PhilHealth suspends new eligibility rule

PHILHEALTH holds off the implementation of the requirement that members must have paid at least nine monthly contributions within the 12 months immediately before hospitalization to avail of benefits.

The new eligibility rule was supposed to take effect this July for all member categories and in cases of benefit availment.

But due to concerns on the proper definition and application of ‘sufficient regularity’ as basis for entitlement to benefits, PhilHealth suspended its implementation pending evaluation by the concerned operational units.

The deferment will remain in effect until the PhilHealth Board issues the appropriate policy.

Employed and individually paying members are entitled to PhilHealth benefits if they have paid at least three monthly contributions within the six months immediately prior to hospitalization. But individually paying members must have paid the quarter immediately before hospital admission to avoid suspension of benefits.

To avail of benefits for pregnancy-related procedures, select operative or surgical procedures, dialysis, chemotherapy and radiotherapy, individually paying members must have paid at least nine monthly contributions within the 12 months immediately before hospitalization.

Sponsored and overseas Filipino workers (OFWs) are entitled to benefits within the one-year validity period of their coverage, whereas registered lifetime members are no longer required to establish proof of premium payment to avail of benefits.