Title
PhilHealth Premiums for Accredited Health Providers
Law
Philhealth Circular No. 06, S. 2011
Decision Date
Mar 22, 2011
PhilHealth Circular No. 06, S. 2011 establishes payment options for premium contributions of accredited professional health care providers categorized as individually paying members, ensuring compliance with the National Health Insurance Program while outlining consequences for non-payment and provisions for income-based exemptions.
A

Payment Schemes for Premium Contributions

  • PHCPs may choose between two payment options upon accreditation application:
    1. Full Payment: Pay premium contributions upfront covering the entire valid accreditation period (up to 3 years)
    2. Partial Payment: Pay premiums equivalent to current year's applicable quarters upfront, with subsequent payments due by March 31 of succeeding years
  • Partial payment must cover total premiums within a maximum of three installments
  • Example detailed illustrating quarterly payments aligned with accreditation validity

Timeline and Amounts for Partial Payments

  • 1st Payment: upon application, covers premium contributions from application date to December of current year
  • 2nd and 3rd Payments: due by March 31 of the following years; may cover one or more years of premium contributions
  • Total payments cannot exceed three installments for the entire accreditation period

Consequences of Non-Payment

  • Each missed payment (full or partial) during accreditation counts as one (1) violation
  • Violations considered under PhilHealth Circular 10, s. 2008, affecting future accreditation renewal or re-accreditation

Income-Based Exemption from Premium Increase

  • PHCPs with average family income of P25,000/month or less pay a fixed annual premium of P1,200 (P300 per quarter)
  • Income eligibility must be supported by the latest Income Tax Return or Community Tax Certificate
  • If claims data later shows income exceeding P25,000/month for 12 months, standard premium rates apply for remaining accreditation period
  • PHCPs currently accredited but no longer formally employed remain responsible for individually paying premiums

Effectivity and Repeal of Inconsistent Guidelines

  • This circular supersedes previous conflicting issuances and guidelines
  • Effective 15 days after publication in the official gazette or a newspaper of general circulation

Signatory

  • Signed and adopted by Dr. Rey B. Aquino, PhilHealth President and CEO, on March 22, 2011

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