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Republic of (he Philippines
PHILIPPINE HEALTH INSURANCE CORPORATION
Citysratc Centre, 709 Shaw BoulcvLiid. Pasig Ciiy
Hculihlme637-991'9 n-it-n- phdhcaiih gov Ph

PHILHEALTH CIRCULAR
No, % . s. 2010

FOR: ALL PHILHEALTH MEMBERS AND DEPENDENTS,

EMPLOYERS, PHILHEALTH OFFICES AND ALL OTHERS
CONCERNED

SUBJECT :Nine (9) Months Contribution as a Requirement for Benefit Availment

Consistent with .Republic Act ~8"75 as amended by Republic Act 92-11 (National Health Insurance Act)
nnd its Implementing Rules and Regulations concerning die requirement for benefit availmem, to wit:

"Section 42. Entitlement to Benefits - A member whose premium contributions for jit least three
i'3j months have been paid within the six (6) months prior to the fust day of" his or his
dependents' availment. shall be entitled to the benefits of the Piogram: Proi'ulcci that such
member can show that he contributed thereto with sufficient regularity, as evidenced m ineir
health insurance ID card, and IJwv;;k\l im'ihtr, that he is not currently subject to legal penalties as
provided for m. ..this Act."
And in.

"Title 11- Definition uf Terms of the RTRR - Sufficient Regularity of Premium Contribution- the
Payment ot premium contribution ot at least nine (9) months within twelve-month period
immr-diiitirly prior to the month ot nvailment ':

the Corporauon shall now require NINE (9) MONTHS OF CONTRIBUTION within 12 (twelve)
months prior to the month ot nvailment fen all confinements including av.ulmcni of outpatient benefit.

This requirement is based on the following conditions as stated above:

1Three (3) months within sd: f'6) months paid premium contributions prior to the First clay of his or
his' dependents' availment, and@"
2Sufticiem regularity ot premium contribution andi",
3. No le^il penalties as defined in RA 787? amended by RA 924].\* \ V_ _ ^M) @ u,

,T. .@i'
To illustrate:| ,-.@v^f^'^'H " *'@@'@-':-

A For condition 1 @ Paid premium contributions oi three- 13'1months from September 20lu @
February 20 U.

CY2010 CY2011
Mav Jmi JU1 Aug Scp1Oct|Nov|Dec JanFcbKT^MApr May Jun
3monthspremiumcontribution^^^^^|
within6monthspriortoMarch2011'^^^H
(inontliofavailment)^^^H
Premium contribution shall be paid prior to confinement, thus, the reckoning date ot payment
contribution shall be die date ot the last day prior to confinement. Any contribution payment paid within
the confinement, allowed under previous))" defined policies (i.e., PhilHenlth Circular Nos. 24 s-2003, 14 .s-
2004 and 7 s-2006), shall no longer be considered Tor the present confinement but for future/prospective

ones.

Example: A patient to be confined on March 15 - 16, 2011.

a. Premium payment for January - March 201 1 made on March 14, 2011 shall be considered
March2011
1 I 3 4 b t> 7 S lJ 111 11 12 13 14KE17|18 iy 20 21 22 23

b. Premium payment for January - March 2011 made on March 15, 2011 and thereafter shall no longer
be considered for the confinement but may be considered for future continemcnts.
Ma ch2011
1 -> 3 4 5 6 7 S 9 10 11 12 ,3 14E^EJ17IK 19 20 21 22 23
XXXX X X X X X

B. For condition 2 (Sufficient Regularity) - Paid conmbudon-; of nine (9) months from March 203 0
- February 201 1

CY 2010
Mar | Apr j May | Jun |~"jul "|~Aug | Sep [ Oct | Nov | Dec
9 months paid premium contribution within the immediate 12 months
proceeding March 2011 (month of avaiiment)

Thus, for a confinement in March 15-16, 2011, the requirement shall be 9 months prud premium
contribution from March 2010- February 2U11 If in cast February contribution is included in the 9
month requirement and is still unpaid, this shall be paid until the last day prior to confinement/nvmlment,
March 14, 2011. Payment made during en; after the confinemenl shall no longer be considered for die
present confinement but for future/prospective ones.

This requirement shall be for nil types of members except those under the Sponsored Program, Lifetime.
fNon-PiiymtO Progi:am and the Overseas Workers Program 'OWP).

This policv sIiliLI be eftcctive for all reimbursements with :idmjssi<jn/treatment (oui>pa.nent*i date smrung
|uh- 1, 2011 ^~^\

DR. REY B/VAQUINO PhilHealth

President jnJCEO/' J _*''
Date siojied: / Ot ^tf-WT O>

OP-S10-32919