Medicare benefits and identification cards
- Each qualified indigent member is issued PhilHealth Identification Cards containing pertinent information.
- PhilHealth Identification Cards contain information on the effectivity and validity of coverage.
- PhilHealth Identification Cards contain the names of legal dependents, using the same definitional approach as Program I.
- Medicare entitlement is implemented through these enrolled indigent members and their dependents, evidenced by their PhilHealth Identification Cards.
Provider participation and service duty
- Accredited PhilHealth providers must render services to each of these new PhilHealth members under the Indigent Sector Component.
- Provider participation is automatic upon accreditation as an accredited PhilHealth provider.
- Provider entitlement to participate does not remove the provider’s responsibility to deliver the required services to indigent members.
Claims filing and payment processing
- Claims for payment of services pertaining to newly covered indigent members and their dependents must be filed for processing.
- Claims must be filed at PhilHealth Central Office, 3rd Floor, JOCFER Building, Commonwealth Avenue, Quezon City, or at PhilHealth’s Regional Health Insurance Office in the provider’s area.
- Claims coverage is tied to services rendered to the indigent members and their dependents for whom PhilHealth Identification Cards are issued.
- The benefit package for indigent members is attached for use in claims filing.
Legal basis for indigent Medicare entitlement
- Indigent members’ entitlement to medicare privileges is provided under Section 4 (a.iv), Rule I; Section 23, Rule IV; and Sections 44(d) and 49, Rule VIII of the Implementing Rules and Regulations of the National Health Insurance Act of 1995.
- Indigent Medicare entitlement is also anchored on the application for accreditation under Section 2.1, Part II (Warranties of Accreditation).
Adoption, guidance, and compliance instruction
- The circular is adopted on 7 April 1999.
- The circular is issued under the authority of ENRIQUE M. ZALAMEA, President and CEO.
- Providers receive instructions for guidance and strict compliance with the Indigent Program implementation requirements.