9/12 eligibility

Ian Alfredo Magno .

HERE in the Philippines, the inception of the so-called “ber” months signals the start of the Christmas season. Without more ado, radio stations right away play that patented Jose Mari Chan tune, and a host of other yuletide jingles, of course.  Yes, the Philippines has the longest – as a matter of fact – Christmas celebration/season in the entire world.

And the countdown begins. If my count serves me right, we are officially 115 days away before Christmas day.  Such a most-awaited moment of the year deserves to be taken due notice of, after all. Meanwhile, we are nearing one other forthcoming significant moment too, though apparently less-awaited, not-much taken notice of, it seems. One more “change” is coming.

Beginning Oct. 1, 2018, to be eligible to avail of Philhealth benefits, the member must have paid his/her premium contribution for nine months in the past 12 months – which is counted from the month of confinement, backwards.  Hence, the reckoning period of 12 months begins and includes the month (and then counted backwards) during which the member or his/her qualified dependent is hospitalized.

What does it mean?  It means that Philhealth members are expected to be more diligent, religious and dutiful in the payment of their premiums. Presently, the qualifying contribution or eligibility scheme is 3/6 or three within six. The present scheme is relatively lenient compared to the forthcoming 9/12 scheme which is set to officially take effect on Oct. 1, 2018 – less room for missed premium payments, so to speak.  This did not come about unannounced nonetheless.

In a dedicated article entitled “Philhealth: New Policy on Benefit Eligibility to Start in October,” which was uploaded on the official Philhealth website as of Aug. 28, 2018, the nine over twelve (9/12) eligibility scheme is aptly explained, to wit:

“The Philippine Health Insurance Corporation (Philhealth) reminds the public anew that the sufficient regularity of payment (SRP) will be required for all benefit availments starting October 1, 2018.

“Previously set for implementation last January, Philhealth postponed the execution of the directive to provide its members with ample time to update their premium contributions in order to ensure themselves and their dependents of uninterrupted social health insurance coverage.

“The SRP rule is contained in PhilHealth Circular No. 2017-0021 which states that, ‘…to establish sufficient regularity of payment, members should have paid six (6) months contributions preceding the three (3) months qualifying contributions within the twelve (12)-month period prior to the first day of confinement…’

“In effect, to be eligible to Philhealth benefits, a member should have paid at least nine (9) months’ worth of premiums in the twelve (12) months preceding the confinements including the confinement month of the patient.

“‘We call on our members to see to it that their membership information and premium contributions are up to date in order to maintain an active Philhealth membership. In doing so, they ensure themselves and their qualified dependents of social health insurance benefits for their medical needs,’ said PhilHealth Acting President and CEO Dr. Roy B. Ferrer.

“Further inquiries on this policy may be referred to Philhealth’s 24/7 Corporate Action Center Hotline, (02) 441-7442. E-mails may also be sent to actioncenter@philhealth.gov.ph for clarifications, comments, and suggestions.  For more updates, members and stakeholders are encouraged to follow PhilHealth on Twitter (@teamphilhealth) and Facebook (facebook.com/Philhealth).”

(Ian Alfredo T. Magno is a lawyer and marketing head at Philhealth.)