB implementation and capitation funds
- LGUs implementing OPB—whether initially, for renewal, or for expansion—must pay the LGU premium counterpart contribution for the release of IDs.
- If such LGUs insist on release of IDs prior to payment, they must submit:
- Certificate of Budget Allocation; and
- notarized Promissory Note for payment of at least one (1) quarter premium counterpart within 30 days after the release of IDs.
- The Corporation reserves the right to withhold the release of PhilHealth Capitation Funds (PCF) if premium payments have not been remitted based on Office Order No. 66, series of 2002.
Change in effectivity date
- If PhilHealth ID Cards for the Sponsored Program are released beyond the thirty (30) days grace period, the LGU may opt to change the IDs’ effectivity date.
- The option to change the effectivity date applies only provided that no member availed of in-patient benefits during the period.
Sanctions and consequences
- The Corporation must suspend Medicare benefits in the territorial jurisdiction of the delinquent party if the LGU/Donor fails to remit the premium counterpart within the grace period specified in the notarized Promissory Note.
- The Corporation may withhold the release of PhilHealth Capitation Funds (PCF) if premium payments are not remitted, referencing the conditions under Office Order No. 66, series of 2002.