PhilHealth lowers eligibility requirement

TO serve more members, PhilHealth will only require at least three monthly contributions within the immediate six months before hospital confinement.

In the past, individually paying members had to have at least nine monthly contributions within the immediate 12 months prior to the month of availment for select surgical procedures, cancer treatment, dialysis and pregnancy related cases.

But in the implementing rules and regulations of the National Health Insurance Act of 2013, members are now entitled to PhilHealth benefits as long as they have paid premium contributions for at least three months.

Members also have the option to pay in full the required premium if the three-over-six months requirement is not met.

Those who are separated from employment or whose coverage as sponsored member or as overseas Filipino worker has ended may pay for the unpaid months of the applicable year.

Meanwhile, PhilHealth adopts the new classification of hospitals and other health facilities of the Department of Health (DOH).

The DOH now classifies health facilities as hospitals (levels 1 to 3), specialty hospitals and other facilities, such as primary care, custodial care, diagnostic/therapeutic and specialized out-patient.

With these changes, some hospitals previously classified as level 1 or level 2 are no longer considered hospital facilities but primary care facilities.