Tuesday, December 29, 2009
Friday, December 25, 2009
Wednesday, December 23, 2009
Wednesday, September 23, 2009
Age 21 @ PHILHEALTH
When you are age 21 and unexpectedly get hospitalize, you cannot avail of PhilHealth benefits because perhaps you are neither a member nor can be covered under your parents’ PhilHealth.
But still you can take option for the continuance of PhilHealth coverage if you enroll or shift to Individually Paying program.
Most enrollee in the group are newly graduated professionals who are not yet employed, medical, law and graduate students, seminarians, priests, ministers, media practitioners and self-employed professionals.
Premium is at affordable rate of100 pesos per month. After a quarter of membership or in the 4th month thereto, enrollee becomes eligible to avail PhilHealth benefits for some medical related treatment except for maternity care benefits and certain elected surgical cases, that a sufficient regularity of payments that is, payment of 3-quarters prior confinement is observably required.
Upon application, prospect member will just present their birth certificate, an original copy to be authenticated by Philhealth frontline staff. In its absence, presentation of baptismal certificate or any two valid IDs maybe done for registration. Applicant must remit the initial contribution of P300 for the outright issuance of PIN and MDR.
As to the mode and easiness of payment, a member can pay by quarter which has its deadline on the last working day of applicable quarter, or post an advance semi-annual or annual remittance. The member or its representative may opt to pay at any of PhilHealth Service Office, accredited Banks or MLhuiller branches within Region VI, as its authorized collecting agents.
Member contracting marriage, can then register his/her spouse to become a dependent and later with the consequent offspring. Only direct family members can be included as dependents, which include parents who are at least 60 years old, provided such dependent is totally dependent from member for support. (Larry T. Tabsing)
But still you can take option for the continuance of PhilHealth coverage if you enroll or shift to Individually Paying program.
Most enrollee in the group are newly graduated professionals who are not yet employed, medical, law and graduate students, seminarians, priests, ministers, media practitioners and self-employed professionals.
Premium is at affordable rate of100 pesos per month. After a quarter of membership or in the 4th month thereto, enrollee becomes eligible to avail PhilHealth benefits for some medical related treatment except for maternity care benefits and certain elected surgical cases, that a sufficient regularity of payments that is, payment of 3-quarters prior confinement is observably required.
Upon application, prospect member will just present their birth certificate, an original copy to be authenticated by Philhealth frontline staff. In its absence, presentation of baptismal certificate or any two valid IDs maybe done for registration. Applicant must remit the initial contribution of P300 for the outright issuance of PIN and MDR.
As to the mode and easiness of payment, a member can pay by quarter which has its deadline on the last working day of applicable quarter, or post an advance semi-annual or annual remittance. The member or its representative may opt to pay at any of PhilHealth Service Office, accredited Banks or MLhuiller branches within Region VI, as its authorized collecting agents.
Member contracting marriage, can then register his/her spouse to become a dependent and later with the consequent offspring. Only direct family members can be included as dependents, which include parents who are at least 60 years old, provided such dependent is totally dependent from member for support. (Larry T. Tabsing)
PF of Government Salaried Physicians
Professional fees (PF) paid by PhilHealth for salaried physicians in government or private training hospitals are pooled for hospital personnel. It has been a policy that the services of the accredited medical practitioners are paid even though they are employed by the government. PFs’ total amount are pooled to form as additional remuneration equally shared by every hospital staff so as in return will offer better services towards PhilHealth patients. Disposition of such is left to the discretion of hospital management or the hospital chief.
In claiming PhilHealth benefits, physician who actually rendered the service must be the signatory in the Claim Form 2 declaring therein that PF is payable to the director, administrator or hospital’s chief. However, the medical director, administrator (physician), chief of clinic or department heads can also sign for the government salaried physicians for as long as these are set aside for pooling, hence, maybe compensated.
Computation of benefits like daily visit shall be based on rate for non-specialists according to what is prescribed in the New Benefit Schedule. While the Peso Conversion Factor (PCF) of 40 shall be used in the computation of professional fee regardless of the accreditation category of the medical director, administrator, etc. except when the said medical director is also the provider of the service as reflected in the operative record, OB sheet or endoscopy report. With this, computation of professional fee is based on the accreditation category of the subject physician-signatory.
To this effect, PhilHealth has prescribed the list of procedures and services which are limited to the specified subclass of doctors. Preoperative Inpatient Consultations are either done by physician who is a diplomate or fellow of Philippine Academy of Family Physicians, College of Physicians, Pediatric Society or Neurological Association. Same is required to radiology services that need to be a fellow or diplomate member of Philippine College of Radiology and for procedures of flourescein angiography from the Philippine Academy of Ophthalmology.
Claims for PF of the above services provided by doctors who are not authorized to render such services are disallowed. Doctors providing surgery or anesthesia services who are classified as general practitioners based on maximum of 80 Relative Value Unit (RVU) for surgeries and RVU –linked services on secondary and tertiary classified hospitals, that is, 3,200 pesos for surgeries per RVU services and 1,280 pesos for anesthesia services and exempted from this rule are government salaried physicians and payment for PF is for pooling. (Larry T. Tabsing)
In claiming PhilHealth benefits, physician who actually rendered the service must be the signatory in the Claim Form 2 declaring therein that PF is payable to the director, administrator or hospital’s chief. However, the medical director, administrator (physician), chief of clinic or department heads can also sign for the government salaried physicians for as long as these are set aside for pooling, hence, maybe compensated.
Computation of benefits like daily visit shall be based on rate for non-specialists according to what is prescribed in the New Benefit Schedule. While the Peso Conversion Factor (PCF) of 40 shall be used in the computation of professional fee regardless of the accreditation category of the medical director, administrator, etc. except when the said medical director is also the provider of the service as reflected in the operative record, OB sheet or endoscopy report. With this, computation of professional fee is based on the accreditation category of the subject physician-signatory.
To this effect, PhilHealth has prescribed the list of procedures and services which are limited to the specified subclass of doctors. Preoperative Inpatient Consultations are either done by physician who is a diplomate or fellow of Philippine Academy of Family Physicians, College of Physicians, Pediatric Society or Neurological Association. Same is required to radiology services that need to be a fellow or diplomate member of Philippine College of Radiology and for procedures of flourescein angiography from the Philippine Academy of Ophthalmology.
Claims for PF of the above services provided by doctors who are not authorized to render such services are disallowed. Doctors providing surgery or anesthesia services who are classified as general practitioners based on maximum of 80 Relative Value Unit (RVU) for surgeries and RVU –linked services on secondary and tertiary classified hospitals, that is, 3,200 pesos for surgeries per RVU services and 1,280 pesos for anesthesia services and exempted from this rule are government salaried physicians and payment for PF is for pooling. (Larry T. Tabsing)
PhilHealth for Senior Citizens
Not all senior citizens are eligible to avail PhilHealth benefits unless one becomes a Philhealth enrollee - a voluntary member, a lifetime member or a dependent of a PhilHealth member.
“There are membership programs which are being provided for our elderly, for them to avail our PhilHealth benefits”, said Regional Vice President Alberto C. Manduriao.
Voluntary members under the Individually Paying program remit the monthly premium contributions while Lifetime members no longer need to pay. And some can be a dependent of their spouse or children.
Eligible members and their dependents avail benefits when confined at any accredited health care facilities for reasons of illness or injury and for undergoing compensable out-patient procedures.
According to Dr. Royce S. Reyes, Chief of Benefit Administration Section of PhRO VI, the commonly filed claims applications for them were illnesses of renal, cardio-vascular and respiratory. Cases like hypertension, diabetes which sometimes resulted to a chronic renal disease and require dialysis sessions.
“Other patients were admitted because of complications like pneumonia and chronic obstructive pulmonary disease”, Reyes noted, “and these are classified under the New PhilHealth Inpatient Benefit Schedule as case Type C”.
When admitted at a Tertiary Hospital under case type C, a member in a single period of confinement may avail a maximum of P28,000 for drugs and medicines; P21,000 for laboratory and supplies. The accredited doctor’s visit is paid at a maximum of P4,000 for General Practitioner and P5,600 when the physician is a Specialist.
Other examples of Case Type C are cerebro vascular disease or stroke, carcinomas with metastasis or even undergoing chemo and radio therapy. The OR fee is pegged at P1,200 per session and Professional Fee for accredited Specialist is at P560 per session.
This ceiling of benefit can also be availed in case of death without a specified caused during confinement. Payment will depend on the actual compensable items incurred by the patient.
However, there are conditions specified by PhilHealth (National Health Insurance) law and this must be construed in relation to other special laws. To become a Lifetime member, one must meet the twin requirements - the age and the contribution factors.(Larry T. Tabsing)
“There are membership programs which are being provided for our elderly, for them to avail our PhilHealth benefits”, said Regional Vice President Alberto C. Manduriao.
Voluntary members under the Individually Paying program remit the monthly premium contributions while Lifetime members no longer need to pay. And some can be a dependent of their spouse or children.
Eligible members and their dependents avail benefits when confined at any accredited health care facilities for reasons of illness or injury and for undergoing compensable out-patient procedures.
According to Dr. Royce S. Reyes, Chief of Benefit Administration Section of PhRO VI, the commonly filed claims applications for them were illnesses of renal, cardio-vascular and respiratory. Cases like hypertension, diabetes which sometimes resulted to a chronic renal disease and require dialysis sessions.
“Other patients were admitted because of complications like pneumonia and chronic obstructive pulmonary disease”, Reyes noted, “and these are classified under the New PhilHealth Inpatient Benefit Schedule as case Type C”.
When admitted at a Tertiary Hospital under case type C, a member in a single period of confinement may avail a maximum of P28,000 for drugs and medicines; P21,000 for laboratory and supplies. The accredited doctor’s visit is paid at a maximum of P4,000 for General Practitioner and P5,600 when the physician is a Specialist.
Other examples of Case Type C are cerebro vascular disease or stroke, carcinomas with metastasis or even undergoing chemo and radio therapy. The OR fee is pegged at P1,200 per session and Professional Fee for accredited Specialist is at P560 per session.
This ceiling of benefit can also be availed in case of death without a specified caused during confinement. Payment will depend on the actual compensable items incurred by the patient.
However, there are conditions specified by PhilHealth (National Health Insurance) law and this must be construed in relation to other special laws. To become a Lifetime member, one must meet the twin requirements - the age and the contribution factors.(Larry T. Tabsing)
NO PIN-NO CLAIM WITH PHILHEALTH
No PhilHealth Identification Number (PIN) - No Claim, a strict policy that will be implemented in CY 2010.
As early as of this time, PhilHealth instituted measures to lead members in complying with this personal and unique requirement. A Regional Advisory was issued to enjoin compliance in advising all Accredited Collecting Banks and Agents like MLhuiller to refer all paying members/employers with No PIN/PEN directly to PhilHealth Office to secure the same.
Subject of this advisory are Employed and OFWs and some Individually Paying Members. An applicant needs only to fill out a request form, submit and wait for the immediate issuance of his/her PIN. While it allows the Employer’s Admin/HR or liaison officers to facilitate on behalf of their employees, personal transaction is encouraged especially when they have to update record of their dependents. Aside from the PIN, PhilHealth also requires Member Data Record (MDR) especially when availing benefits.
PhilHealth observed that among the employed sector, most Private Employers neither have their PhilHealth Employer Number (PEN) nor PIN of their employees. From the government, it is obvious that most of the teachers, military and police personnel have not yet secured their PIN.
As a current policy, PhilHealth allows the use of SSS and GSIS policy number in posting the member’s premium contribution payments as well as in claims filing.
The clean up utility mapping drive by PhilHealth VI Contribution Section revealed that more than 7,000 registered employees have no PIN. Unfortunately, considerable quantity of those requesting for MDR are members with confinement who apply for their PhilHealth Identification Number only during such request.
As to OFWs, those who hastily left the country for work did not have their PIN for only the registration process was complied by them.
Under the Universal Counter System of PhilHealth (all-in-1 system), member may approach any of our Service Offices and all their concerns are set to be acted directly.
A member can invoke his/her rights to PhilHealth but along these rights is an attached responsibility, one of this is applying for Philhealth Identification Number (PIN). (Larry T. Tabsing)
As early as of this time, PhilHealth instituted measures to lead members in complying with this personal and unique requirement. A Regional Advisory was issued to enjoin compliance in advising all Accredited Collecting Banks and Agents like MLhuiller to refer all paying members/employers with No PIN/PEN directly to PhilHealth Office to secure the same.
Subject of this advisory are Employed and OFWs and some Individually Paying Members. An applicant needs only to fill out a request form, submit and wait for the immediate issuance of his/her PIN. While it allows the Employer’s Admin/HR or liaison officers to facilitate on behalf of their employees, personal transaction is encouraged especially when they have to update record of their dependents. Aside from the PIN, PhilHealth also requires Member Data Record (MDR) especially when availing benefits.
PhilHealth observed that among the employed sector, most Private Employers neither have their PhilHealth Employer Number (PEN) nor PIN of their employees. From the government, it is obvious that most of the teachers, military and police personnel have not yet secured their PIN.
As a current policy, PhilHealth allows the use of SSS and GSIS policy number in posting the member’s premium contribution payments as well as in claims filing.
The clean up utility mapping drive by PhilHealth VI Contribution Section revealed that more than 7,000 registered employees have no PIN. Unfortunately, considerable quantity of those requesting for MDR are members with confinement who apply for their PhilHealth Identification Number only during such request.
As to OFWs, those who hastily left the country for work did not have their PIN for only the registration process was complied by them.
Under the Universal Counter System of PhilHealth (all-in-1 system), member may approach any of our Service Offices and all their concerns are set to be acted directly.
A member can invoke his/her rights to PhilHealth but along these rights is an attached responsibility, one of this is applying for Philhealth Identification Number (PIN). (Larry T. Tabsing)
Benefit Packages
A SEPARATE transmittal is now required to Health Care Providers (HCP) in filing PhilHealth Packages apart from the regular claims to hasten the turn around time of processing.
PhilHealth Regional Office (PhRO) VI issued an Advisory effective June 1, 2009. It also directed that Professional Fee (PF) whether actual, deducted or net should be included in the Statement of Account or Billing Statement to ensure that reimbursements are provided to the rightful beneficiary for the PF. This shall be added prior to the signature of the member or the authorized representative confirming or concurring thereto.
PhilHealth Packages are derived from Maternity Care - Normal Spontaneous Delivery (MCP-NSD), Newborn Care (NCP), Voluntary Surgical Contraception Procedures, TB-DOTS, and Cataract claims. Other benefit packages are Outpatient Malaria, Severe Acute Respiratory Syndrome (SARS), Avian Influenza (Bird Flu) and Swine (H1N1) Flu.
Payments under the schemes are generally made to the accredited health care providers, facilities and professionals, for the supposed complete services to PhilHealth beneficiaries.
MCP covers 1st to 4th normal spontaneous deliveries both in hospital and non-hospital maternity facilities for a case rate of P4,500. (Non-hospital facility: P3250 for pre- natal, delivery & newborn care +P850 for post-natal and family planning. For hospital - P2,500 for room and board, drugs and medicines, diagnostic and OR fee; P2,000 for health care professional).
NCP rate is P1,000 which covers the newborn screening (P500), 1st dose of Hepa B (P250) and vaccination, BCG and others (P250).
TB-DOTS Package on the other hand, has a case payment of P4,000. Of which, P2,500 is paid after the intensive phase and P1,500 is given after the maintenance phase under eligibility criteria that the TB case is new or the patient neither had a treatment for TB nor has taken up TB drugs for less than one month; it has smear positive or negative pulmonary TB or extrapulmonary TB; and TB of children. Excluded to the package are cases of failure on previous treatment, relapse or return after default.
Cataract Package case rate is P16,000 - P8,000 for charges on room, drugs, meds, supplies including intraocular lens, x-ray, laboratory & ancillary procedures and use of OR complex and machines while the other P8,000 is paid to the doctor. Pre-operative tests done prior the confinement, consultation and physician standby service, PF for anesthesia service and complex cataract surgery (RVS code 66982) requiring techniques not generally used in routine cataract surgery or performed in amblyogenic developmental stage are excluded.
Voluntary Surgical Contraception Procedures, Bilateral Tubal Ligation (BTL) and Vasectomy has a case payment of P4,000. The component of which is P3,000 for the facility services and P1,000 for physician to cover family planning counseling and client assessment, intraoperative service services including provision of anesthesia and postoperative consultation procedures including management of complications.
PhilHealth Regional Office (PhRO) VI issued an Advisory effective June 1, 2009. It also directed that Professional Fee (PF) whether actual, deducted or net should be included in the Statement of Account or Billing Statement to ensure that reimbursements are provided to the rightful beneficiary for the PF. This shall be added prior to the signature of the member or the authorized representative confirming or concurring thereto.
PhilHealth Packages are derived from Maternity Care - Normal Spontaneous Delivery (MCP-NSD), Newborn Care (NCP), Voluntary Surgical Contraception Procedures, TB-DOTS, and Cataract claims. Other benefit packages are Outpatient Malaria, Severe Acute Respiratory Syndrome (SARS), Avian Influenza (Bird Flu) and Swine (H1N1) Flu.
Payments under the schemes are generally made to the accredited health care providers, facilities and professionals, for the supposed complete services to PhilHealth beneficiaries.
MCP covers 1st to 4th normal spontaneous deliveries both in hospital and non-hospital maternity facilities for a case rate of P4,500. (Non-hospital facility: P3250 for pre- natal, delivery & newborn care +P850 for post-natal and family planning. For hospital - P2,500 for room and board, drugs and medicines, diagnostic and OR fee; P2,000 for health care professional).
NCP rate is P1,000 which covers the newborn screening (P500), 1st dose of Hepa B (P250) and vaccination, BCG and others (P250).
TB-DOTS Package on the other hand, has a case payment of P4,000. Of which, P2,500 is paid after the intensive phase and P1,500 is given after the maintenance phase under eligibility criteria that the TB case is new or the patient neither had a treatment for TB nor has taken up TB drugs for less than one month; it has smear positive or negative pulmonary TB or extrapulmonary TB; and TB of children. Excluded to the package are cases of failure on previous treatment, relapse or return after default.
Cataract Package case rate is P16,000 - P8,000 for charges on room, drugs, meds, supplies including intraocular lens, x-ray, laboratory & ancillary procedures and use of OR complex and machines while the other P8,000 is paid to the doctor. Pre-operative tests done prior the confinement, consultation and physician standby service, PF for anesthesia service and complex cataract surgery (RVS code 66982) requiring techniques not generally used in routine cataract surgery or performed in amblyogenic developmental stage are excluded.
Voluntary Surgical Contraception Procedures, Bilateral Tubal Ligation (BTL) and Vasectomy has a case payment of P4,000. The component of which is P3,000 for the facility services and P1,000 for physician to cover family planning counseling and client assessment, intraoperative service services including provision of anesthesia and postoperative consultation procedures including management of complications.
Wednesday, September 9, 2009
The Philhealth 60 days
The Philhealth 60 days
The 60day period is considered as quiet to be a long time for those awaiting for PhilHealth refund, however, a number still fails to beat the prescriptive limit. Under the policy, filing for local confinement is within 60 days and 180 days for confinement abroad. Late claims are simply, denied.
This period is prescribed by the national health insurance law. Bonafide member and their dependents can automatically avail benefits from any of the accredited facilities after presenting eligibility standard to avail medical care attention.
Actually, PhilHealth unlike other insurances extends to patient all the Philhealth benefits outrightly. One needs not to wait the 60 day when he can immediately charge to PhilHealth certain in and out-patient hospital supplies and services.
The very essence of hospitals is to provide medical services including drugs, medicines and supplies, diagnostics, laboratory and medical procedures and equipment. It is not pleasing but there are facilities that are claiming for the room & board and doctor’s fee but failed to provide other benefit items required for medication. So, one has to buy items outside and later claim the reimbursement from PhilHealth.
Lack or limited supplies and services aside from delimiting and overpricing of stocks when one has to charge it to Philhealth have been an issue raised against our health care providers. However, we have to note that PhilHealth pay claims of outside bought items and services. The option to what facility or health care professional PhilHealth patient would sought for treatment is on member’s discretion. Member should only remember that he has to file his claim within 60 days.
A member should also determine what items with the corresponding amount deducted from his billing before paying the uncovered amount. The official receipts both from the facility and the attending doctor are need to be asked by the member so that he has the evidenced records of all the actual medical expenses including the benefits availed.
PhilHealth does not pay for all your health care costs. It pays only for covered items and services when its rules are met. Members usually give a co-payment for the portion of the actual cost that is not covered by PhilHealth. As to medicines rules set that they must be generic and/or included in the PNDF. It innovates to give a lee way that drugs, medicines, supplies and necessary laboratory procedures supported by official receipts dated 30 days prior to admission can now be reimbursed like those in hemodialysis, peritoneal dialysis, chemotherapy and other elective surgeries.
Our partner-health care providers from time to time are keep updated of the latest issuances and various activities have been undertaken to promote close coordination. We establish a mechanism feedback for PhilHealth clients to air their grievances against PhilHealth staff and/or any of its stakeholders. (Larry T. Tabsing)
The 60day period is considered as quiet to be a long time for those awaiting for PhilHealth refund, however, a number still fails to beat the prescriptive limit. Under the policy, filing for local confinement is within 60 days and 180 days for confinement abroad. Late claims are simply, denied.
This period is prescribed by the national health insurance law. Bonafide member and their dependents can automatically avail benefits from any of the accredited facilities after presenting eligibility standard to avail medical care attention.
Actually, PhilHealth unlike other insurances extends to patient all the Philhealth benefits outrightly. One needs not to wait the 60 day when he can immediately charge to PhilHealth certain in and out-patient hospital supplies and services.
The very essence of hospitals is to provide medical services including drugs, medicines and supplies, diagnostics, laboratory and medical procedures and equipment. It is not pleasing but there are facilities that are claiming for the room & board and doctor’s fee but failed to provide other benefit items required for medication. So, one has to buy items outside and later claim the reimbursement from PhilHealth.
Lack or limited supplies and services aside from delimiting and overpricing of stocks when one has to charge it to Philhealth have been an issue raised against our health care providers. However, we have to note that PhilHealth pay claims of outside bought items and services. The option to what facility or health care professional PhilHealth patient would sought for treatment is on member’s discretion. Member should only remember that he has to file his claim within 60 days.
A member should also determine what items with the corresponding amount deducted from his billing before paying the uncovered amount. The official receipts both from the facility and the attending doctor are need to be asked by the member so that he has the evidenced records of all the actual medical expenses including the benefits availed.
PhilHealth does not pay for all your health care costs. It pays only for covered items and services when its rules are met. Members usually give a co-payment for the portion of the actual cost that is not covered by PhilHealth. As to medicines rules set that they must be generic and/or included in the PNDF. It innovates to give a lee way that drugs, medicines, supplies and necessary laboratory procedures supported by official receipts dated 30 days prior to admission can now be reimbursed like those in hemodialysis, peritoneal dialysis, chemotherapy and other elective surgeries.
Our partner-health care providers from time to time are keep updated of the latest issuances and various activities have been undertaken to promote close coordination. We establish a mechanism feedback for PhilHealth clients to air their grievances against PhilHealth staff and/or any of its stakeholders. (Larry T. Tabsing)
PhilHealth- CSR of ILECO 1
PhilHealth- CSR of ILECO 1
Iloilo Electric Cooperative (ILECO) 1 enrolled their member-consumers to the National Health Insurance program. As such, it will shoulder the yearly premium contributions. Under sponsored program, premium is shared by the Sponsor with the counterpart paid by the government thru PhilHealth.
Initially, ILECO 1 prioritized the head of the family so that all the qualified immediate kin can also benefit the social health program.
15 LGUs under its jurisdiction were tasked and became signatories to the tripartite Memorandum of Agreement forged with ILECO1 and PhilHealth. Their social welfare office identified indigent members screened through the conduct of means test. Part of the requirements was the passage of LGU Resolution adopting the program and every LGU supported the project.
Under the program, members with their dependents can avail PhilHealth benefits during the effectivity of their Philhealth cards. There are 694 PhilHealth ID card turned-over by PhilHealth to ILECO 1 and these will benefit around 4,000 beneficiaries this year.
Aside from the regular hospital benefits, sponsored members and dependents can avail free consultation and diagnostic procedures from Rural Health Units, avail 1st to 4th normal delivery package from accredited Maternity Centers and free tuberculosis treatment from any of the accredited TB-DOTS Center. Above to this, a Capitation Fund will be doled out by PhilHealth to the LGUs - 300 pesos per sponsored member to augment RHU medical finances in catering the needs of indigent PhilHealth patients.
During the MOA signing held last September 4, 2009 LCEs attended were mayors or their representatives. But the following LCEs took effort to be physically present and these include Vic Tabaquirao of Tubungan, 2nd district mayors, Arcadio Gorriceta of Pavia and Greg Villarico of San Miguel and Mayor Ramon Yee of Cabatuan. The rest had their representatives except for Tigbauan and Oton, while Mayor Ninfa Garin who earlier sent VM Aquiles Alcalde and their SBs, Cristine Garin of Guimbal and Juliet Flores of Miagao joined later.
MOA assignatories were ILECO 1 President Atty. Salvador P. Cabaluna III, RVP Alberto C. Manduriao for PhilHealth and the respective Local Chief Executives (LCE).
Witnessing the event were the members of the electric cooperative board together with its employees, and Engr. Raynaldo Sobusa who consistently made coordination for its realization.
“There is no politics here”, emphasized by Engr. Wilfred Billena, ILECO 1 General Manager, “we are just doing our Corporate Social Responsibility (CSR) to help our stakeholders”, he added. He pledged to continue this endeavor and assured to increase their beneficiaries next year.
“It’s the 1st in Region VI and we are very happy that this program is recognized as vehicle for Corporate Social Responsibility, a new trend in management, especially by ILECO 1 institution”, Lourdes F. Diocson, PhilHealth Field Operation Chief explained. (Larry T. Tabsing)
Iloilo Electric Cooperative (ILECO) 1 enrolled their member-consumers to the National Health Insurance program. As such, it will shoulder the yearly premium contributions. Under sponsored program, premium is shared by the Sponsor with the counterpart paid by the government thru PhilHealth.
Initially, ILECO 1 prioritized the head of the family so that all the qualified immediate kin can also benefit the social health program.
15 LGUs under its jurisdiction were tasked and became signatories to the tripartite Memorandum of Agreement forged with ILECO1 and PhilHealth. Their social welfare office identified indigent members screened through the conduct of means test. Part of the requirements was the passage of LGU Resolution adopting the program and every LGU supported the project.
Under the program, members with their dependents can avail PhilHealth benefits during the effectivity of their Philhealth cards. There are 694 PhilHealth ID card turned-over by PhilHealth to ILECO 1 and these will benefit around 4,000 beneficiaries this year.
Aside from the regular hospital benefits, sponsored members and dependents can avail free consultation and diagnostic procedures from Rural Health Units, avail 1st to 4th normal delivery package from accredited Maternity Centers and free tuberculosis treatment from any of the accredited TB-DOTS Center. Above to this, a Capitation Fund will be doled out by PhilHealth to the LGUs - 300 pesos per sponsored member to augment RHU medical finances in catering the needs of indigent PhilHealth patients.
During the MOA signing held last September 4, 2009 LCEs attended were mayors or their representatives. But the following LCEs took effort to be physically present and these include Vic Tabaquirao of Tubungan, 2nd district mayors, Arcadio Gorriceta of Pavia and Greg Villarico of San Miguel and Mayor Ramon Yee of Cabatuan. The rest had their representatives except for Tigbauan and Oton, while Mayor Ninfa Garin who earlier sent VM Aquiles Alcalde and their SBs, Cristine Garin of Guimbal and Juliet Flores of Miagao joined later.
MOA assignatories were ILECO 1 President Atty. Salvador P. Cabaluna III, RVP Alberto C. Manduriao for PhilHealth and the respective Local Chief Executives (LCE).
Witnessing the event were the members of the electric cooperative board together with its employees, and Engr. Raynaldo Sobusa who consistently made coordination for its realization.
“There is no politics here”, emphasized by Engr. Wilfred Billena, ILECO 1 General Manager, “we are just doing our Corporate Social Responsibility (CSR) to help our stakeholders”, he added. He pledged to continue this endeavor and assured to increase their beneficiaries next year.
“It’s the 1st in Region VI and we are very happy that this program is recognized as vehicle for Corporate Social Responsibility, a new trend in management, especially by ILECO 1 institution”, Lourdes F. Diocson, PhilHealth Field Operation Chief explained. (Larry T. Tabsing)
Wednesday, August 19, 2009
Monday, August 3, 2009
Wednesday, May 27, 2009
Monday, May 25, 2009
Thursday, May 21, 2009
PHILHEALTH BENEFIT PACKAGES
A SEPARATE transmittal soon to be required to Health Care Providers (HCP) in filing PhilHealth Packages apart from the regular claims to hasten the turn around time of processing.
PhilHealth Regional Office (PhRO) VI issued an Advisory to take effect on June 1, 2009. It also directed that Professional Fee (PF) whether actual, deducted or net should be included in the Statement of Account or Billing Statement to ensure that reimbursements are provided to the rightful beneficiary for the PF. This shall be added prior to the signature of the member or the authorized representative confirming or concurring thereto.
PhilHealth Packages are derived from Maternity Care - Normal Spontaneous Delivery (MCP-NSD), Newborn Care (NCP), Voluntary Surgical Contraception Procedures, TB-DOTS, and Cataract claims. Other benefit packages are Outpatient Malaria, Severe Acute Respiratory Syndrome (SARS), Avian Influenza (Bird Flu) and Swine (H1N1) Flu.
Payments under the schemes are generally made to the accredited health care providers, facilities and professionals, for the supposed complete services to PhilHealth beneficiaries.
MCP covers 1st to 4th normal spontaneous deliveries both in hospital and non-hospital maternity facilities for a case rate of P4,500. (Non-hospital facility: P3250 for pre- natal, delivery & newborn care +P850 for post-natal and family planning. For hospital - P2,500 for room and board, drugs and medicines, diagnostic and OR fee; P2,000 for health care professional).
NCP rate is P1,000 which covers the newborn screening (P500), 1st dose of Hepa B (P250) and vaccination, BCG and others (P250).
TB-DOTS Package on the other hand, has a case payment of P4,000. Of which, P2,500 is paid after the intensive phase and P1,500 is given after the maintenance phase under eligibility criteria that the TB case is new or the patient neither had a treatment for TB nor has taken up TB drugs for less than one month; it has smear positive or negative pulmonary TB or extrapulmonary TB; and TB of children. Excluded to the package are cases of failure on previous treatment, relapse or return after default.
Cataract Package case rate is P16,000 - P8,000 for charges on room, drugs, meds, supplies including intraocular lens, x-ray, laboratory & ancillary procedures and use of OR complex and machines while the other P8,000 is paid to the doctor. Pre-operative tests done prior the confinement, consultation and physician standby service, PF for anesthesia service and complex cataract surgery (RVS code 66982) requiring techniques not generally used in routine cataract surgery or performed in amblyogenic developmental stage are excluded.
Voluntary Surgical Contraception Procedures, Bilateral Tubal Ligation (BTL) and Vasectomy has a case payment of P4,000. The component of which is P3,000 for the facility services and P1,000 for physician to cover family planning counseling and client assessment, intraoperative service services including provision of anesthesia and postoperative consultation procedures including management of complications.
PhilHealth Regional Office (PhRO) VI issued an Advisory to take effect on June 1, 2009. It also directed that Professional Fee (PF) whether actual, deducted or net should be included in the Statement of Account or Billing Statement to ensure that reimbursements are provided to the rightful beneficiary for the PF. This shall be added prior to the signature of the member or the authorized representative confirming or concurring thereto.
PhilHealth Packages are derived from Maternity Care - Normal Spontaneous Delivery (MCP-NSD), Newborn Care (NCP), Voluntary Surgical Contraception Procedures, TB-DOTS, and Cataract claims. Other benefit packages are Outpatient Malaria, Severe Acute Respiratory Syndrome (SARS), Avian Influenza (Bird Flu) and Swine (H1N1) Flu.
Payments under the schemes are generally made to the accredited health care providers, facilities and professionals, for the supposed complete services to PhilHealth beneficiaries.
MCP covers 1st to 4th normal spontaneous deliveries both in hospital and non-hospital maternity facilities for a case rate of P4,500. (Non-hospital facility: P3250 for pre- natal, delivery & newborn care +P850 for post-natal and family planning. For hospital - P2,500 for room and board, drugs and medicines, diagnostic and OR fee; P2,000 for health care professional).
NCP rate is P1,000 which covers the newborn screening (P500), 1st dose of Hepa B (P250) and vaccination, BCG and others (P250).
TB-DOTS Package on the other hand, has a case payment of P4,000. Of which, P2,500 is paid after the intensive phase and P1,500 is given after the maintenance phase under eligibility criteria that the TB case is new or the patient neither had a treatment for TB nor has taken up TB drugs for less than one month; it has smear positive or negative pulmonary TB or extrapulmonary TB; and TB of children. Excluded to the package are cases of failure on previous treatment, relapse or return after default.
Cataract Package case rate is P16,000 - P8,000 for charges on room, drugs, meds, supplies including intraocular lens, x-ray, laboratory & ancillary procedures and use of OR complex and machines while the other P8,000 is paid to the doctor. Pre-operative tests done prior the confinement, consultation and physician standby service, PF for anesthesia service and complex cataract surgery (RVS code 66982) requiring techniques not generally used in routine cataract surgery or performed in amblyogenic developmental stage are excluded.
Voluntary Surgical Contraception Procedures, Bilateral Tubal Ligation (BTL) and Vasectomy has a case payment of P4,000. The component of which is P3,000 for the facility services and P1,000 for physician to cover family planning counseling and client assessment, intraoperative service services including provision of anesthesia and postoperative consultation procedures including management of complications.
Thursday, May 7, 2009
Wednesday, May 6, 2009
Monday, May 4, 2009
Wednesday, April 22, 2009
The New Cataract Payment Scheme
New cataract claim payment scheme
By: Larry Tabsing
PhilHealth payment of cataract extraction procedures shall now be on a case payment basis. The new policy has been laid down through PhilHealth Circular No. 16 2009 recently released by PhilHealth. This will be applicable to availment starting May 1, 2009.
By: Larry Tabsing
PhilHealth payment of cataract extraction procedures shall now be on a case payment basis. The new policy has been laid down through PhilHealth Circular No. 16 2009 recently released by PhilHealth. This will be applicable to availment starting May 1, 2009.
The new cataract package has a case payment scheme wherein claims arising from a cataract extraction procedures shall be paid P16,000 pesos regardless whether the procedure was done in one or both eyes in one operative session.
This payment scheme applies to all applicable health care providers for cataract surgery in an ambulatory surgical clinics, and in secondary or tertiary hospitals, whether done in outpatient or inpatient set up regardless of number of days of confinement. However, cataract procedures covered under this package are limited only for intracapsular cataract extraction with insertion of intraocular lens prosthesis; extracapsular cataract removal with insertion of intraocular lens prosthesis like irrigation and aspiration; and, phacoemulsification.
For this, P8,000 is payment for hospital charges for room and board, drugs and medicines used during confinement, x-ray, laboratory and ancillary procedures done during confinement and use of operating room complex and machines. While the other P8,000 goes to professional fee of doctor who performed the procedure.
For this, P8,000 is payment for hospital charges for room and board, drugs and medicines used during confinement, x-ray, laboratory and ancillary procedures done during confinement and use of operating room complex and machines. While the other P8,000 goes to professional fee of doctor who performed the procedure.
Excluded in the package are payment for preoperative tests done prior to confinement, professional fee for preoperative consultation and/or physician standby service as well as the anesthesia service, and complex cataract surgery requiring techniques not generally used in routine cataract surgery or performed on patients in the amblyogenic developmental stage.
In claims filing, in cases where members are required by hospitals to buy drugs, medicines and supplies or required to seek out other necessary services like laboratory procedures from other facilities, reimbursements to members is allowed if the facility cannot provide the necessary items and services covered by the benefit but these have been used during confinement. Members have to submit official documents and/or other purchased documents. Reimbursements however depend on the actual cost of the receipts submitted but not more than the difference between the maximum benefit and the facility reimbursement
In claims filing, in cases where members are required by hospitals to buy drugs, medicines and supplies or required to seek out other necessary services like laboratory procedures from other facilities, reimbursements to members is allowed if the facility cannot provide the necessary items and services covered by the benefit but these have been used during confinement. Members have to submit official documents and/or other purchased documents. Reimbursements however depend on the actual cost of the receipts submitted but not more than the difference between the maximum benefit and the facility reimbursement
The New Cataract Payment Scheme
New cataract claim payment scheme
By: Larry Tabsing
PhilHealth payment of cataract extraction procedures shall now be on a case payment basis. The new policy has been laid down through PhilHealth Circular No. 16 2009 recently released by PhilHealth. This will be applicable to availment starting May 1, 2009.
The new cataract package has a case payment scheme wherein claims arising from a cataract extraction procedures shall be paid P16,000 pesos regardless whether the procedure was done in one or both eyes in one operative session.
This payment scheme applies to all applicable health care providers for cataract surgery in an ambulatory surgical clinics, and in secondary or tertiary hospitals, whether done in outpatient or inpatient set up regardless of number of days of confinement. However, cataract procedures covered under this package are limited only for intracapsular cataract extraction with insertion of intraocular lens prosthesis; extracapsular cataract removal with insertion of intraocular lens prosthesis like irrigation and aspiration; and, phacoemulsification.
For this, P8,000 is payment for hospital charges for room and board, drugs and medicines used during confinement, x-ray, laboratory and ancillary procedures done during confinement and use of operating room complex and machines. While the other P8,000 goes to professional fee of doctor who performed the procedure.
Excluded in the package are payment for preoperative tests done prior to confinement, professional fee for preoperative consultation and/or physician standby service as well as the anesthesia service, and complex cataract surgery requiring techniques not generally used in routine cataract surgery or performed on patients in the amblyogenic developmental stage.
In claims filing, in cases where members are required by hospitals to buy drugs, medicines and supplies or required to seek out other necessary services like laboratory procedures from other facilities, reimbursements to members is allowed if the facility cannot provide the necessary items and services covered by the benefit but these have been used during confinement. Members have to submit official documents and/or other purchased documents. Reimbursements however depend on the actual cost of the receipts submitted but not more than the difference between the maximum benefit and the facility reimbursement
By: Larry Tabsing
PhilHealth payment of cataract extraction procedures shall now be on a case payment basis. The new policy has been laid down through PhilHealth Circular No. 16 2009 recently released by PhilHealth. This will be applicable to availment starting May 1, 2009.
The new cataract package has a case payment scheme wherein claims arising from a cataract extraction procedures shall be paid P16,000 pesos regardless whether the procedure was done in one or both eyes in one operative session.
This payment scheme applies to all applicable health care providers for cataract surgery in an ambulatory surgical clinics, and in secondary or tertiary hospitals, whether done in outpatient or inpatient set up regardless of number of days of confinement. However, cataract procedures covered under this package are limited only for intracapsular cataract extraction with insertion of intraocular lens prosthesis; extracapsular cataract removal with insertion of intraocular lens prosthesis like irrigation and aspiration; and, phacoemulsification.
For this, P8,000 is payment for hospital charges for room and board, drugs and medicines used during confinement, x-ray, laboratory and ancillary procedures done during confinement and use of operating room complex and machines. While the other P8,000 goes to professional fee of doctor who performed the procedure.
Excluded in the package are payment for preoperative tests done prior to confinement, professional fee for preoperative consultation and/or physician standby service as well as the anesthesia service, and complex cataract surgery requiring techniques not generally used in routine cataract surgery or performed on patients in the amblyogenic developmental stage.
In claims filing, in cases where members are required by hospitals to buy drugs, medicines and supplies or required to seek out other necessary services like laboratory procedures from other facilities, reimbursements to members is allowed if the facility cannot provide the necessary items and services covered by the benefit but these have been used during confinement. Members have to submit official documents and/or other purchased documents. Reimbursements however depend on the actual cost of the receipts submitted but not more than the difference between the maximum benefit and the facility reimbursement
PhilHealth cites 8 Iloilo LGUs for universal coverage
PhilHealth cites 8 Iloilo LGUs for universal coverage
By: Larry T. Tabsing
PhilHealth recognized 8 local government units in the province of Iloilo for enrolling more than the targeted poor families for universal coverage to the National Health Insurance program.
The Municipality of Bingawan topped as the most number of sponsored indigent households of 274% followed by San Enrique (208%) and Mina (203%).Then Concepcion, Barotac Viejo, Banate, Batad and Badiangan. All of their mayors personally received the recognition except for Concepcion and Batad.
There are about 18 LGUs that have enrolled more than the targeted poor families but PhilHealth on this focused on LGU initiated universal enrollments less the provincial and legislative sponsorship.
There are about 90,859 poor families in the Province (based on the 2006 NSCB data net of the 21,204 poor families in Iloilo City). As of December 2008 there were already 70,982 poor families enrolled into the Program (inclusive of the provincial, municipal and legislative enrollment). About 19,877 poor families needs to be enrolled into the program, which is now the target to cover before October 2009.
Regional Vice President Alberto C. Manduriao said that the intention of the Program is to ensure that the poor will have free access to quality health service and make the members and theirs dependents feel they are secured. “In times that someone in the family get sick they are assured that they can get quality health care services in any of the PhilHealth accredited health care facilities and confident that their hospital bill will be taken cared of”, he noted..
Addressing the Local Chief Executives RVP Manduriao stresses, “Through you, their local official, you have given them back their sense of dignity as a human being for they will no longer be afraid or ashamed of entering a hospital if they need medical service”.
Manduriao challenged the health workers asking why PhilHealth member has to go to the hospital when the illness can be prevented and treated in the RHU. “Baka walang tiwala mga tao magpagamot sa RHU dahil siguro, wala lagi si Doc? Wala o kulang ang gamut at mga gamit sa RHU, masungit ang nurse? O baka naman walang health program sa RHU kaya ganun!, he surmised. “We still believe that Health is Good Governance; Health Good Investment and Health is Good Politics”, he stressed.
Under the Sponsored - Indigent Program, in every family a LGU enrolled, PhilHealth pays back P300 as Capitation payment to augment their budget or fund for health services; ensure that indigents are given quality out-patient service in the RHU. The 80% of the Capitation fund to purchase drugs, medicines, medical, laboratory and dental supplies, equipment and even for the repair and renovate your health facility if necessary.
RHU can be accredited under the 3 in 1 scheme - the OPB, MCP and TB-DOTs. PhilHealth is paying an additional P4,500.00 for every normal delivery (member can claim up to 4 normal spontaneous delivery), P1,000.00 for the new-born care package and P4,000 for every treated TB patient.
Infact, the amount due to the different LGUs in Iloilo as Capitation payment is P15.5M , but paid only P1.76M not because it does not have the money but simply because certain Municipal Health Officers and Municipal accountants are not submitting the required monthly Reports and the Capitation utilization report which are pre-requisite to support the release of the remaining P13.8M.
The recognition was done during the Semana sa Iloilo at the Provincial Health sponsored Hospital Operations and Services awards.
By: Larry T. Tabsing
PhilHealth recognized 8 local government units in the province of Iloilo for enrolling more than the targeted poor families for universal coverage to the National Health Insurance program.
The Municipality of Bingawan topped as the most number of sponsored indigent households of 274% followed by San Enrique (208%) and Mina (203%).Then Concepcion, Barotac Viejo, Banate, Batad and Badiangan. All of their mayors personally received the recognition except for Concepcion and Batad.
There are about 18 LGUs that have enrolled more than the targeted poor families but PhilHealth on this focused on LGU initiated universal enrollments less the provincial and legislative sponsorship.
There are about 90,859 poor families in the Province (based on the 2006 NSCB data net of the 21,204 poor families in Iloilo City). As of December 2008 there were already 70,982 poor families enrolled into the Program (inclusive of the provincial, municipal and legislative enrollment). About 19,877 poor families needs to be enrolled into the program, which is now the target to cover before October 2009.
Regional Vice President Alberto C. Manduriao said that the intention of the Program is to ensure that the poor will have free access to quality health service and make the members and theirs dependents feel they are secured. “In times that someone in the family get sick they are assured that they can get quality health care services in any of the PhilHealth accredited health care facilities and confident that their hospital bill will be taken cared of”, he noted..
Addressing the Local Chief Executives RVP Manduriao stresses, “Through you, their local official, you have given them back their sense of dignity as a human being for they will no longer be afraid or ashamed of entering a hospital if they need medical service”.
Manduriao challenged the health workers asking why PhilHealth member has to go to the hospital when the illness can be prevented and treated in the RHU. “Baka walang tiwala mga tao magpagamot sa RHU dahil siguro, wala lagi si Doc? Wala o kulang ang gamut at mga gamit sa RHU, masungit ang nurse? O baka naman walang health program sa RHU kaya ganun!, he surmised. “We still believe that Health is Good Governance; Health Good Investment and Health is Good Politics”, he stressed.
Under the Sponsored - Indigent Program, in every family a LGU enrolled, PhilHealth pays back P300 as Capitation payment to augment their budget or fund for health services; ensure that indigents are given quality out-patient service in the RHU. The 80% of the Capitation fund to purchase drugs, medicines, medical, laboratory and dental supplies, equipment and even for the repair and renovate your health facility if necessary.
RHU can be accredited under the 3 in 1 scheme - the OPB, MCP and TB-DOTs. PhilHealth is paying an additional P4,500.00 for every normal delivery (member can claim up to 4 normal spontaneous delivery), P1,000.00 for the new-born care package and P4,000 for every treated TB patient.
Infact, the amount due to the different LGUs in Iloilo as Capitation payment is P15.5M , but paid only P1.76M not because it does not have the money but simply because certain Municipal Health Officers and Municipal accountants are not submitting the required monthly Reports and the Capitation utilization report which are pre-requisite to support the release of the remaining P13.8M.
The recognition was done during the Semana sa Iloilo at the Provincial Health sponsored Hospital Operations and Services awards.
Monday, April 20, 2009
Thursday, April 2, 2009
35% increase in PhilHealth Benefit Payment
MORE THAN 69 million members of Philippine Health Insurance Corporation (PhilHealth) nationwide will enjoy increase in in-patient care benefit ceilings for confinements starting April 5 this year.
"We have recognized the fact that rapid inflation has somehow reduced the significance of our existing benefit levels. There is an urgent need therefore to adjust our subsidies to meet the rising cost of hospitalization among our members," said Dr. Rey B. Aquino, PhilHealth President and CEO. Substantial increase in subsidies for hospitalization fees and professional charges of physicians, in response to the emerging and re-emerging of diseases and other health conditions in the country albeit the escalating cost of hospitalization, is expected to reach at 35 percent increase on annual benefit payments of the corporation.
In the 2009 revised in-patient benefit schedule, items such as subsidy for room and board, drugs and medicines, x-ray, laboratories and supplies and payment for professional fees of accredited physicians (including surgeons and anesthesiologists) have increased significantly, without any corresponding increase in premium contributions by members.
In the benefit item for room and board, confinement at the tertiary level hospitals will now have a subsidy of 500 pesos to 1,100 pesos per day depending on the case/type of illness as compared to the 400 pesos to 1,035 pesos subsidy. Though the increase in allowances for hospital room and board fees is moderate, a 260 percent increase in drugs and medicines for Case Type B in Primary Hospital is demonstrated, from P2,500.00 to P9,000.00 per single period of confinement. Such amount (P9,000.00) was then the maximum ceiling for drugs and medicines in Tertiary Level hospital under Case B category of illness. Rules on Philippine National Drug Formulary (PNDF), Antimicrobial Resistance Surveillance Program (ARSP) and rational drug use shall be observed.
With the new in-patient package, payment for x-ray, supplies, laboratory & other ancillary procedures grew as much as 76 percent. Additionally, maximum benefit for supplies and radiology, laboratory and ancillary procedures shall depend on hospital category and case type of illness and shall be covered by the rule on single period of confinement.
On the other hand, payment for operating room (OR), for patients undergoing surgical procedures will depend on the category of hospital and the RVU (Relative Value Unit) of the procedure. In the case of primary hospital, payment for OR is fixed at 500 pesos per use of operating room. However, P750.00 to a maximum of P7,500.00 OR fee shall be paid to ambulatory surgical clinics (ASC), freestanding dialysis centers and to hospitals depending on its category and RVU of the given procedure.
Further, maximum amount for professional fees both of the general practitioners and specialists combined rose up to 136 percent. "These benefits were increased in varying degrees across all case types (or illness types) as applicable, in participating tertiary, secondary and primary hospitals in the country," Aquino stressed. Likewise, consequent increase for anesthesiologist and surgeon's fees were also included based on PhilHealth's recently approved tiered payments for professional fees and the revised valuations for certain surgical and medical procedures.
Amid this significant move by the corporation to increase its benefits for in-patient care, its 1,500 partner hospitals are also called to continuously better their services and abstain from unnecessary jacking up of their fees so that PhilHealth members can fully enjoy these increases in benefits, added Aquino. (PRO VI-PAU)
Check Replacement
PhilHealth observed that several benefit payment checks are still under the name of the deceased member and members who are outside of the country, hence, cannot be encashed and consequently had staled.
“It’s only when proper and valid documents to support a claim for check replacement that we can change the payee of the check”, explained by Roberto Dais, PhilHealth in-charge for check replacement, “without such, the check is generated on the member’s name.”
The problem usually happens on claims of deceased member, who died while confined or after discharged from the hospital but with pending claims because of previous hospitalization.
The check can be changed to the new payee but rightful claimant must first comply with the needed requirements such as the member’s death certificate as well as member-claimant proof of relationship.
Priority is given to those listed as dependents in the Member Data Record (MDR), from spouse to any of the child/ren authorized by the other siblings and biological parents. If member has no direct heir, a collateral relative may proceed to claim.
As to members who are abroad, check usually stales because their spouse cannot claim the same. “Common reason is, they alleged to have no joint accounts in bank wherein the check could be deposited, so they just await for the return of their member-spouse”, Dais added.
Under PhilHealth policy, benefit payment check is generally issued to the member. And only under two conditions: when payee is deceased or is out of the country, that replacement is allowed to the legitimate claimant.
A Special Power of Attorney granting authority to do PhilHealth transactions is one of the easy proofs. In its absence, the rightful claimant must submit a request and proof of member’s status abroad. Claimant has still to provide valid identification, IDs of both member and claimant. PhilHealth noted certain cases that spurious claimant faked the documents in order to claim.PhilHealth Regional Office VI head Alberto C. Manduriao stressed that members who understand their rights and complied their responsibilities do not find difficulty in processing and claiming PhilHealth benefits. So PhilHealth encourages members and dependents to be informed of these.
Monday, January 19, 2009
Wednesday, January 7, 2009
Tuesday, January 6, 2009
Subscribe to:
Posts (Atom)