Participation and Responsibilities of Accredited PhilHealth Providers
- Accredited PhilHealth providers are automatically entitled and required to participate in the Indigent Sector Component of the NHIP.
- They have the responsibility to render medical services to the indigent members and their dependents.
- Members receive PhilHealth Identification Cards containing coverage validity and names of legal dependents.
Procedures for Claims and Benefits
- Claims for services provided to indigent members and their dependents must be filed at the PhilHealth Central Office, located at the 3rd Floor, JOCFER Building, Commonwealth Avenue, Quezon City.
- Specific PhilHealth forms (Nos. 1, 2, and 3) must be used when filing claims.
- An attached benefit package defines the scope of benefits available to indigent members.
Legal Basis and Regulatory Provisions
- Entitlement to Medicare benefits for indigent members is found in the National Health Insurance Act of 1995 Implementing Rules and Regulations, specifically:
- Section 4 (a.iv), Rule I;
- Section 23, Rule IV;
- Sections 44 (d) and 49, Rule VIII.
- Warranties of Accreditation under Section 2.1, Part II of the provider’s accreditation application also govern provider obligations.
Compliance and Enforcement
- The circular mandates strict compliance by accredited providers to the responsibilities and procedures outlined.
- It serves as official notification enabling the smooth implementation of the indigent program within the Province of Iloilo.
This detailed explanation captures the key provisions, scope, definitions, procedures, and legal frameworks governing the implementation of the indigent program in Iloilo as per PhilHealth Circular No. 47, S. 1999.