Objective
- Provides implementing guidelines and procedures for covering senior citizens not yet enrolled under NHIP.
Definition of Terms
- Senior Citizen: Filipino citizen aged 60 or above, including dual citizens with proof and 6 months residency.
- Senior Citizen not currently covered: those without PhilHealth ID, insufficient contributions, or sponsorship.
- OSCA: Local office led by a senior citizen for senior citizen affairs.
- LHIO: PhilHealth office at provincial or city level for service delivery.
General Provisions
- New membership category for senior citizens not covered under NHIP.
- Qualified dependents who are senior citizens to be enrolled separately.
- Senior citizens gainfully employed must contribute if income exceeds poverty threshold.
Enrollment
- Primarily coordinated with OSCA or designated local offices.
- OSCA maintains a quarterly updated list of senior citizens with detailed personal data.
- List submitted electronically to LHIO with transmittal letter and printed copy.
- PMRF forms to be submitted alongside list or individually if electronic submission not possible.
- LHIOs to coordinate with DSWD and NGOs for enrollment coverage.
- Senior citizens organizations may assist after orientation.
- Direct enrollment possible; requires PMRF, recent photo, and proof of senior citizen status (ID or certificate).
- Unauthorized representatives not permitted to enroll senior citizens.
Declaration of Qualified Dependents
- Qualified dependents include legitimate spouse not enrolled, unmarried children under 21, disabled adult children fully dependent, and foster children under RA 10165.
Premium Contributions
- Funded by proceeds of RA No. 10351 (Sin Tax Law).
- PhilHealth bills DBM through DOH annually.
- Premium rates not less than those for indigent members; subject to actuarial assessment.
Benefits and Entitlements
- Senior Citizens and dependents entitled to inpatient care, outpatient services, Z-benefits for catastrophic cases, specific treatment packages (TB-DOTS, animal bite, malaria, HIV/AIDS), maternity and newborn care, and voluntary contraceptive procedures.
- Benefits subject to annual review.
- Dependent benefits valid until deceased member's coverage expires.
Benefit Availment
- Must present PhilHealth ID or valid proof of senior citizen status.
- Enrollment during or after confinement allowed if documents attached to claim.
- Dependents require PhilHealth Benefit Eligibility Form and member data record or PMRF.
- PhilHealth CARES staff to assist members in accredited hospitals.
Transitory Provisions
- Senior citizens confined between November 25, 2014 and Circular effectivity with no prior automatic benefits have 60 days to file claims.
- Required documents include PMRF, claim forms, clinical records, waiver forms, and other supporting documents.
Repealing Clause
- Inconsistent previous PhilHealth issuances repealed or amended.
Effectivity
- Circular effective fifteen days after publishing in two newspapers.
- To be deposited with National Administrative Register at UP Law Center.