I. RATIONALE

The PhilHealth ID Card is the member's passport for the availment of Medicare benefits. The ID bears the proof of the member's program coverage for the year that commences on the 1st or 16th day of the month. As a general rule, the PhilHealth ID Card is released to an indigent member upon payment of the LGU premium counterpart by the premium sponsor/donor. It has been observed that collection of LGU premium counterpart contribution remains low due to the lenient implementation of the above Guidelines, hence the Corporation deems it necessary to address this issue.

II. DEFINITION OF TERMS

1. Grace Period - refers to the 30 calendar days after expiration of membership validity, for the LGU to remit their premium counterpart.
   
   
2. Types of LGUs and/or Donors based on premium payment:

2.1 Non-delinquent LGUs and/or Donors - refers to those who have no outstanding balance or have at least paid 75% of the total LGU premium counterpart of previous year.

2.2 Delinquent LGUs and/or Donors refer to those who have more than 25% balance on previous year's total LGU premium counterpart.

3. LGU Premium Counterpart - refers to the premium subsidy for the indigent members that may be paid under the following arrangements:

3.1 Solely by an LGU;

3.2 By a Donor on behalf of the LGU;

3.3 Shared by the LGUs (i.e. barangay, municipal and provincial) or with other donors (i.e. private, legislators and national government agencies).

4. Mode of Remittance - refers to the LGU/Donor's preferred mode of paying the premium counterpart that is quarterly, semi-annual or annual.

III. GUIDELINES (Please refer to Annex "A"^[*] )

The following shall be adopted specifically for the release of PhilHealth ID Cards for the Sponsored Program:

A. Initially Implementing the Program

1. The Corporation shall require the payment of LGU premium counterpart contributions to LGUs initially implementing the Sponsored Program based on their preferred mode of remittance.
   
   
2. Should the LGUs/Donors insist for the release of the IDs prior to payment, the LGU/Donor shall be required to submit a Certificate of Budget Allocation and a notarized Promissory Note (Please refer to Annex "B"^[*] ) for the payment of at least one (1) quarter premium counterpart within 30 days after the release of IDs.

B. Renewal of Membership Enrollment

1. IDs should be released at least fifteen (15) days prior to expiration of the previous year's membership coverage.
   
   
2. To facilitate timely encoding and ID generation for indigent members, the Local Social Welfare Development Officer (LSWDO) shall submit and certify only the list of indigent members to be replaced and their replacement indigent family. Names of indigent families not reflected on the list shall be automatically renewed.
   
   
3. The LGU/Donor shall be required to remit the LGU premium counterpart contribution prior to renewal of the membership coverage. However, if remittance of LGU Premium counterpart is not possible prior to expiration due to reasons such as: unavailability of funds; on-going re-negotiation with the local chief executives (LCEs); and/or delay in the processing of disbursement vouchers (DVs), the following shall be adopted for the release of IDs:

3.1 For "Non-Delinquent" LGUs and/or Donors, the following are the requirements for the release of IDs:

3.1.1 Submission of a Certificate of Budget Allocation; and

3.1.2 Notarized Promissory Note for the payment of the first quarter premium counterpart of current year within the grace period.

3.2 For "Delinquent" LGUs and/or Donors, the following are the requirements for the release of IDs:

3.2.1 Full payment of the balance of previous year's account and submission of the Certified true copy of the Official Receipt as proof of payment;

3.2.2 Submission of a Certificate of Budget Allocation; and

3.2.3 Notarized Promissory Note for the payment of the first quarter premium counterpart of current year within the grace period.

4. If the LGU/Donor fails to remit its premium counterpart within the grace period, as specified in the notarized Promissory Note, the Corporation shall suspend the provision of Medicare benefits in the territorial jurisdiction of the delinquent party.

C. Expansion of Membership Enrollment

1. For "Non-Delinquent" LGUs and/or Donors, the following are the requirements for the release of IDs:

1.1 Submission of a Certificate of Budget Allocation; and

1.2 Notarized Promissory Note for the payment of at least one (1) quarter premium counterpart within the 30 days grace period after the release of IDs.

2. For "Delinquent" LGU and/or Donors, the following are the requirements for the release of IDs:

2.1 Submission of a Certificate of Budget Allocation; and

2.2 Payment of at least one (1) quarter premium counterpart

D. Enrollment through Legislative Sponsorship

The IDs of enrolled indigent families shall be released upon submission of a copy of the Legislator's proposal for the allocation of a portion of the Priority Development Assistance Fund (PDAF) duly approved by the House Committee on Appropriation or a copy of the Special Allotment Release Order (SARO). However, the concerned Unit/Division/Group of PhilHealth shall coordinate with the Office of the Legislator and the Department of Budget and Management for the release of the Notice of Cash Allotment (NCA) of the concerned Legislator.

E. LGUs with OPB Implementation

1. The LGUs implementing the OPB, either initially, for renewal, or expansion, shall be required to pay the LGU premium counterpart contribution for the release of IDs.
   
   
2. Should the LGUs insist on the release of IDs prior to payment, the LGUs shall be required to submit a Certificate of Budget Allocation and a notarized Promissory Note for the payment of at least one (1) quarter premium counterpart within 30 days after the release of IDs.
   
   
3. The Corporation reserves the right to withhold the release of the PhilHealth Capitation Funds (PCF) if premium payments have not been remitted based on Office Order No. 66, series of 2002.

F. Change in Effectivity Date

Should the PhilHealth ID Cards for the Sponsored Program be released beyond the thirty (30) days grace period, the LGU may opt to change the IDs' effectivity date provided no member availed of the in-patient benefits during the period.

IV. EFFECTIVITY

This Order shall take effect immediately.

Adopted: 07 July 2003

(SGD.) FRANCISCO T. DUQUE III, M.D., M.SC.
President and CEO

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^[*] Text Available at Office of the National Administrative Register, U.P. Law Complex, Diliman, Quezon City.