PhilHealth Issues Individual Policy Contract to Individually Paying Members


Starting January 1, 2013 all Individually Paying Members (IPMs) shall be issued an Individual Policy Contract (IPC).

PhilHealth XII Regional Vice-President, Ramon F. Aristoza Jr. explained that “the IPC is intended to guide and encourage IPMs to sustain active participation in the National Health Insurance Program (NHIP) and guarantee entitlement to PhilHealth benefits thereby providing continuous financial risk protection in health care costs within a specified validity period.

Upon signing of IPC, an IPM shall be required to pay  a minimum initial premium contribution according to the number of years contracted which is: Php450.00 or 25% of the annual premium for 1 year validity, Php900.00 or 50% of the annual premium for 2 years validity and Php1,800.00 or 1 year full payment for 3 years validity.
Rosito Barroso, married with 3 dependents and a resident of Purok Ramos, Sta. Cruz, City of Koronadal is among the 286 IPMs who were issued IPC at the regional office from January 14-15, 2013. His contract has a 3-year validity (January 1, 2013-December 31, 2015).

Full payment of premium contributions upon contract signing shall be locked in to the current rate which is Php1,800.00 per year. For those who opt to pay only the initial minimum premium requirement, succeeding payments may be paid on a monthly, quarterly, semi-annual or annual mode.  

Payments shall be applied prospectively and deadline shall be on the last working day of the month prior to the applicable period being paid.

Grace period shall be allowed for delayed remittance and may vary according to selected mode of payment.
 


Example:

Mode of payment
Deadline
Example
Grace Period
Example
Monthly
On or before the last working day of the month prior to the applicable month
January 31, 2013
(for February 2013 premium)
5days
February 1-5, 2013
Quarterly
On or before the last working day of the month prior to the applicable three-month period
March 27, 2013
(for April-June 2013premium)
10days
April 1-10, 2013
Semi-annual
Or before the last working day of the month prior to the applicable six-month period
June 28, 2013
(for July-December 2013)
15days
July 1-15, 2013
Annual
On or before the last working day of the month prior to the applicable twelve-month period
December 27, 2013
(for January-December 2014 premium)
30days
January 1-30, 2014

A 3% interest charge for payment made after the grace period or a succeeding late remittance within a 12-month fiscal year IPC validity shall be applied. However, it will be allowed only once within a 12-month period.

The initial premium contribution and Policy Validity Period with succeeding payment schedule are indicated in the IPC. An enhanced Member Data Record (MDR) showing the same details will also be issued to the member.

To avail of benefits, the IPC shall serve as one of the primary documents for IPMs and their qualified dependents to submit.

RVP Aristoza said that IPMs who are issued IPC shall be entitled to avail of benefits based on the 3/6 minimum premium requirement for all type of illnesses, except for Case Type Z illnesses which requires 1 year advance full payment of premium contribution.

Further, he added that “a member is also assured of no disruption of benefits entitlement.” In case of default or missed payment, a member shall be allowed to pay his/her overdue premium plus the applicable interest charges within 60 days from date of discharge.

Filing of claims for those with premium arrears paid shall be made directly to the nearest PhilHealth Office. “PhilHealth frontliners will assist the IPM on the procedures for direct filing”, assured RVP Aristoza.

In case of death of member, the dependents may continue to avail of NHIP benefits for the period already paid in advance. (amorsequito, proxii)

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