Policy and government health goal
- PhilHealth and the Armed Forces of the Philippines (AFP) act to promote social health insurance.
- Their collaboration aims to achieve universal health care coverage.
- PhilHealth and AFP agree to collaborate to provide continuous coverage of AFP pensioners under the Individually Paying Program (IPP), a component program of PhilHealth for self-employed, professionals and voluntary members.
Collaboration basis and operational start
- PhilHealth and AFP commit to work together under Operational Guidelines dated October 24, 2011.
- The collaboration provides a mechanism for AFP pensioners to pay PhilHealth premium contributions via pension deduction.
Coverage and eligible pensioners
- AFP pensioners enroll under the Individually Paying Program (IPP) through pension deduction based on the procedures in the circular.
- The circular covers AFP pensioners except those who are 56 years old and are qualified under the Lifetime Member Program.
- Coverage includes AFP pensioners who are retired AFP personnel who are not yet 56 years old.
- Coverage includes qualified beneficiaries of deceased AFP uniformed personnel.
Defined terms for the program
- “AFP Finance Center” is the office of AFP tasked to execute payment of pensions.
- “AFP Pension and Gratuity Management Center (PGMC)” is the AFP office responsible for managing pension and separation benefits of AFP personnel and their legal beneficiaries under applicable retirement laws.
- “Authority to Deduct (ATD) PhilHealth Premium” is a form accomplished by the pensioner signifying interest to join the program and serving as proof of consent/authorization for deduction of monthly PhilHealth premiums; payment options are indicated in the form.
- “Certificate of Qualified AFP Pensioner” is a certificate issued by the AFP Finance Center certifying qualification/eligibility of the pensioner(s) to be part of the program and to be deducted PhilHealth premium through pension deduction based on their pension status.
- “Pension” is the retirement benefit received monthly by AFP pensioners from which PhilHealth premium shall be deducted.
- “Pensioner (AFP)” is a retired military person or legal beneficiary receiving pension; an optional retiree is an AFP personnel who availed of early retirement after 20 years in service; a Complete disability discharge retiree is separated due to physical disability incurred in the line of duty.
Enrollment, forms, and consent
- AFP pensioners must fill out the PhilHealth Member Registration Form (Annex A).
- AFP pensioners must attach a photocopy of appropriate documentary requirements for qualified dependents.
- AFP pensioners must attach a photocopy of their pensioner’s ID.
- AFP pensioners must fill out the Authority to deduct PhilHealth Premium (ATD) (Annex B).
- The ATD (Annex B) constitutes the pensioner’s consent/authorization for payment of PhilHealth premiums via pension deduction.
Where to submit and how to obtain forms
- Pensioners may submit their documents at any PhilHealth Regional Office (PHRO), Service Office (SO), and Branch.
- Pensioners may also submit their documents at AFP Camps, including AFP PGMC at Camp Aguinaldo.
- The forms are available at PhilHealth offices and AFP camps.
- The forms are downloadable from PhilHealth website (philhealth.gov.ph) and AFP websites AFP-PGMC (afppension.ghq_mqo.com) and AFP-Finance Center (afpfinancecenter.com).
Premium deduction, remittance, and advance payment
- The AFP Finance Center deducts premium contributions from AFP pensioners’ pensions at Camp Aguinaldo.
- Deductions are made based on the signed ATDs indicating the amount of contribution as prescribed by PhilHealth.
- Optional retirees who avail of lump sum pensions must pay in advance the contributions corresponding to the number of years they will not receive their monthly pensions.
- AFP must remit the collected premiums to PhilHealth on or before the 10th day of the month succeeding the applicable/payroll month.
Benefit availment, claims, and supporting documents
- Benefit entitlement by AFP pensioners enrolled under the project is governed by PhilHealth Circular No. 24, s-2003 on the Omnibus Guidelines on the Entitlement to NHIP Benefits.
- AFP pensioners enrolled under the project and their dependents must submit documents when availing benefits in accredited healthcare providers.
- The required benefit-availment documents are:
- a duly accomplished PhilHealth Claim Form 1;
- a clear copy of Certificate of Premium Payment (Annex C) or Certificate of Qualified AFP Pensioner/s (Annex D); and
- a clear copy of the Member Data Record (MDR).
- For updating records and related requirements, the documentary rules under PhilHealth Circular No. 26, s-2006 on Updated Summary of Documentary Requirements apply.
- Claims processing follows PhilHealth Circular No. 26, s-2006 on the Updated List of Documentary Requirements in the Availment of PhilHealth Benefits.
- Claims processing includes requirements on local and overseas confinements, including information on automatic deduction and direct filing.
Operational responsibility and administrative effect
- The circular operationalizes pension deduction through the AFP Finance Center as the office executing pension payments and carrying out premium deductions based on eligible pension status.
- The circular operationalizes pension and separation benefits management through the AFP Pension and Gratuity Management Center (PGMC).
- The program’s implementation requires pensioner enrollment through PhilHealth registration and execution of the ATD (Annex B) as consent/authorization for deduction.