Membership alone won’t suffice

Ian Alfredo Magno

AS of June 12, 2017, Philhealth published Circular No. 2017-0007 which distinguishes the active member from the inactive member. Part III provides the definition:

“ACTIVE MEMBER – a registered member who has qualifying contributions and with sufficient regularity of payment and is entitled to avail of Philhealth benefits as prescribed by the Corporation

“INACTIVE MEMBER – a registered member who has no qualifying contributions and is not entitled to avail of Philhealth benefits.”

Often, people ask how they could possibly avail of Philhealth benefits.  The answer is, of course, one must be eligible.  And to be eligible, one must have qualifying contributions – that is, three months of premium payments within the last six  months.

This serves as the requirement that separates the active from the inactive member.  Casually, it is known as the “3 within 6” policy.  This is provided in Section 12 of Republic Act 7875 as amended by Republic Act 9241 and Republic Act 10606, which says: “SEC. 12. Entitlement to Benefits. – A member whose premium contributions for at least three (3) months have been paid within six (6) months prior to the first day of availment, including those of the dependents, shall be entitled to the benefits of the Program….”

When is this six-month period reckoned from?

Item 1, Part III of Philhealth Circular No. 032-2014 provides: “All members mentioned in this Circular shall be entitled to Philhealth benefits, provided that premium contribution has been paid for at least three (3) months within the six (6) months prior to the first day of availment.  The qualifying six months is inclusive of the confinement month.”

While the patient’s month of confinement is counted/included in the six-month period denoted in the “3 within 6” jargon, it must be carefully stressed that the date/day of confinement is excluded.  Meaning, this six-month period is specifically counted and particularly reckoned from the day prior to the actual date of confinement.

Therefore, payments made on admission date or during confinement period or after discharge shall not be counted as qualifying contributions (except otherwise declared by Philhealth).

In a nutshell, the issuance of Circular No. 2017-0007 would hopefully help the greater public better recognize that Philhealth membership alone does not suffice.  That is, to be eligible, one must regularly contribute premium payments.  Being a member is not enough.  One must be a responsible Philhealth member.

(Lawyer Ian Alfredo T. Magno is based in Cagayan de Oro. E-mail: ianalfredom@gmail.com)