Law Summary
Application of Senior Citizens' Privilege for Health Services
- Implementation pursuant to R.A. 9257 and Administrative Order No. 177, s. 2004.
- Senior citizens entitled to discounts and free services in specified health settings:
- Subsidized medical and dental services (including diagnostics and labs) in inpatient/outpatient government service wards are free if medically necessary.
- 20% discount on medical and dental services in pay sections of government health facilities if medically necessary.
- 20% discount on services in private health facilities including specialized treatments.
- 20% discount on professional fees of attending health care professionals in private facilities.
Rules on the Application of Senior Citizens Privileges to PhilHealth Benefits
Subsidized Services in Government Facilities
- PhilHealth benefits first applied to services/items not subsidized by the government.
- Facility must attach official receipts for purchases claimed.
- Remaining benefits then applied to subsidized services.
- Adjustments allowed only if documented and not previously claimed.
- Sample calculation demonstrates benefit application priority.
Twenty Percent Discount in Pay Sections and Private Facilities
- 20% discount deducted first from the total hospital charges.
- PhilHealth reimbursement applies only on the remaining 80%.
- Sample calculation provided for hospital charges.
Twenty Percent Discount on Professional Fees
- 20% discount deducted first before PhilHealth benefit computation.
- If member pays professional fees fully and files claim, original official receipt (OR) must be attached.
- Under-deduction of benefit paid to member with original OR.
- Accredited professionals must issue OR reflecting 20% discount and PhilHealth reimbursement.
- Sample OR format provided illustrating the discount and reimbursement details.
Additional Warranties of Accreditation to Ensure Implementation
For Accredited Health Facilities
- Required postings: room rates, test fees, professional fees, medicines in conspicuous places.
- Price lists must be submitted with accreditation applications or renewals.
- Official receipts must state usual rates and discounted prices.
- Facilities must establish grievance mechanisms for senior citizens.
- Guidelines required on discipline and reporting for professionals refusing proper discounts.
- Non-compliance considered breach of accreditation and may lead to sanctions or non-renewal.
For Accredited Health Care Professionals
- Must post schedule of professional fees conspicuously.
- Must issue official receipts indicating 20% senior citizen discount and PhilHealth reimbursement.
- Copies of ORs for covered services made available to PhilHealth upon request.
Effectivity
- Guidelines effective 15 days after publication.
- Adopted on February 8, 2005 by Secretary Francisco T. Duque III, MD, MSc.