ALAMIN ang mga bagong

polisiya at kaganapan sa
PhilHealth

LUNEwS
Monday morning news round up
November 10, 2014 edition

Anong Bago?

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

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.

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 ensure
their survival and well-being

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 pregnancy
related conditions such as pre-term labor and
pregnancy induced hypertension
Only low-risk normal vaginal deliveries
compensable in non-hospital facilities

shall be

Mechanics for Availment:

For Registered members or dependents
Coveredmember 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 of
the year

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.

The health care provider shall refer the following

pregnant women to Medical Social Worker or Social
Worker 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)

Pregnant women who did not qualify for Point of Care

enrollment shall be covered through the provisions of
Section 39b (Paid in full the required premium for the
calendar year) of the IRR of National Health Insurance Act
of 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 physician;
Photocopy of laboratory/ultrasound result;
Photocopy of her admission records
Pay to the nearest LHIO or PRO the corresponding
annual premium contribution for the current calendar
year regardless of the date when their pregnancy was
confirmed.

Benefit Packages for Women About to Give Birth

Maternity Care Package (MCP)
Hospitals Php 6,500.00
Infirmaries/ Birthing Homes/ - Php 8,000
dispensaries/maternity clinics
Normal Spontaneous Delivery (NSD) Package
Hospitals Php 5,000.00
Infirmaries/ Birthing Homes/ - Php 6,500
dispensaries/maternity clinics

Antenatal Care Package Php 1,500.00

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 PhilHealth
Cesarian Section
Complicated vaginal delivery
Breech Extraction
Vaginal delivery after cesarean section

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

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

General Provisions
Members who intend to declare their parents below
60 years old with permanent disability shall submit
the following documents:
Duly accomplished PMRF to include disabled parent
as additional dependent; and
Medical Certificate issued by the attending
physician with the details and extent of disability

Parents below 60 years old with current

admission that resulted to permanent disability
can immediately be declared as dependent,
provided that prior to discharge they have
submitted the required documents stated
above to any PhilHealth Office for evaluation
and amendment of MDR.
Effectivity: 15 days after its publication
Manila Bulletin/Publication Date: November 1, 2014

OTHER
UPDATES

Organizational Design and QMS

November 4- QMS: Meeting with AJA Registrars
November 5- OD : 3rd Presentation 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

Moment Mo To PRO

PRO Caraga ACTIVITIES

Conducted TSEKAP Orientation to
DepEd Caraga personnel and staff last
October 23, 2014 at Bugsay, Cortes,
Surigao del Sur

Philhealth Caraga: Making the most of Corporate Social

Responsibility
RVP Johnny Y. Sychua, with LHIO-Bislig
City Chief Juliet A. Golez attended the
House 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

Other Activities

GCAA
Champs

GCAA Champs

Volleyball Tournament Mens

Division

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
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Magandang Gabi Dok with PhilHealth
every Friday, 8:30 to 9:00 p.m. over
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