FAST FACTS: Avail yourself of PhilHealth services without having to pay premiums

MANILA, Philippines – Budget Secretary Amenah Pangandaman approved on May 23 the release of P25.16 billion to the Philippine Health Insurance Corp. (PhilHealth) to cover the one-year health insurance premiums of 8.39 million qualified Filipino indigents. 

Such release is mandated by the Universal Health Care Law, which provides that the national government covers the premiums of those who fall under indirect contributors. The same law mandates that all Filipinos shall be included in the National Health Insurance Program (NHIP) of the government. 

Who are the indirect contributors?

Indirect contributors include: 

• Indigent families identified by the Department of Social Welfare and Development (DSWD)
• Beneficiaries of the Pantawid Pamilyang Pilipino Program (4Ps)
• Senior citizens
• Persons with disabilities
• Patients identified at point-of-service (POS) or those who are not yet in the PhilHealth database but are financially incapable to pay premiums
• All Filipinos aged 21 years old and above who cannot pay the premiums
• Sangguniang Kabataan officials.

How are indigents determined? 

The DSWD identifies qualified Filipinos for the indigent membership through the National Targeting Household System (NTHS) for Poverty Reduction or the “Listahanan.” 

It is a targeted survey conducted every four years that identifies poor households as a basis in identifying potential beneficiaries for social protection programs and services of the government. It is the same survey that serves as the basis for the identification of 4Ps beneficiaries.

According to the PhilHealth website, all indigents identified by the DSWD “shall be automatically enrolled and covered” by PhilHealth. The female spouses of the families are designated as the primary members of the program. The following may be considered dependents to the coverage: 

• Legitimate spouse who is not a member 
• Child/children in the household who are below 21 years old, unmarried, and unemployed
• Disabled children who are 21 years old or above
• Foster child
• Parents who are 60 years old or above, unless an already enrolled member 
• Disabled parents, regardless of age

These dependents must be declared by the principal member, who, in this case, is the female spouse. The names of the dependents must be listed in the principal member’s Member Data Record (MDR).

“Qualified dependents shall be entitled to a separate coverage of up to 45 days per calendar year. However, the 45 days allowance shall be shared among them,” the website says. 

Senior citizens are covered too

Since the enactment of Republic Act No. 10645 in 2014, all senior citizens aged 60 and above are automatically covered by PhilHealth. Previously, only indigent senior citizens were covered.

Senior citizens may enroll through submission of their member registration form through local offices for senior citizens affairs, or through local health insurance offices. 

On April 4, the Department of Budget Management (DBM) approved the release of P42.93 billion to cover the one-year health insurance premiums of over 8.5 million senior citizens. 

Benefits for members

Inclusion in the NHIP entitles enrolled Philhealth members to health benefit packages, which include primary care; medicines; diagnostics and laboratory; and preventive, curative, and rehabilitative services. 

Primary care

Primary care provided by PhilHealth can be availed through their Konsulta program (formerly called Tsekap). A member can avail themselves of the following services: check-up, health screening and assessment, laboratory, and prescribed drugs and medicines.

The following are the laboratory or diagnostic examinations that can be availed: 

• CBC with platelet count
• Urinalysis
• Fecalysis
• Sputum Microscopy
• Fecal Occult Blood
• Pap smear
• Lipid profile (total cholesterol, HDL, and LDL cholesterol, Triglycerides)
• FBS
• OGTT
• ECG
• Chest x-ray
• Creatinine
• HbA1c

To avail oneself of the package, a PhilHealth member must register in any of the health facilities that are accredited Konsulta package providers. Registration can be done online via self-registration through PhilHealth’s website, or via walk-in registration at any PhilHealth office. 

An individual can avail himself or herself of free primary care service in the facility where he or she has registered. There will be charges for service acquired outside the chosen facility. 

Accommodation

All patients are entitled to basic or ward accommodation in any PhilHealth-accredited hospital without having to pay co-payment or co-insurance fees, according to the Universal Health Care Act. 

The same law also requires all government hospitals to operate not less than 90% of their bed capacity as basic or ward accommodation. Specialty hospitals are required to have not less than 70%, while private hospitals are required to have no less than 10% of their bed capacity. 

The Universal Health Care Act ensures that any person can avail themselves of the service without having to present a PhilHealth card, provided that the patient must still present any valid identification document. 

The law’s implementing rules and regulation states that those who are not in the PhilHealth database “shall be duly registered by health care facilities,” subject to the guidelines PhilHealth will release.

The above-mentioned benefits are available to both indirect contributors and direct contributors, the latter being those who have the ability to pay premiums such as employed individuals. Direct contributors enjoy additional benefits PhilHealth may provide them. – Rappler.com