[ PHILHEALTH CIRCULAR NO. 004, February 17, 2012 ]
AMENDMENT TO PHILHEALTH CIRCULAR 17, S. 2011 ON THE IMPLEMENTATION OF THE PARTIAL SUBSIDY SCHEME PARTICULARLY THE LGU-SPONSORED PROGRAM
I. RATIONALE
As part of the efforts to attain Universal Health Care or Kalusugang Pangkalahatan (KP), the Corporation, in accordance with the provisions of PhilHealth Board Resolution (PBR) Nos. 1571, s. 2011 and 1579, s. 2012, shall support the expansion and sustainability of existing enrollments of Local Government Units (LGUs)/Sponsors in CY 2011 under the Sponsored Program component of the National Health Insurance Program (NHIP).
Pursuant to PBR No. 1571, s. 2011, the annual premium contribution rate under the Partial Subsidy Scheme shall be increased to P2,400.00 per member effective July 1, 2012. However, the said annual premium contribution rate shall be at P1,200.00 per member: Provided, That the LGU/Sponsor signified its intention to enroll or provide health insurance coverage to its identified beneficiaries for two (2) years or up to December 31, 2013 and paid the prescribed initial premium contribution within the 1st Semester of CY 2012.
In response to the clamor of most LGUs for deferment of the implementation of the increase of premium contributions, the Corporation, through PBR No. 1579, s. 2012, extended the end of validity date for all existing enrollments of LGUs/Sponsors under the Sponsored Program from December 31, 2011 to March 31, 2012 at NO COST to the LGU/Sponsor. It also provides that in case the LGU/Sponsor would signify an intention to renew enrollment for two (2) years ending December 31, 2013. the end of validity date of their identified members shall be further extended to June 30, 2012 at NO COST to the LGU/Sponsor.
In view of the foregoing, PhilHealth Circular No. 17, s. 2011 shall be modified accordingly to include all necessary amendments in accordance with the provisions as stipulated in the above mentioned PBRs for the coverage of poor and low-income families under the Partial Subsidy Scheme.
II. OBJECTIVE
This Circular provides for the amendment to PhilHealth Circular No. 17, s. 2011 for the coverage of poor and low-income families identified by the LGU/Sponsor under the Partial Subsidy Scheme.
III. COVERAGE
This Circular covers the enrollment of poor and low-income families identified by the GU/Sponsor under the Partial Subsidy Scheme.
IV. GUIDELINES
A.Validity Period
1. The validity period in the enrolment of members under the Partial Subsidy Scheme shall follow the calendar year, e.g. health insurance coverage for one (1) year shall end December 31, 2012, health insurance coverage for two (2) years shall end December 31, 2013.
2.The health insurance coverage of existing enrollments of an LGU/Sponsor under the Sponsored Program with end of validity date of December 31, 2011 shall be extended to March 31, 2012 at NO COST to the LGU/Sponsor: Provided, That the end of validity date shall be further extended lo June 30, 2012 at NO COST to the LGU/Sponsor should the latter signify its intention to enroll for two (2) years or up to December 31, 2013 by signing the amended Memorandum of Agreement (MOA) and pay the prescribed initial premium contribution within the 1st Semester of CY 2012.
B.Premium Contribution Rate
The annual premium contribution under the Partial Subsidy Scheme shall be at TWO THOUSAND FOUR HUNDRED PESOS (P2,400.00) per member effective July 1, 2012..
1. Existing enrollments
2.New or additional enrollments
C. Premium remittance and release of PhilHealth Identification Cards (PICs)
1.The LGU/Sponsor shall have remitted hereunder to the Corporation an initial payment of the total premium contribution required for the health insurance coverage of its identified beneficiaries as indicated in the validity period on the PICs prior to the release of the latter to the LGU/Sponsor:
2. The outstanding balance on the premium contribution trom the LGU/Sponsor must be paid in full within the validity period as indicated on the PIC of the enrolled members.
3. Computation of applicable premium contribution shall be on a pro-rated basis. A billing statement shall be issued to the concerned LGU/Sponsor prior to the release of the PICs. Thereafter, the billing statement for the outstanding balance shall be issued to the concerned LGU/Sponsor ten (10) calendar days following the end of each calendar quarter.
4. To expedite processing and release of PICs to the intended beneficiary members, the LGU/Sponsor shall submit to the Corporation, for its validation, a certitied list of its beneficiaries attaching the duly accomplished PhilHealth Member Registration Form (PMRF) of those beneficiaries who do not yet have their assigned PhilHealth Identification Number (PIN) including the required supporting documents.
5.The LGU/Sponsor shall submit to the Corporation a Certificate of Availability of Funds (CAF) within the First Quarter of each calendar year to ensure continued coverage of its enrolled beneficiaries, particularly those LGUs/Sponsors with outstanding balance on the premium contributions. Non-submission of the CAF to the Corporation within the period specified shall cause the latter for the non-renewal or termination of coverage of the identified beneficiaries.
D. Institutional Arrangement
1. The LGU/Sponsor should submit a Letter of Intent indicating the number of families that they would like to enroll, the area where the said families reside, and their proposed payment arrangement under the Partial Subsidy Scheme.
2. A Memorandum of Agreement (MOA) must be executed between the Corporation and concerned LGU/Sponsor to implement the Partial Subsidy Scheme of the National Health Insurance Program.
V. EFFECTIVITY
All other provisions of PhilHealth Circular No. 17, s. 2011 not affected by these amendment shall remain valid and in full force.
This Circular shall be published in any newspaper of general circulation and shall be deposited thereafter with the national Administrative register at the University of the Philippines Law Centre.
Please be guided accordingly.
Adopted: 17 February 2012
(SGD.) DR. EDUARDO P. BANZON
President and Chief Executive Officer
As part of the efforts to attain Universal Health Care or Kalusugang Pangkalahatan (KP), the Corporation, in accordance with the provisions of PhilHealth Board Resolution (PBR) Nos. 1571, s. 2011 and 1579, s. 2012, shall support the expansion and sustainability of existing enrollments of Local Government Units (LGUs)/Sponsors in CY 2011 under the Sponsored Program component of the National Health Insurance Program (NHIP).
Pursuant to PBR No. 1571, s. 2011, the annual premium contribution rate under the Partial Subsidy Scheme shall be increased to P2,400.00 per member effective July 1, 2012. However, the said annual premium contribution rate shall be at P1,200.00 per member: Provided, That the LGU/Sponsor signified its intention to enroll or provide health insurance coverage to its identified beneficiaries for two (2) years or up to December 31, 2013 and paid the prescribed initial premium contribution within the 1st Semester of CY 2012.
In response to the clamor of most LGUs for deferment of the implementation of the increase of premium contributions, the Corporation, through PBR No. 1579, s. 2012, extended the end of validity date for all existing enrollments of LGUs/Sponsors under the Sponsored Program from December 31, 2011 to March 31, 2012 at NO COST to the LGU/Sponsor. It also provides that in case the LGU/Sponsor would signify an intention to renew enrollment for two (2) years ending December 31, 2013. the end of validity date of their identified members shall be further extended to June 30, 2012 at NO COST to the LGU/Sponsor.
In view of the foregoing, PhilHealth Circular No. 17, s. 2011 shall be modified accordingly to include all necessary amendments in accordance with the provisions as stipulated in the above mentioned PBRs for the coverage of poor and low-income families under the Partial Subsidy Scheme.
II. OBJECTIVE
This Circular provides for the amendment to PhilHealth Circular No. 17, s. 2011 for the coverage of poor and low-income families identified by the LGU/Sponsor under the Partial Subsidy Scheme.
III. COVERAGE
This Circular covers the enrollment of poor and low-income families identified by the GU/Sponsor under the Partial Subsidy Scheme.
IV. GUIDELINES
A.Validity Period
1. The validity period in the enrolment of members under the Partial Subsidy Scheme shall follow the calendar year, e.g. health insurance coverage for one (1) year shall end December 31, 2012, health insurance coverage for two (2) years shall end December 31, 2013.
2.The health insurance coverage of existing enrollments of an LGU/Sponsor under the Sponsored Program with end of validity date of December 31, 2011 shall be extended to March 31, 2012 at NO COST to the LGU/Sponsor: Provided, That the end of validity date shall be further extended lo June 30, 2012 at NO COST to the LGU/Sponsor should the latter signify its intention to enroll for two (2) years or up to December 31, 2013 by signing the amended Memorandum of Agreement (MOA) and pay the prescribed initial premium contribution within the 1st Semester of CY 2012.
B.Premium Contribution Rate
The annual premium contribution under the Partial Subsidy Scheme shall be at TWO THOUSAND FOUR HUNDRED PESOS (P2,400.00) per member effective July 1, 2012..
1. Existing enrollments
For those enrollments with a one (1) year validity period ending December 31, 2012,the total premium contribution required shall be at NINE HUNDRED PESOS (P900.00) per member.
For those enrollments with a two (2) year validity period ending December 31, 2013,the total premium contribution required shall be at ONE THOUSAND EIGHT HUNDRED PESOS (P1,800.00) per member: Provided, That the LGU/ Sponsor has signed an amended MOA with the Corporation and has paid at least the prescribed initial premium contribution within the 1st Semester of CY 2012.
2.New or additional enrollments
For those enrolments with one (1) year validity period ending December 31, 2012, the total premium contribution required shall be at ONE THOUSAND TWO HUNDRED PESOS (P1,200.00) per member.
For those enrolments with two (2) year validity period ending December 31, 2013, the total premium contribution required shall be at TWO THOUSAND FOUR HUNDRED PESOS (P2,400.00) per member: Provided, That the LGU/ Sponsor has signed a MOA with the Corporation and has paid at least the prescribed initial premium contribution within the 1st Semester of CY 2012.
C. Premium remittance and release of PhilHealth Identification Cards (PICs)
1.The LGU/Sponsor shall have remitted hereunder to the Corporation an initial payment of the total premium contribution required for the health insurance coverage of its identified beneficiaries as indicated in the validity period on the PICs prior to the release of the latter to the LGU/Sponsor:
Release PICs
Renewals - 1 year coverage ending December 31, 2012
P900.00 P56.25 - 2 year coverage ending December 31, 2013 P1,800.00 P112.50 New/Additional - 1 year coverage ending December 31, 2012 P1,200.00 P75.00 - 2 year coverage ending December 31, 20123 P2,400.00 P150.00
2. The outstanding balance on the premium contribution trom the LGU/Sponsor must be paid in full within the validity period as indicated on the PIC of the enrolled members.
3. Computation of applicable premium contribution shall be on a pro-rated basis. A billing statement shall be issued to the concerned LGU/Sponsor prior to the release of the PICs. Thereafter, the billing statement for the outstanding balance shall be issued to the concerned LGU/Sponsor ten (10) calendar days following the end of each calendar quarter.
4. To expedite processing and release of PICs to the intended beneficiary members, the LGU/Sponsor shall submit to the Corporation, for its validation, a certitied list of its beneficiaries attaching the duly accomplished PhilHealth Member Registration Form (PMRF) of those beneficiaries who do not yet have their assigned PhilHealth Identification Number (PIN) including the required supporting documents.
5.The LGU/Sponsor shall submit to the Corporation a Certificate of Availability of Funds (CAF) within the First Quarter of each calendar year to ensure continued coverage of its enrolled beneficiaries, particularly those LGUs/Sponsors with outstanding balance on the premium contributions. Non-submission of the CAF to the Corporation within the period specified shall cause the latter for the non-renewal or termination of coverage of the identified beneficiaries.
D. Institutional Arrangement
1. The LGU/Sponsor should submit a Letter of Intent indicating the number of families that they would like to enroll, the area where the said families reside, and their proposed payment arrangement under the Partial Subsidy Scheme.
2. A Memorandum of Agreement (MOA) must be executed between the Corporation and concerned LGU/Sponsor to implement the Partial Subsidy Scheme of the National Health Insurance Program.
a.For LGUs/Sponsors with existing MOA with the Corporation on the implementation of the Sponsored Program, the former shall be required to sign an amended MOA with the latter to implement the Partial Subsidy Scheme.
b. For LGUs without existing MOA with the Corporation, prior to the signing of the MOA, the former must pass a Local Sanggunian Resolution adopting the national Health Insurance Program (NHlP) authorizing the Local Chief Executive (LCE) to enter into MOA with the Corporation, and the continuous allocation of funds for the health insurance coverage of its identified beneficiaries as evidenced by a CAF (Certificate of Availability of Funds).
V. EFFECTIVITY
All other provisions of PhilHealth Circular No. 17, s. 2011 not affected by these amendment shall remain valid and in full force.
This Circular shall be published in any newspaper of general circulation and shall be deposited thereafter with the national Administrative register at the University of the Philippines Law Centre.
Please be guided accordingly.
Adopted: 17 February 2012
President and Chief Executive Officer