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(NAR) VOL. 14 NOS. 3-4 / OCTOBER - DECEMBER 2003

[ PHILHEALTH CIRCULAR NO. 53, S. 1999, May 10, 1999 ]

CLARIFICATION ON ELIGIBILITY TO AVAIL OF MEDICARE BENEFITS



For purposes of clarifying the Corporation's policy on the eligibility of voluntary and self-employed members of the Social Security System (SSS) to avail of Medicare benefits, the following guidelines are hereby issued:
  1. All voluntary and self-employed members of the SSS who have paid at least three monthly contributions within a six-month period prior to the first day of his or his dependent's confinement, shall be entitled to the benefits of the National Health Insurance Program (NHIP)

  2. Members who have paid their premiums before his or his dependents' confinement date but have failed to meet the three months-within-six months rules shall not be eligible to the benefits. His payments, however, will be applied to the succeeding months and, if applicable, shall be the basis for his future claims.

  3. In case the applicable period stated in the Special Bank Receipt (SBR) is earlier than the date of payment, it shall be applied to the succeeding months and the applicable period stated in the SBR shall be rendered irrelevant.

  4. "Proof of payment" requirement shall mean "proof of payment covering at least three months within a six-month period before confinement date and shall not necessarily mean the latest payment.

  5. In line with the "no retroactive payment" policy of the SSS, all payments must be made in advance.

  6. Payment of premiums shall still be made through the SSS payment mechanism until further notice.

For compliance.

Adopted: 10 May 1999

(SGD.) ENRIQUE M. ZALAMEA
President and CEO

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