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)
