Guidelines for RA 9257 Senior Citizens Benefits

Coverage and who must comply

The Order applies to all hospitals and health-related facilities from both government and private sectors.
The Order applies to health care professionals and the Philippine Health Insurance Corporation (PhilHealth), and other related healthcare facilities and services.
The Order applies to establishments dispensing medicines, including drug stores, hospital pharmacies, pharmacies, and similar establishments dispensing medicines.
The Order covers senior citizens’ availment of privileges in the medical, dental, laboratory/diagnostic, and medicines contexts described in the guidelines.

Key definitions used

Medicines include both prescription and non-prescription medicines and articles approved by the Bureau of Food and Drugs (BFAD) for diagnosis, cure, mitigation, treatment, and prevention of disease and injury, excluding food and devices or their components/parts/accessories.
Unbranded generic medicines are drugs not covered by patent protection labeled solely by their international non-proprietary or generic name and without a brand name.
Medical devices are instruments, apparatus, machines, implants, or in vitro reagents intended for use, or actually used, for diagnosis, treatment, monitoring, or prevention, that do not achieve intended purposes by chemical action within or on humans and are not dependent on being metabolized to achieve results.
Medical services include hospital room and services, medical supplies, professional services of physicians and other health care professionals, and diagnostic/laboratory tests necessary for diagnosis and/or treatment.
Dental services include services related to oral examination, cleaning, fillings, extractions, gum treatments, restoration/replacement/repositioning of teeth, and alterations of the alveolar or periodontium process of the maxilla and mandible necessary for diagnosis and/or treatment.
Diagnostic and laboratory tests include X-ray, CT-scans, blood chemistry exams, histopathology and immunopathology, hematology, urine analysis, parasitology and bacteriology tests, serology, blood banking, and other diagnostic radiology/clinical laboratory examinations necessary for diagnosis and/or treatment.
Health care professional means any doctor of medicine, dentist, nurse, midwife, or other practitioner duly licensed to practice in the Philippines.
Establishments dispensing medicines include drug stores, hospital pharmacies (government or private), medical and optical clinics, and similar establishments dispensing medicines, duly licensed and/or franchised by BFAD and the local government units.
Government health facilities include specified government-operated or government-maintained hospitals and outpatient facilities, including DOH-retained hospitals; specialty hospitals that are government-owned and controlled corporations (GOCCs); medical clinics in GOCCs; and hospitals/health facilities owned and managed by local government units, state colleges and universities, the Department of National Defense, the Department of Interior and Local Government, and other government agencies. The government hospitals include service or charity or subsidized inpatient/outpatient sections and non-subsidized pay sections.
Private hospitals and medical facilities cover pay inpatient and outpatient privately owned health and medical facilities established/operated with private funding (including donation, principal/investment/other means by individuals or organizations), including hospitals and clinics licensed by the Bureau of Health Facilities and Services (BHFS) of the DOH and/or local government units.
Identification document means proof of senior citizen status used to avail benefits, including an ID issued by the city or municipal mayor/OSCA or barangay captain where the senior citizen resides, the passport of the senior citizen, and other documents establishing the person is a citizen of the Republic and at least sixty (60) years of age.

Health privileges and discounts granted

Free subsidized services (government service wards) are granted to all senior citizens confined in service wards of government health facilities, consisting of free medical and dental services, and free diagnostic and laboratory fees, when medically necessary and in accordance with available Clinical Practice Guidelines (CPGs) or Hospital Treatment Protocols.
20% discount (government pay sections) is granted to all senior citizens confined in pay sections (both inpatient and outpatient) of government health facilities, covering medical and dental services and diagnostic and laboratory fees, when medically necessary and compliant with available CPGs or Hospital Treatment Protocols.
20% discount (private health facilities) is granted to all senior citizens in private hospitals and medical facilities for medical and dental services and diagnostic and laboratory fees, including professional fees of attending doctors, and including use of specialized treatment rooms/equipment such as hemodialysis and radiotherapy, when medically necessary.
No discount for non-medically necessary services: services not medically necessary for treatment and diagnosis must not be provided with any discount, including cosmetic surgeries, executive check-up packages, physical examinations without clinical evidence of effectiveness and efficiency, and no discount for special reagents, dyes, contrast media, and radioactive isotopes used in laboratory and diagnostic tests.
20% discount on unbranded generic medicines is granted to senior citizens in the purchase of unbranded generic medicines from establishments dispensing medicines for their exclusive use.
PhilHealth membership encouragement: all Filipinos are encouraged to be PhilHealth members or dependents; senior citizens who are not yet non-paying PhilHealth members may become members if sponsored/enrolled by their Local Government Unit (LGU) or if they enroll as individually paying members.
PhilHealth discount application rule is implemented through the next operational mechanisms: when services fall within PhilHealth coverage, charges for services not included in subsidized services are deducted and charged to the senior citizen’s PhilHealth coverage before PhilHealth reimbursement for subsidized services.

Implementation rules in hospitals

Hospital bed for subsidized service wards (government) is deemed medically necessary when it complies with available CPGs or hospital treatment protocols and is granted free, charged to the hospital budget.
Inpatient laboratories and diagnostics (government service wards) are “free” for senior citizens when the attending physician determines medically necessity in accordance with available CPGs or Hospital Treatment Protocols, and when evidence-based health screening tests endorsed by the DOH are provided; otherwise, inpatient labs/diagnostics that are not medically necessary are granted only a 20% discount.
Outpatient laboratories and diagnostics (government) are free when the attending physician determines medically necessity in accordance with available CPGs or Hospital Treatment Protocols, DOH-endorsed evidence-based screening tests for the local setting are provided, the services are determined medically necessary, and the requesting physician is a government-employed physician in the government facility where testing will be conducted.
Outside physician requests (government) are granted only a 20% discount after final evaluation of the recipient government facility as medically necessary; no discount applies to special reagents, dyes, contrast media, and radioactive isotopes in laboratory/diagnostic tests.
Dental services (government subsidized free services) are granted free based on the medical necessity determination of the attending dentist.
PhilHealth interaction (government facilities) requires government facilities, when the senior citizen is a PhilHealth member or dependent, to deduct and charge services not included in subsidized services to the senior citizen’s PhilHealth benefits coverage before PhilHealth-accredited facilities seek reimbursement for subsidized services.

Pay-section discounts in government and private

Government pay sections—hospital bed: a hospital bed in pay sections is deemed medically necessary under available CPGs or Hospital Treatment Protocols, is charged to the senior citizen, and is granted a 20% discount.
Government pay sections—laboratory/diagnostic examinations: inpatient and outpatient laboratory and diagnostic examinations are granted a 20% discount, when diagnosis and/or treatment comply with available CPGs or hospital treatment protocols; facilities may designate Medical Officers for Senior Citizens (MOSC) to facilitate medical-necessity determination.
Government pay sections—service ward rule for labs/diagnostics: inpatient laboratories and diagnostics provided when a senior citizen is admitted beyond the service ward level are granted only a 20% discount.
Government pay sections—no discount on certain tests: no discount applies to special reagents, dyes, contrast media, and radioactive isotopes used in laboratory and diagnostic tests.
Government pay sections—PhilHealth rule: when the senior citizen is a PhilHealth member or dependent, the 20% discount is not charged to PhilHealth coverage; only the 80% of fees/charges the senior citizen is expected to shoulder may be charged to PhilHealth benefits.
Private hospitals—hospital bed: a hospital bed in a private hospital is deemed medically necessary and granted a 20% discount, with the smallest available room/board accommodation deemed medically necessary; if unavailable at confinement, all other room/board accommodations get a discount equivalent to the 20% discount in the smallest available accommodation; existing bed-related privileges also accrue to the senior citizen.
Private hospitals—laboratory/diagnostics: all inpatient and outpatient laboratory and diagnostic examinations receive a 20% discount based on the smallest room and board accommodation provided medical necessity and compliance with available CPGs or hospital treatment protocols; private facilities may use MOSC for medical necessity determination.
Private hospitals—dental services: dental services deemed medically necessary by the attending dentist receive a 20% discount.
Private hospitals—PhilHealth rule: when the senior citizen is a PhilHealth member or dependent, the 20% discount is not charged to PhilHealth benefits coverage; only the 80% of fees expected to be shouldered may be charged to PhilHealth benefits.
Private hospitals—professional fees: professional fees for inpatient and outpatient medical and dental services receive a 20% discount, and a corresponding official receipt must be issued by the concerned physician/dentist.

Unbranded generic medicines sale requirements

Discount dispensing is mandatory for eligible senior citizens buying unbranded generic medicines for exclusive use under the 20% discount.
Pharmacist discretion and legal sourcing: registered pharmacists in establishments have full discretion and responsibility in dispensing medicines, including generic alternatives, consistent with the Generics Act of 1988 and relevant laws.
Required proof for the discount is supported by: (1) the senior citizen’s identification document; (2) a doctor’s prescription containing required details (including senior citizen name, age, sex, address, date, generic name, dosage form/strength, quantity, physician/dentist address/contact, PRC license number, PTR number, and narcotic license number if applicable), and a prescription is required for over-the-counter medicines to safeguard health and prevent abuse; only prescriptions containing the listed information are honored; (3) a purchase booklet issued by OSCA containing specified senior and purchase information, with all medicine purchases recorded; and (4) an authorization letter plus the representative’s identification when purchased by a representative.
Prescription quantity rule: as a general rule, dispensing for any single occasion must not exceed one (1) month supply and must be in accordance with the physician’s prescription.
Special record book requirement: drug stores must maintain a special record book for senior citizens, subject to inspection by the BFAD and BIR.
Partial filling mechanics: for partial filling, the pharmacist must indicate the partially filled quantity in the special record book and the unfilled balance on the prescription; the senior citizen retains the partially filled prescription and presents it later to complete the quantity.
Promotional campaign discount coordination: establishments offering special discounted prices less than 20% of regular retail prices may deduct the percentage discount from the total 20% required by RA 9257, while ensuring a total 20% senior citizen discount is still observed.
Non-transferability: senior citizen medicine discount privileges are non-transferable and exclusive for the senior citizen.
Duty to report non-compliance: all establishments must comply with these medicine-discount guidelines, and OSCA chairpersons are instructed to report non-compliance.

Stakeholder duties and posted information

Senior citizen verification requirement: hospitals (government and private) must require senior citizens to present any of the following: (1) an ID card issued by the city/municipal mayor/OSCA or barangay captain of residence; (2) the senior citizen’s passport; or (3) other documents establishing citizenship and at least sixty (60) years of age.
Government facilities—price posting: government facilities must post room rates, laboratory/diagnostic fees, medicine prices, and other fees/rates in conspicuous places near or at the main entrance and must submit the price lists annually to the National Center for Health Facility Development-DOH and PHIC.
Government facilities—posting of the administrative order: government facilities must post the Order in conspicuous places where consumers/patients can access the information and policies governing discounts/free services.
Government facilities—official receipts and discount pricing: official receipts must be issued for every paid-for medical/dental service, laboratory/diagnostic test, and medicine; receipts must state the usual rates/fees and the discounted price.
Government facilities—no precondition income testing: no “Income Means Test” nor any other tests shall be applied to senior citizens as a precondition for availing free services described.
Private hospitals—room rates posting and diagnostic transparency: private hospitals must post room rates in the admitting section; diagnostic and laboratory tests based on room/board accommodation, medical supplies, and medicines must be provided upon request of the senior citizen with a list ensuring discount validation.
Private hospitals—official receipts and attachment: private hospitals must issue official receipts for paid-for services/medicines; the 20% discount is granted upon full payment, and a billing statement showing usual rates/fees and the discounted price must be attached to the official receipt.
Private hospitals—grievance mechanism: private hospitals must set up a grievance mechanism to entertain questions about discounts on professional fees.
Private hospitals—written notice of sanctions: private hospitals must inform in writing the aggrieved party of the necessary sanction for health professionals who refuse to grant the proper discount.
Health care professionals—administrative and anti-abuse duties: health care professionals must (1) inscribe their name and PRC number in request for diagnostics/labs and in medicine prescriptions; (2) ensure prescriptions are for exclusive use of the senior citizen to curb abuse by non-seniors; (3) inform the senior citizen of usual fees; and (4) provide an official receipt stating usual and discounted professional fees.
Drugstores—generic menu and receipts: drugstores must provide, upon request of the senior citizen, a generic menu card, and must provide an official receipt stating usual prices and discounted prices.

Funding responsibilities for discounts

Government funding—initial and subsequent appropriations: the amount necessary to carry out the Act in government health facilities upon effectivity is charged out of the funds of the Office of the President, and subsequent sums needed are included in the subsequent General Appropriations Act.
Quarterly reporting for CY 2004 and CY 2005: government hospitals must submit quarterly the number of senior citizens served and the unit costing per senior citizen to their respective National Government Agency or LGU for reimbursement at the Office of the President.

Budget inclusion starting CY 2006: starting CY 2006, National Government Agencies or LGUs must include in their budget proposals funding necessary to implement programs and services required by the Order.
GOCCs—quantified free service charge: for government owned and controlled corporations, the total amount of discounts granted to senior citizens is charged to the Quantified Free Service.
Private funding—income tax deduction structure: costs of the 20% discount in private establishments are partially funded by deduction of the discount from gross income for the same taxable year the discount is granted, provided total claimed tax deduction net of VAT if applicable is included in gross sales receipts for tax purposes and is subject to proper documentation and to the National Internal Revenue Code, as amended; the remaining cost not funded this way is borne by the provider.

Penalties and sanctions

Violation by any person—first offense: a fine of not less than PHP 50,000 but not exceeding PHP 100,000, and imprisonment of not less than six (6) months but not more than two (2) years, applies for the first violation of any provision of RA 9257 as implemented by the Order.
Violation by any person—subsequent offenses: a fine of not less than PHP 100,000 but not exceeding PHP 200,000, and imprisonment of not less than two (2) years but not more than six (6) years, applies for any subsequent violation.
Abuse of privileges by any person: abuse is punished with a fine of not less than PHP 5,000 but not more than PHP 50,000 and imprisonment of not less than six (6) months.
Alien or foreign offender: if the offender is an alien or foreigner, he/she is deported immediately after service of sentence without further deportation proceedings.
Violation by corporations: if the offender is a corporation, organization, or similar entity, officials directly involved are liable.
Cancellation/revocation of permits: upon filing of an appropriate complaint, and after due notice and hearing, proper authorities may cause cancellation or revocation of business permit, permit to operate, franchise, and other similar privileges of any business entity that fails to abide by the Act’s provisions.