PhilHealth Implementation of the New Premium Contributions and Requirement of Policy Contracts for the Individually Paying Program (IPP)
I. RATIONALE AND OBJECTIVES
In response to the thrust of the Aquino Administration for Kalustigang Pangkalaliatan (KP) to provide universal health care to all Filipinos and in line with the attainment of the 2015 health targets under the Millenium Development Goals (MDGs), the Philippine Health Insurance Corporation (PhilHealth) shall provide enhanced benefits to improve financial risk protection of its members. Further, PhilHealth shall also provide all Filipinos with Primary Care Benefit (PCB) Package and an option to avail of the No Balance Billing (NBB) policy on health care services.
To efficiently implement product improvements and sustain the provision of National Health Insurance Program (NHIP) benefit packages, increasing investment in health care through the adjustment of current premium contribution rates for all members is essential. Thus, through PhilHealth Board Resolution No. 1571, series of 2011, the PhilHealth Board and Management approved the increase in premium contributions of those enrolled or to be enrolled under the Individually Paying Program to Two Thousand Four Hundred Pesos (PhP 2,400) per year effective July 1, 2012.
Further, to ensure continuous coverage of members in the Informal Sector, PhilHealth shall issue a policy contract which provides financial risk protection to the members and their dependents.
This Circular covers those enrolled or to be enrolled under the individually-paying Program (IPP) of PhilHealth such as the following:
- Self-employed individuals - those who work for themselves and are therefore both the employer and employee.
- Separated from employment - those who have been previously employed (with employer-employee relationship) and are currently without means of income.
- Employees of international organizations and foreign governments based in the Philippines who have no prior agreement with PhilHealth for the coverage of their Filipino employees.
- Unemployed individuals who are not qualified as indigents.
- All other individuals not covered under the previous categories mentioned, including but not limited to the following:
- Parents who are not qualified as legal dependents, indigents or retirees/pensioners;
- Retirees who did not meet the minimum of 120 monthly premium contributions to qualify as non-paying members; and
- Children who are not qualified as legal dependents
- Organized Groups - such as the following;
- Existing members under the KaSAPI Program and Group Enrollment schemes of PhilHealth
- Members under the new iGroup Program
III. IMPLEMENTING GUIDELINES
To ensure the proper implementation of the new premium rates for the Individually-Paying Program, the following guidelines shall be applied:
1. For individually-Paying Members (IPMs)
- The annual premium contribution for IPMs earning an average gross monthly income of Twenty Five Thousand Pesos (PhP 25,000) and below shall he One Thousand Two 1-lundred Pesos (PhP 1,200), if paid before July 1, 2012. If paid on or after July 1, 2012, the annual premium contribution shall he Two Thousand Four Hundred Pesos (PhP 2,400) per year.
- IPMs including Self-employed Professionals earning an average gross monthly income above PhP 25,000.00 shall continue to pay their annual premium contribution of Three Thousand Six HLmdred Pesos (PhP 3,600.00) per year beginning CY 2012, as provided in PhilHealth Circular No. 24 and Office Order No. 65, series of 2010.
- IPMs who would like to avail the current annual premium rate of One Thousand Two Hundred Pesos (PhP 1,200), shall be required to perform the following for the period May 1 to June 30, 2012:
- Sign an Individually Policy Contract (JPC) with PhilHealth for a lock-in period of two years; and
- Pay in advance the first year premium requirement equivalent to One Thousand Two Hundred Pesos (PhP 1,200) with the balance to be settled on a quarterly, semi-annual or annual basis as agreed in the IPC.
- IPMs who have made advance payments prior to said date shall not be required to sign a Policy Contract until their next payment.
- All Contracts shall be effective on the date of initial payment.
- The separate Circular with implementing guidelines for the issuance of the 1 PCs shall be released.
2. For Organized Groups (OGs)
- Premium rates for OG members enrolled starting July 1, 2012 shall be Two Thousand Four Hundred Pesos (PhP 2,400) per year.
- OGs who would like to avail the current annual premium rate of PhP 1,200 per year shall be required to perform the following for the period May to June 30, 2012:
- Sign a Memorandum of Agreement (MOA) and Group Policy Contract (GPC) with PhilHealth with a lock-in period of two years; and
- Pay in advance the first year premium requirement equivalent to One Thousand Two Hundred Pesos (PhP 1,200) for each enrollee with the balance to be settled on a quarterly, semi-annual or annual basis as agreed in the GPC.
- Collection of initial and succeeding payments from individual members shall he done by the OG and shall be remitted directly to the nearest LH1O. The OG shall periodically inform its members about the remittance of their premiums to PhilT 1 alth.
- Premium incentives for OGs shall be based on the attached iGroup Premium Schedule.
- The Circular and Office Order for the implementation of the iGroup Program and issuance of GPCs shall be released separately.
This Circular shall take effect immediately after due publication un any newspaper of general circulation and deposited with the National Administrative Register at the University of the Philippines Law Center.
All issuances that are inconsistent with the provisions of this Circular are deemed superseded.
For information and guidance
DR. EDUARDO P. BANZON
President and CEO