SUBJECT :Implementation of the New Premium Contributions and Requirement of Policy Contracts for the Individually Paying Program (H'P)
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1 f the Philippies *~PHILIPPINE HEALTH INSURANCE CRPRATIN \Cityslalc Cetre, 709 Shaw Bulevard. Pasig City ;..Hcallhlic PHILHEALTH CIRCULAR N T ' " :ALL INDIVIDUALLY PAYING MEMBERS, KaSAPI PRGRAM ENRLLEES, MEMBERS UNDER THE GRUP ENRLLMENT SCHEME, ACCREDITED HEALTH CARE PRVIDERS, ACCREDITED CLLECTING AGENTS AND ALL FFICES CNCERNED SUBJECT :Implemetati f the New Premium Ctributis ad Requiremet f Plicy Ctracts fr the Idividually Payig Prgram (H'P) I.RATINALE AND BJECTIVES I respse t the thrust f the Aqui Admiistrati fr Kltisugtwg Ptmgkalahata (KP) t prvide uiversal health care t all Filipis ad i lie with the attaimet f the 2015 health targets uder the Milleium Develpmet Gals (MDGs), the Philippie Health Isurace Crprati (PhilHealrh) shall prvide ehaced beefits t imprve fiacial risk prtecti f its members. Further, PhilHealth shall als prvide all Filipis with Primary Care Beefit (PCB) Package ad a pti t avail f the N Balace Billig (NBB) plicy health care services. T efficietly implemet prduct imprvemets ad sustai the prvisi f Natial Health Isurace Prgram (NHIP) beefit packages, icreasig ivestmet i health care thrugh the adjustmet f curret premium ctributi rates fr all members is essetial. Thus, thrugh PhilHealth Bard Resluti N. 1571, series f 2011, the PhilHealth Bard ad Maagemet apprved the icrease i premium ctributis f thse erlled r t be erlled uder the Idividually Payig Prgram t Tw Thusad Fur Hudred Pess (PhP 2,4) per year effective July t, Further, t esure ctiuus cverage f members i the Ifrmal Sectr, PhilHealth shall issue a plicy ctract which prvides fiacial risk prtecti t the members ad their depedets. II.CVERAGE This Circular cvers thse erlled r t be erlled uder the Idividually-payig Prgram (IPP) f PhilHealth such as the fllwig: S*"* [.:a. re A.qjiCii-1-rxu.
2 a.self-emplyed idividuals - thse wh wrk fr themselves ad are therefre bth the emplyer ad emplyee. b.separated frm emplymet - thse wh have bee previusly emplyed (with emplyer-emplyee relatiship) ad are curretly withut meas f icme. c.emplyees f iteratial rgaizatis ad freig gvermets based i the Philippies wh have prir agreemet with PhilHealth fr the cverage f their Filipi emplyees. d.uemplyed idividuals wh are t qualified as idigets. e.all ther idividuals t cvered uder the previus categries metied, icludig but t limited t the fllwig: i. Parets wh are t qualified as legal depedets, idigets r retirees/ pesiers; ii. Retirees wh did t meet the miimum f 120 mthly premium ctributis t qualify as -payig members; ad iii. Childre wh are t qualified as legal depedets f.rgaized Grups - such as the fllwig: i. i^istig members uder the KaSAPI Prgram ad Grup Erllmet schemes f PhilHealth ii. Members uder the ew igrup Prgram III. IMPLEMENTING GUIDELINES T esure the prper implemetati f the ew premium rates fr the Idividually- Payig Prgram, the fllwig guidelies shall be applied: 1. Fr Idividually-Payig Members (IPMs) a.the aual premium ctributi fr IPMs earig a average grss mthly icme f Twety Five Thusad Pess (PhP 25,0) ad belw shall be e Thusad Tw Hudred Pess (PhP 1,2), if paid befre July 1, If paid r after July 1, 2012, the aual premium ctributi shall be Tw Thusad Fur Hudred Pess (PhP 2,4) per year. b.ipms icludig Self-emplyed Prfessials earig a average grss mthly icme abve PhP 25,0. shall ctiue t pay their aual premium ctributi f Three Thusad Six Hudred Pess (PhP,6.) per year begiig CY 2012, as prvided i PhilHealth Circular N. 24 ad ffice rder N. 65, series f M - av
3 c.1pmc h wuld like t avail the curret aual premium rate f e Thusad Tw Hudred Pess (PhP 1,2), shall be required t perfrm the fllwig fr the perid May 1 t Jue 0, 2012: i. Sig a Idividually Plicy Ctract (IPC) with PhilHealth fr a lck-i perid f tw years; ad ii. Pay i advace the first year premium requiremet equivalet t e Thusad Tw Hudred Pess (PhP 1,2) with the balace t be settled a quarterly, semi-armual r aual basis as agreed i the IPC. d.ipms wh have made advace paymets prir t said date shall t be required t sig a Plicy Ctract util their ext paymet. e.all Ctracts shall be effective the date f iitial paymet. f.the separate Circular with implemetig guidelies fr the issuace f the I PCs shall be released. 2. Fr rgaized Grups (Gs) a.premium rates fr G members erlled startig July 1, 2012 shall be Tw Thusad Fur Hudred Pess (PhP 2,4) per year. b.gs wh wuld like t avail the curret aual premium rate f PhP 1,2 per 2012: year shall be required t perfrm the fllwig fr the perid May 1 t Jue 0, i. Sig a Memradum f Agreemet (MA) ad Grup Plicy Ctract (GPC) with PhilHealth with a lck-i perid f tw years; ad ii. Pay i advace the first year premium requiremet equivalet t e the GPC. Thusad Tw Hudred Pess (PhP 1,2) fr each erllee with the balace t be settled a quarterly, semi-aual r aual basis as agreed i c.cllecti f iitial ad succeedig paymets frm idividual members shall be de by the G ad shall be remitted directly t the earest LHI. The G shall peridically ifrm its members abut the remittace f their premiums t PhilTT, alth. d.premium icetives fr Gs shall be based the attached igrup Premium Schedule. e.the Circular ad ffice rder fr the implemetati f the igrup Prgram ad issuace f GPCs shall be released separately.
4 IV. EFFECTIVITY This Circular shall take effect immediately after due publicati i ay ewspaper f geeral circulati ad depsited with the Natial Admiistrative Register at the Uiversity f the Philippies Law Ceter. All issuaces that are icsistet with the prvisis f this Circular are deemed superseded. Fr ifrmati ad guidace. UlLEDVARt) P. BANZNQr/ Presidet^astCE-f?~ Date:...
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