Philhealth November Updates

8/10/2019 Philhealth November Updates

1/25

LUN wS

Monday morning news round upNovember 10, 2014 edition

L MIN ang mga bagong

polisiya at kaganapan sa

PhilHealth


2/25

Anong Bago?


3/25

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


4/25

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.


5/25

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


6/25

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


7/25

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


8/25

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.


9/25

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)


10/25

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.


11/25

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


12/25

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


13/25

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


14/25

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


15/25

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


16/25

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


17/25

OTHER

UPDATES


18/25

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


19/25

Moment Mo To PRO


20/25

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


21/25

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


22/25

Other Activities


23/25

GCAA

Champs


24/25

GCAA Champs

Volleyball TournamentMens

Division


25/25

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

Philhealth November Updates

Documents

Transcript of Philhealth November Updates