Law Summary
Definition of Sufficient Regularity in Premium Payment
- Sufficient regularity is defined as the payment of premiums for at least nine (9) months within the twelve (12) months immediately preceding the month of availment.
Updated PhilHealth Contribution Payment Rule
- The Corporation mandates nine (9) months of premium contributions within the preceding twelve (12) months before benefit availment.
- This applies to all confinements and the availment of outpatient benefits.
- Based on three conditions: payment of three (3) months within six (6) months, proof of regularity with nine (9) months in the last twelve (12), and absence of legal penalties.
Illustration of Compliance with Contribution Requirement
- Example: For confinement on March 15-16, 2011:
- Condition 1: Three months paid premiums between September 2010 to February 2011.
- Payment must be made before the confinement date; payment during confinement counts for future benefits only.
- Example of deadline: Payment for January-March 2011 made on March 14, 2011 is valid; payment on March 15 or later is not.
Sufficient Regularity Illustrated
- Nine (9) months of paid contributions from March 2010 to February 2011 are required for March 2011 benefits.
- If the February payment is not settled, it must be paid before the last day prior to confinement (e.g., March 14, 2011).
- Late payments during or after confinement apply only to future availments.
Exceptions and Implementation
- Requirements do not apply to members under the Sponsored Program, Lifetime (Non-Paying) Program, and Overseas Workers Programs (OWP).
- Policy effective for all benefits beginning July 1, 2011.
- All inconsistent provisions are repealed or amended accordingly.