(NAR) VOL. 21 NO.4 OCTOBER - DECEMBER 2010
“Section 42. Entitlement to Benefits – A member whose premium contributions for at least three (3) months have been paid within the six (6) months prior to the first day of his or his dependents’ availment, shall be entitled to the benefits of the Program: Provided, that such member can show that he contributed thereto with sufficient regularity, as evidenced in their health insurance ID card: and Provided further, that he is not currently subject to legal penalties as provided for in…..this Act.”
And in,
“Title II – Definition of Terms of the RIRR – Sufficient Regularity of Premium Contribution – the Payment of premium contribution of at least nine (9) months within twelve-month period immediately prior to the month of availment.”
the Corporation shall now require NINE (9) MONTHS OF CONTRIBUTION within 12 (twelve) months prior to the month of availment for all confinements including availment of outpatient benefit.
This requirement is based on the following conditions as stated above:
1. Three (3) months within six (6) months paid premium contributions prior to the first day of his or his dependents’ availment, and
2. Sufficient regularity of premium contribution and
3. No legal penalties as defined in RA 7875 amended by RA 9241.
To illustrate:
Example: A patient to be confined on March 15-16, 2011
A. For condition 1 – Paid premium contributions of three (3) months from September 2010-February 2011.
CY 2010 | CY 2011 |
May | Jun | Jul | Aug | Sep | Oct | Nov | Dec | Jan | Feb | Mar | Apr | May | Jun |
3 months premium contribution within 6 months prior to March 2011 (month of availment) |
Example: A patient to be confined on March 15-16, 2011
a. Premium payment for January-March 2011 made on March 14, 2011 shall be considered.
March 2011 |
1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | 17 | 18 | 19 | 20 | 21 | 22 | 23 |
March 2011 |
1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | 17 | 18 | 19 | 20 | 21 | 22 | 23 |
x | x | x | x | x | x | x | x | x |
CY 2010 | CY 2011 |
Feb | Mar | Apr | May | Jun | Jul | Aug | Sep | Oct | Nov | Dec | Jan | Feb | Mar |
9 months paid premium contribution within the immediate 12 months preceding March 2011 (month of availment) |
This requirement shall be for all types of members except those under the Sponsored Program, Lifetime (Non-Paying) Program and the Overseas Workers Programs (OWP).
This policy shall be effective for all reimbursements with admission/streatment (out-patient) date starting July 1, 2011.
All other provisions inconsistent herewith are hereby repealed/amended accordingly.
(SGD.) DR. REY B. AQUINO
President and CEO