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PhilHealth Revised Provisions for the Recovery and Disposition of Unclaimed Refunds from Accredited IHCPs
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Philippine Health Insurance Corporation (PhilHealth) announces the amendments to PC 42, s2009 (Revised Provisions for the Recovery and Disposition of Unclaimed Refunds from Accredited IHCPs):


The following provisions in PC 42, s2009 are hereby, amended, or deleted:


1. Section A. Item 1

A Financial Statement (FS) as of 2008 and a duly notarized Report on Unclaimed Refund (RUR) from 1995 to 2008 shall be submitted by all currently and previously accredited IHCPs. IHCPs that do not have accumulated refunds are likewise obliged to submit a duly notarized RUR indicating that there are no fefunds to be returned to PhilHealth. Thereafter, all currently accredited IHCPs are required to submit the FS annually and the RUR as prescribed.
2. Section A. Item 5
PhilHealth shall accept payment from IHCPs with or without the Billing Statement (BS), provided, that such payment shall be subject to verification vis-a-vis the submitted RUR and FS.

On the other hand, a demand letter will be issued to IHCPs under these circumstances:
  • failure to comply with the submission of RUR and/or FS;
  • non-submission of corrected RUR and/or FS;
  • non-return of unclaimed refund to the Corporation.
3. Section A. Item 6.1
The total amount of unclaimed refund that is being requested to be paid on installment basis is more than P1,000,000.00 supported by the latest audited FS and/or cash flow or liquidity statement of the IHCP.

Installment may be allowed for P1,000,000.00 or less, provided, that the IHCP can show proof that its present financial standing is incapable of paying the amount in full. Such proofs may include but not limited to the latest audited FS and/or cash flow or liquidity statement.
4. Section A. Item 6.2
The IHCP should submit the request in writing addressed to the concerned PhilHealth Regional Office (PhRO) within five (5) working days from receipt of the billing statement of demand letter, as the case maybe. The written request must be submitted together with the supporting documents stated in Section A, item 6.1

The PhRO shall forward all documents of the IHCP together with its initial evaluation of the latter's financial status and recommendation to the Internal Legal Department (ILD) of PhilHealth within five (5) working days from receipt of request from IHCP.

The ILD then submits its recommendation to the President and CEO within five (5) working days upon receipt of endorsement from the PhRO.
5. Section A. Item 6.3
ILD shall send an approval letter to the IHCP through the PhRO concerned stating therein the schedule of installment payments to be fully paid within a period of six (6) months. If request is not granted, ILD shall likewise inform the requesting IHCP of the denial coursed through the concerned PhRO
6. Section A. Item 6.4
Item 6.4 in Section A of PC 42, s2009 is deleted.
7. Section A. Item 6.5
Only the names of members in the validated RUR list will be published and processed for payment.
8. Section B. Item 4
Members shall claim their refund from PhilHealth within two years from the date their names are published in a newspaper of general circulation advising them of the refund. After the two year has lapsed, the fund will be reverted back to the Corporation's mother account.

Should the member fail to claim the refund within the two year period from date of publication, he/she may file an appeal within thirty (30) calendar days addressed to the President and CEO of PhilHealth.

The Corporation will no longer accept after the thirty (30) day period has lapsed.
All concerned are advised to refer to other provisions in PC 42, s2009 that are not inconsistent with the changes herein as they remain in full force and effect.

This circular becomes effective fifteen (15) days after publication in the Official Gazetter or in a newspaper of general circulation.

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