Philhealth Eligibility Requirement — Balik Uli sa 9 over 12 Premiums

Updated February 8, 2018

9 Monthly Contributions Na!

 

Salamat nakinig ang Philhealth
Sa October 1, 2018 na effective ang
9-within-12-months na rule!

Siguro maraming nagreklamo sa biglaang announcement ng 9-within-12-months, so Philhealth moved the effectivity from January 1, 2018 to October 1, 2018 para members will have time to adjust…na dapat naman. 

Ano ang gagawin ng mga na-deny ang Philhealth claims in January 2018 dahil na-apply agad ang 9-within-12 months na rule?

Request for your Philhealth documents from the hospital you were confined in, and file directly at the nearest Philhealth branch.

Up to September 30, 2018 only:

Ang eligibility for Philhealth coverage ay payment of 3 monthly premiums within the 6 months prior to confinement. Kasama sa pagbilang ng 6 months ang month of confinement.

Effective October 1, 2018:

Babalik sa 9 monthly Philhealth contributions ang eligibility for Philhealth coverage. Dapat nabayaran mo ang Philhealth contributions mo para sa 9 months sa loob ng 12 months BEFORE your hospital admission. Kasama sa pagbilang ng 12 months ang month of confinement.

At tandaan na pay your Philhealth premiums BEFORE the day of confinement. Hindi puede yong magbayad on the day of confinement. Kahit umaga ka magbayad, at hapon ka na-confine, at tama naman yong bilang ng months paid, hindi ka pa rin eligible, kasi on the date of confinement ka nagbayad.

Kaya mas maganda yong magbayad regularly BEFORE payment deadlines para lagi kang ELIGIBLE.

Paano ang pagbilang ng 9 months?

Halimbawa, na-admit ka sa ospital ngayong buwan. Magbilang ka ng 12 months pabalik.  Isama mo sa pagbilang ang ngayong buwan, ang buwan na na-admit ka. Then i-check mo kung meron kang nabayaran na 9 months sa loob ng 12 months na yan. Kung meron, puede mong magamit ang Philhealth mo.

Itong 9-over-12 na rule ba ay para sa lahat ng types of Philhealth members?

Almost lahat. Except lang yong mga merong Validity Dates sa mga Philhealth cards nila tulad ng mga Sponsored o merong Validity Dates sa premium payment receipt nila katulad ng mga land-based OFWs.

Is the monthly Philhealth contribution from Individual Payors still 200 pesos?

Yes. Still 200 pesos per month. Ang nag-increase ng monthly premium ay yong mga Employed, Seafarers at Kasambahay

Examples ng payments na eligible sa Philhealth benefits:

Kung na-confine ka sa month of December, eligible ka for Philhealth benefits kung nabayaran mo ang 9 months within sa 12 na nakaraang months, at dapat meron kang 3 months na nabayaran within 6 months bago confinement.

Remember, kasama ang pag-count ng 12 months at pag-count ng 6 months yong month of confinement.

Yong months in BLUE ay nabayaran:

Ang month of confinement ay December:

Example 1 Example 2 Example 3
December December December
November November November
October October October
September September September
August August August
July July July
June June June
May May May
April April April
March March March
February February February
January January January

 

Example 4 Example 5 Example 6
December December December
November November November
October October October
September September September
August August August
July July July
June June June
May May May
April April April
March March March
February February February
January January January

Kung na-confine ka sa ibang months, magbilang ka lang ng 12 months BEFORE confinement. Kasama ang pagbilang mo ng 12 months ang month of confinement.

References:
Philhealth Circular No. 2017-0021, entitled Application of Sufficient Regularity of Payment of Premium Contributions to the Required Qualifying Contributions for Eligibility to Philhealth Benefits.

Philhealth Advisory No. 2018-0011: All Admissions Starting October 1, 2018

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