(NAR) VOL. 19 NO. 1 / JANUARY - MARCH 2008

[ PHILHEALTH CIRCULAR NO. 02, S. 2008, January 23, 2008 ]

CLARIFICATION ON THE IMPLEMENTATION OF PHILHEALTH CIRCULAR NO. 7, S. 2007 AS AMENDED BY CIRCULAR NO. 12, S. 2007 RE: MEMBER DATA RECORDS (MDR) AS PRIMARY DOCUMENT IN THE AVAILMENT OF PHILHEALTH BENEFITS



As PhilHealth aims to provide greater quality services to its members, PhilHealth Circular No. 7 as amended by Circular No. 12. have been issued effective 01 September 2007 admissions.

As we embark towards a faster and convenient way of transacting business to PhilHealth by its members and accredited health care providers, the Corporation endeavors to have an accurate database of members, thus, the Member Data Record (MDR) has keen identified as the primary or first document to be submitted when a member claims his/her PhilHeaJth benefits. This document should be emphasized foremost to the employed members.

However, in consideration of the member's need to register/update/secure his/her MDR, a member who could not submit his/her MDR to the accredited health care provider can avail of the benefits, provided, he/she submits/attached a secondary document as prescribed in PhilHealth Circular No. 26, s. 2006 (Updated Summary of Documentary Requirements) to the properly accomplished PhilHealth Claim Form 1:

Examples:

Particulars

Secondary Document in the Absence of MDR
  
A. MEMBER-PATIENT  
  
1. Sponsored Member
Clear copy of valid PhilHeafth Membership Identification Card or original of PHiC CE 1 Form issued by PhilHealth.
 
2. Individually Paying Member
Clear copy of Official Receipts covering one (1) full quarter payment within six (6) month/nine (9) months within twelve (12) months prior to the month of confinement whichever is applicable.
 

3. Overseas Workers Program (OWP) Member


   
Clear copy of Official Receipts/e-Receipt covering qualifying contribution of one (1) year
 
DEPENDENT-PATIENT (including dependent/s of unregistered/registered employed member)
 
1. Legal Spouse
Clear copy of Marriage Contract/Certificate with registry number
 
2. Children below 21 years old

Clear copy of Birth Certificate with registry number or Baptismal Certificate wherein the name of parents are indicated therein

 
3. Parents 60 years old and above

Birth Certificate or Marriage Certificate/Contract with registry number of member-child or Baptismal Certificate wherein the name of the parent is indicated therein; AND

 
 

Birth Certificate with registry number of dependent- parents, " in its absence, copy of either passport/ driver's license/senior citizen's ID or a notarized affidavit of two disinterested persons attesting to the date of birth of parent, attach to the Certificate of No Record found from NSO or Local Civil Registry".


In the light of the abovementioned clarification, all members of the National Health Insurance Program are encouraged to update and secure their copy of their MDR from anv PhilHealth office nationwide to ensure a more convenient way of availing of the benefits

All PhilHealth Regional Offices (PROs), NCR Branches and Service Offices (SOs) shall accommodate the request for the reprinting/issuance of MDR, regardless of member category and area of jurisdiction.

SOs that are not yet connected to the PhilHealth Re-engineered Membership Information System (PReMIS) shall immediately coordinate with their respective PROs for the issuance of the needed MDR to members, especially those who are availing the PhilHealth benefits.

Further, all accredited health care provider's personnel in-charge with Medicare/ PhilHealth transactions are enjoined to ensure the proper implementation of this Circular and provide quality service to the NHIP members.

For information and compliance.

Adopted: 23 Jan. 2008

(SGD.) LORNA O. FAJARDO
Acting President and CEO


Source: Supreme Court E-Library
This page was dynamically generated
by the E-Library Content Management System (E-LibCMS)