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