Sufficient regularity

Ian Alfredo Magno

IN a previous issue, we had occasion to discuss the adjusted rate of Philhealth premiums beginning 2018.  This issue is intended to update the public pertaining to the so-called requirement of “qualifying contribution” vis-a-vis the similarly required “sufficient regularity.”

Qualifying contribution, this is the required number of months in a given period, premiums for which must have been paid prior to hospitalization of a member or dependent to render such member/dependent eligible to avail of the benefits under Philhealth.

In a previuos circular, particularly Circular 2017-0021 which was published on Oct. 27, 2017, Philhealth emphasized that eligibility to benefits means that a member must have made at least three months contribution within the immediate six months prior to the first day of confinement.  It likewise requires that a member must also have sufficient regularity of premium contribution, and should not be subject to legal penalties.

Meanwhile, Philhealth Board Resolution No. 2097, series of 2016 pronounced that sufficient regularity of payment means that a member must have paid at least six months’ contributions preceding the three months qualifying contributions within the immediate 12-month period prior to the first day of confinement.

So, what does it mean?

It actually does not sound complicated as it seems. It connotes that a member must be religious in complying with the required premium payments.

We now know that the qualifying contribution of at least three months with paid premiums is required within the six months prior to confinement.  In addition to that, however, sufficient regularity is likewise sought.  This means that premiums for the six-month period prior to such “3-months-with-paid-premiums” must likewise have been paid in order for “sufficient regularity of payment” to exist.”  Without which, a member would not be eligible to avail of the benefits.

To summarize, in all practicality, members are henceforth required to have nine months with paid premiums for the preceding 12-month period prior to the first day of hospitalization.

In his official issuance, Dr. Pargas, the vice president for corporate affairs group, enumerated the exemptions to the requirement:

“Through special provisions, however, Philhealth Circular 2017-0021 provides exemptions in the application of the said policy for certain membership types.

“For instance, newly enrolled members whose membership to the NHIP covers less than nine (9) months from the initial date of registration, shall only be required payment of at least three (3) months within six (6) months prior to the first day of confinement.

“In addition, women about to give birth must pay the annual premium contribution prior to discharge from the accredited hospital to immediately avail themselves of maternity care benefits.

“On the other hand, Sponsored members and Overseas Filipino Workers (OFWs) with expired coverage may shift membership to the Informal Economy within the three (3) months’ grace period following the month of expiration of coverage of their membership validity. Employed members, including seasonal employees who have been recently separated from work may also shift to the Informal Economy within the three (3) months’ grace period.”

(Ian Alfredo T. Magno is a lawyer based in Cagayan de Oro and a legal officer at Philhealth. E-mail: ianalfredom@gmail.com)