Law Summary
Key Definitions Relevant to Sponsored Program
- Grace Period: 30 calendar days after membership expiry for LGU to remit premium payment.
- Non-delinquent LGUs/Donors: Paid at least 75% or have no outstanding balance in previous year's premium.
- Delinquent LGUs/Donors: Owe more than 25% of previous year's premium counterpart.
- LGU Premium Counterpart: Subsidy paid for indigent members, either by LGUs alone, donors on LGUs' behalf, or shared among multiple LGUs/donors.
- Mode of Remittance: LGU/Donor's payment frequency (quarterly, semi-annually, or annually).
Procedures for Initial Implementation of the Sponsored Program
- Payment of LGU premium counterpart required in preferred remittance mode.
- If LGUs/Donors request ID release before payment, must submit Certificate of Budget Allocation and notarized Promissory Note agreeing to pay at least one quarter premium within 30 days.
Renewal of Membership Enrollment Process
- IDs must be released at least 15 days before current membership expires.
- Local Social Welfare Development Officer is responsible for submitting certified lists of indigent members for replacement; non-listed families' memberships are auto-renewed.
- Premium counterpart payment required prior to renewal.
- In exceptional cases (e.g., fund unavailability, disbursement delays), IDs may be released under conditions based on LGU/donor delinquency status:
- For Non-delinquent: submission of Certificate of Budget Allocation and notarized Promissory Note for payment within grace period.
- For Delinquent: full payment of prior balance with official receipt, Certificate of Budget Allocation, and notarized Promissory Note.
- Failure to remit within grace period leads to suspension of Medicare benefits in the delinquent LGU's jurisdiction.
Guidelines for Expansion of Membership Enrollment
- Non-delinquent LGUs/donors must submit Certificate of Budget Allocation and notarized Promissory Note for at least one quarter's premium payment within grace period after ID release.
- Delinquent LGUs/donors must submit Certificate of Budget Allocation and pay at least one quarter's premium before ID release.
Enrollment via Legislative Sponsorship
- Release of IDs upon submission of Legislator’s allocation proposal approved by House Committee on Appropriation or Special Allotment Release Order.
- Coordination with Legislator's Office and DBM required for release of Notice of Cash Allotment.
Implementation Protocol for LGUs with OPB
- LGUs must pay premium counterpart for ID release regardless of implementation stage.
- If IDs requested prior to payment, submission of Certificate of Budget Allocation and notarized Promissory Note for payment within 30 days required.
- PhilHealth Capitation Funds may be withheld if premiums are unpaid as per relevant regulations.
Provision Regarding Change in ID Effectivity Date
- LGUs may change ID effectivity date if release occurs beyond grace period, provided no member has availed in-patient benefits during that period.
Immediate Effectivity
- The guidelines took effect immediately upon issuance on 07 July 2003.