PhilHealth intensifies enrolment at point-of-care

With PhilHealth, no one is left behind.


In its effort to provide true financial risk protection to all Filipinos especially the poor, the Philippine Health Insurance Corporation (PhilHealth) has further strengthened its enrolment program, this time at the very points where they are extremely needed.
In its Circular 32, s-2013 which took effect November 29, 2013, PhilHealth formalized its “point-of-care enrolment program” which targets non-members belonging to Class C-3 or D confined in government hospitals.

The program will also benefit existing members not currently eligible to financial protection due to lack of qualifying contributions and also classified as Class C3 or D.
Qualified patients and their qualified dependents shall be provided with PhilHealth coverage under the Sponsored Program. Their premium contributions shall be borne by the government facility, provided that they are certified poor by the medical social worker at the time of admission.

"This enrolment mechanism targets the poor which still comprise a significant portion of our society today" announced PhilHealth President and CEO Alexander A. Padilla. "We have partnered with all Department of Health (DOH) hospitals nationwide to mandatorily implement the POC" he stressed.

To date, there are 85 DOH-retained hospitals in the country and this number will further expand to widen access with the participation of Local Government-owned hospitals subject to PhilHealth’s approval.

The PhilHealth Chief expressed hope that POC will change traditional health-seeking behavior especially of the poor who opts to defer treatments because of lack of financial resources. "This program will change such behavior to one that voluntarily seeks medical treatment in hospitals, knowing that there is help waiting there from their PhilHealth" Padilla added.

Under the rules, those qualified using the intake survey sheet prescribed by the DOH shall be enrolled and paid for by the sponsoring hospital in the amount of P2,400 and valid "from the first day of the confinement month and shall end on the last day of the same year."

Beneficiaries shall be entitled to PhilHealth benefits which include inpatient, outpatient (except primary care benefit) and to the No Balance Billing policy where patients shall no longer pay the balance of hospital charges, if any.

In order not to defeat the objective of the program, the state health insurance agency emphasized that "under no circumstance shall the hospital ask the patient of any amount as their share for premium."

"It should be clear that poor patients should be afforded with financial protection at the point of need and not to give them more trouble by asking them incidental charges" Padilla further explained, adding that they are forwarding the list of qualified patients to the Department of Social Welfare and Development for possible inclusion in their poverty list, also known as Listahan ng mga Pamilyang Nangangailangan or Listahanan.

Indigent families in the DSWD list are automatically given PhilHealth coverage wholly financed by the National Government.

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