Download - Philhealth November Updates
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LUN wS
Monday morning news round upNovember 10, 2014 edition
L MIN ang mga bagong
polisiya at kaganapan sa
PhilHealth
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Anong Bago?
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Office Order No. 0109-2014: 2014 Official
Letterhead / Stationery
Republic of the Philippines Times New Roman,
bold, italics, 9 pts
PHILIPPINE HEALTH INSURANCE CORPORATION Helvetica blod, 12 pts
Citystate Centre, 709 Shaw Blvd., Pasig City Times New Roman,
regular, 8.5 pts
Call Center: (02) 441-7442 Trunkline: (02) 441-7444 Times New Roman,
regular, 8.5 pts
www.philhealth.gov.ph Times New Roman,
regular, 8.5 pts
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Office Order No. 0109-2014 : 2014 Official
Letterhead / Stationery
All offices corporate-wide are directed to use the
new application immediately in all external and
internal communications in line with the
implementation of the Quality Management
System.
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PhilHealth Circular 022, s.2014
Title:
Social Health Insurance Coverage and Benefits for
Women About to Give Birth
Key points:Un-enrolled women about to give birth shall be
covered
All mothers and their newborns to have financial
access to essential health services that will ensuretheir survival and well-being
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General Guidelines
PhilHealth shall provide benefits for all maternal
deliveries regardless of parity, subject to the
provision of qualifying contributions.
It shall also cover admissions due to pregnancyrelated conditions such as pre-term labor and
pregnancy induced hypertension
Only low-risk normal vaginal deliveries shall becompensable in non-hospital facilities
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Mechanics for Availment:
For Registered members or dependents
Covered- member paid at least 3 months within
the last six months (3/6) prior to first day of
availment
Not Covered- if they do not have qualifying
contribution, they shall update their premium
contributions, specifically the missed payment in
previous quarter/s and for the remaining quarter ofthe year
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For Non-Registered members
Pregnant women who are able to pay the premium
must immediately register and pay the
corresponding premium for the whole year.
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The health care provider shall refer the following
pregnant women to Medical Social Worker or SocialWorker for assessment and enrollment via Point of
Care per PC 32,s-2013:
not yet registered;
registered but lacks qualifying contributions
qualified dependents of their parents (covered
or not covered)
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Pregnant women who did not qualify for Point of Care
enrollment shall be covered through the provisions of
Section 39b (Paid in ful l the required prem ium for the
calendar year) of the IRR of National Health Insurance Actof 2013 following the procedures prior to discharge from
health facility, to wit:
Submit to the PhilHealth LHIO or PRO an
accomplished PMRF and any of the following
documents;Medical Cert from her phy sic ian;
Photoco py o f labor atory/u l t rasound resul t ;
Photocopy o f her adm iss ion records
Pay to the nearest LHIO or PRO the corresponding
annual premium contribution for the current calendaryear regardless of the date when their pregnancy was
confirmed.
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Benefit Packages for Women About to Give Birth
Maternity Care Package (MCP)
HospitalsPhp 6,500.00
Infirmaries/ Birthing Homes/ - Php 8,000
dispensaries/maternity clinics
Normal Spontaneous Delivery (NSD) PackageHospitalsPhp 5,000.00
Infirmaries/ Birthing Homes/ - Php 6,500
dispensaries/maternity clinics
Antenatal Care PackagePhp 1,500.00
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Benefit Packages for Women About to Give Birth
Payment for Cases Referred to Hospitals
Intrapartum monitoring Php 650.00
Antenatal care services Php 2,150.00
with intrapartum monitoring services
Other Methods of Deliveries Covered by PhilHealthCesarian Section
Complicated vaginal delivery
Breech Extraction
Vaginal delivery after cesarean section
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Benefit Availment and Claims Filing
For submission within 60 calendar days after
discharge:
PhilHealth Benefit Eligibility Form (PBEF) or other
documents required by PhilHealth as proof of
eligibility such as MDR, etc.
PhilHealth Claim Form 1 (CF1)PhilHealth Claim Form 2 (CF2)
PhilHealth Claim Form 3 (CF3)
Effectivity: 15 days after its publication
Philippine Daily Inquirer/Publication Date: November 1, 2014
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PhilHealth Circular 023, s.2014
Title:
Coverage of Parents Below 60 years old with
Permanent Disability
Key points:
Covers all parents below 60 years old with permanent
disability subject to the evaluation of the Medical
Certificate presented
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General Provisions
Members who intend to declare their parents below60 years old with permanent disability shall submit
the following documents:
Duly accomplished PMRF to include disabled parentas additional dependent; and
Medical Certificate issued by the attending
physician with the details and extent of disability
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Parents below 60 years old with current
admission that resulted to permanent disabilitycan immediately be declared as dependent,
provided that prior to discharge they have
submitted the required documents stated
above to any PhilHealth Office for evaluationand amendment of MDR.
Effectivity: 15 days after its publication
Manila Bulletin/Publication Date: November 1, 2014
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OTHER
UPDATES
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Organizational Design and QMS
November 4- QMS: Meeting with AJA Registrars
November 5- OD : 3rdPresentation of the Draft
Organizational Structure to the
PMT-OD and Execom members: Presentation of the Staffing
Review Overview to the PMT-OD
and Execom Members
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Moment Mo To PRO
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PRO Caraga ACTIVITIES
Conducted TSEKAP Orientation to
DepEd Caraga personnel and staff lastOctober 23, 2014 at Bugsay, Cortes,
Surigao del Sur
Philh lth C M ki th t f C t S i l
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Philhealth Caraga: Making the most of Corporate Social
Responsibility
RVP Johnny Y. Sychua, with LHIO-Bislig
City Chief Juliet A. Golez attended theHouse Dedication and Turn Over
Ceremony of LGU Hinatuan, Surigao del
last October 24, 2014 and turned-over
PFP checks and distributed MDRs to
recipient families
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Other Activities
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GCAA
Champs
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GCAA Champs
Volleyball TournamentMens
Division
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Radyo Natin To!
Dear PhilHealth
every Wednesday, 3:30 to 4:00 p.m. over
Radio DZRH 666 kHz-AM
PhilHealth, Hataw sa Serbisyo
every Thursday, 11:00 to 11:30 a.m. over
Radio DWIZ 882 kHz-AM
Magandang Gabi Dok with PhilHealthevery Friday, 8:30 to 9:00 p.m. over
Radio DZMM 630 kHz-AM