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Here is the continuation of yesterday’s feature article on Philhealth contributions and membership renewals.  In today’s blog, we will cover the answers to common questions from Philhealth members such as refunds for unused contributions, how to “reactivate” membership after failing to pay several months, and how to continue paying for your Philhealth membership after you have resigned from your employment.

Read on!

How do I maintain my eligibility?

The key to maintaining eligibility is paying your premiums on-time.  If there are gaps in premium contribution, eligibility will also be affected.  Here are several tips for each member category to ensure that you’ll always be able to use your benefits:

  1. Sponsored Members
  • If the member’s card is about to expire, the member must proactively inquire, whether the Sponsor will renew his/her membership.
  • If not, the member may opt to register as an Individually Paying Member.
  1. Individually Paying Member
  • Ensure that each calendar quarter has been paid.
  • If possible, pay your premiums yearly for your own convenience.
  1. Overseas Workers Program Member
  • Premiums must be remitted prior to your membership’s expiration.
  • If your contract abroad is already terminated, make sure that you shift member category from OWP to IPM (or other applicable categories) to be able to pay premiums again.
  1. Employed Members
  • For seasonal employment or if you’re going to take a leave without pay, just head to the nearest Philhealth Service Office to pay your contributions for the months that you will not be compensated. You may continue paying your premiums as an Individually Paying Member (IPM).
  • To pay your premiums as an IPM, visit any Philhealth office and present a copy of the RF-1 from your employer indicating that you are on leave without pay or a Certification from your employer indicating the same.
  • Once you get separated from employment, make sure you shift category to IPM.

If I missed paying the past quarters, can I still pay for this now to become eligible again?

This is an example of a retroactive payment.  Unfortunately, Philhealth does not accept retroactive payments to avoid abuse of benefits.  This policy has to be in place to avoid those instances when members only choose to pay when they get sick or need to avail of benefits (and conversely stop paying when they don’t need it), which will be unfair for those who pay their premium contributions regularly.

What is the tolerable delay for paying premiums for a member to still be able to use his/her benefits?

None.  Philhealth strictly follows its policies on premium payment and benefit availment.

 Can contributions be refunded by the member who was not able to use it?

No. Philhealth is a social insurance program, wherein members’ premiums are pooled into a single fund used to pay for the benefits of sick members.  Even if a member is not able to use benefits or does not get sick within a particular enrolment year, funds are kept in the pool.

If I stopped paying my premium for considerable amount of time, can I still use my benefits?  Do I need to pay the missed contributions to be able to avail of the benefits again?

No.  Only active members are eligible to avail of Philhealth benefits.  Member should have paid at least three months premium contributions within the immediate six month period prior to medical confinement.  However, payment of at least nine months within the last 12 months shall be asked of Individually Paying Members availing of the following procedures/packages:

  • Pregnancy-related cases
  • Dialysis (except those undergoing emergency dialysis service during confinement)
  • Chemotherapy
  • Cataract Extraction
  • Radiotherapy
  • Selected surgical procedures

Individually Paying Members and Employed Members will now be required to have at least nine (9) months contributions within twelve (12) months prior to the month of availment for all confinements including availment of outpatient benefits.

What if the member passes away?  Can the dependents still use their benefits?

In case the member dies, his/her membership privileges are also terminated.  However, dependents of Sponsored Members may still avail of the Philhealth benefits for the unexpired portion of the member’s contribution.

I used to be employed, but am now self-employed.  Can I still continue paying for my premiums?  How do I go about this?

In case you get separated from employment, you may continue your Philhealth membership by becoming an Individually Paying Member and paying the applicable premium.  Simply accomplish the Philhealth Member Registration Form (PMRF) and tick the box “For Updating” and the appropriate box of the membership category to which you are shifting.  Make sure you continuously and religiously pay your premiums so as to avoid suspension of benefits.

If you have further questions regarding your Philhealth membership, claims, and other benefits, you may call their hotline at 02-441-7442.  They are available to take your call 24/7!

If this blog helped you, share it with others so it would help them too.

Source: www.philhealth.gov.ph

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