Participation of Accredited PhilHealth Providers
- All accredited PhilHealth providers are automatically entitled to participate in the Indigent Sector Component of NHIP.
- Providers have a corresponding responsibility to render medical services to the indigent members and their dependents.
Identification and Verification
- Each indigent member is issued a PhilHealth Identification Card.
- The ID card contains essential information such as the effectivity and validity of the coverage.
- It also lists the names of legally qualified dependents eligible for benefits.
Claims Filing Procedures
- Claims for payment of services rendered to indigent members and their dependents must be filed at designated PhilHealth offices.
- These offices include the PhilHealth Central Office located on the 3rd Floor, JOCFER Building, Commonwealth Avenue, Quezon City, or at PhilHealth's Regional Health Insurance Offices.
- Service providers must refer to the benefit package attached for indigent members when filing claims.
Legal Bases for Medicare Entitlement
- The entitlement to Medicare privileges for indigent PhilHealth members is grounded on several provisions of the Implementing Rules and Regulations (IRR) of the National Health Insurance Act of 1995:
- Section 4 (a.iv), Rule I
- Section 23, Rule IV
- Sections 44(d) and 49, Rule VIII
- Additional guarantees are found in Section 2.1, Part II (Warranties of Accreditation) of the provider's accreditation application.
Compliance and Enforcement
- The circular mandates strict compliance by all accredited providers.
- It serves as official guidance to ensure uniform implementation of the indigent program under PhilHealth.
Administrative Details
- The PhilHealth Circular No. 48, Series of 1999 was adopted on 7 April 1999.
- Issued by Enrique M. Zalamea, President and CEO of PhilHealth at the time.
- The circular is officially disseminated to inform providers and stakeholders of their roles and obligations under the indigent program.