Pantawid Pamilya beneficiaries now PhilHealth members

Beneficiaries of the DSWD’s  Pantawid Pamilyang Pilipino Program (4Ps) are now covered by Philhealth.

The 2012 General Appropriations Act provided a budget of P12.028 billion as subsidy for the health insurance premium of indigent families enrolled in the National Health Insurance Program.

The amount covers the national government subsidy for the health insurance premium of indigents under the National Household Targeting for Poverty Reduction (NHTS-PR) of the Department of Social Welfare and Development (DSWD).

Since the 4Ps beneficiaries are included in the NHTS-PR list, they are provided Philhealth coverage under the Sponsored Program.

Their membership entitles the beneficiaries and their dependents to special benefits under the Primary Care Benefit 1 (PCB1) Package in rural health units, health centers or the outpatient department of government hospitals.

The package covers primary preventive services, diagnostic examinations and medicines for outpatient treatment of certain illnesses.

They can also avail of insurance coverage for hospitalization in PhilHealth accredited hospital and non-hospital facilities.

The Pantawid Pamilya beneficiaries are also entitled to the no balance billing policy when admitted in non-private accommodation of government hospitals for any of the 23 cases covered under case payment; when availing of outpatient surgeries, hemodialysis and radiotherapy in non-hospital facilities; when availing of outpatient packages for tuberculosis, malaria, HIV/AIDS; and when availing of the services under the maternity care package (MCP) and newborn care package in accredited birthing homes, lying-in clinics and other MCP providers.

No Balance Billing Policy means that no other fees or expenses shall be charged or paid for by the member above and beyond the package rates.

In the absence of Philhealth ID card or member data record, the Pantawid Pamilya ID card can be presented to establish a member’s eligibility to avail of PhilHealth benefits.

For qualified dependents, supporting documents be presented to establish proof of eligibility.