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Mandatory PhilHealth Coverage of Senior CitizensPursuant to Republic Act No. 10645

Source: TAMANG SAGOT PhilHealth Circular 33, s.2014 Implementing Guidelines for the Mandatory PhilHealth Coverage of Senior Citizens pursuant to Republic Act No. 10645Sabtang National School of FisheriesFebruary 22, 2015

Mandatory PhilHealth Coverage of Senior Citizens

TAMANG SAGOTPhilHealth Circular 33, s.2014 Implementing Guidelines for the Mandatory PhilHealth Coverage of Senior Citizens pursuant to Republic Act No. 10645

1. What is RA 10645 all about?RA 10645 amended a section in the Expanded Senior Citizens Act of 2010That section now reads:All senior citizens shall be covered by the national health insurance program of PhilHealth. Funds necessary to ensure the enrollment of all senior citizens NOT currently covered by any existing category shall be sourced from the National Health Insurance Fund of PhilHealth from proceeds of Republic Act No. 10351, in accordance with the pertinent laws and regulations.provided coverage for Senior Citizens NOT currently covered by any membership program of the NHIP.R.A. 106451. What is RA 10645 all about?3. Who are the Senior Citizens?The Senior Citizens or the Elderly areFilipino Citizens who are residents of the Philippines

aged 60 years old or above

AND3. Who are the Senior Citizens?The Senior Citizens or the Elderly areDual Citizens with proof of Filipino citizenship

aged 60 years old or above

AND have at least 6 months of residency in the Philippines

AND4. In what membership category will PhilHealth enroll senior citizens with no coverage?A new member category was created: Senior CitizenThis category is for a senior citizen who is

not yet issued with a PhilHealth Identification Number or PIN;

a member in the formal or informal economy but has no qualifying contributions to be entitled to the Program benefits;4. In what membership category will PhilHealth enroll senior citizens with no coverage?A new member category was created: Senior CitizenThis category is for a senior citizen who is

not an identified indigent under NHTS-PR;

not currently a Sponsored Member;not yet qualified as a Lifetime Member;5. Can a Senior Citizens member declare dependents? Just like any other PhilHealth Member.

YES,A Senior Citizen member may declare the following as qualified dependents in the PMRF:DECLARATION OF QUALIFIED DEPENDENTSLegitimate spouse who is not enrolled under the NHIP;Children, legitimate or illegitimate below 21 years of age, who is unmarried and unemployed;Children who is 21 years of age or above but suffering from a congenital disability, either physical or mental, or any disability that reders him or her totally dependent to the member for support; andFoster child6. What if the dependent of a Senior Citizen is a Senior Citizen as well? Dependents of Senior Citizen members who are senior citizens themselves, e.g. legal spouses, can be enrolled as Senior Citizen members too.7. What if the senior citizen is a dependent of a member who has an existing covergage? Dependents who are senior citizens can be enrolled as Senior Citizen members.8. What about senior citizens who are gainfully employed? Will they continue to remit contributions? Senior Citizens who are gainfully employed or remains to have a regular source of income shall continue to contribute to the NHIP.YES9. Who will pay for the contributions of the Senior Citizen members? The premium contributions of those who will be enrolled under the Senior Citizen category shall be sourced from the proceeds of RA 10351, commonly known as theSin Tax Law10. Is the Senior Citizen category the same with the Lifetime Member category? The LMP members need NOT pay contributions to be eligible to the benefits.

The Senior Citizen members have premium contributions which are paid from the proceeds of Sin Tax Law. No11. What will be the membership documents that will be provided to Senior Citizens? A PhilHealth ID Card and MDR (Membership Data Record Form) shall be printed and given to the Senior Citizen as proof of enrollment.

However, while IT system are being adjusted, only the MDR shall be given. 12. What are benefit entitlements of Senior Citizens? Senior citizen members will be entitled to benefits for inpatient hospital care, day/ambulatory services, Z-benefits and other special benefit packages.Upon the effectivity of RA 10645 (Nov 25, 2014). Senior Citizen members and their qualified dependents shall be entitled to the following benefit packages under the NHIP:

Inpatient hospital careDay/ambulatory services;Special benefits from catastrophic cases referred to as Z benefits;TB-DOTS Packages

BENEFITS AND ENTITLEMENTSUpon the effectivity of RA 10645 (Nov 25, 2014). Senior Citizen members and their qualified dependents shall be entitled to the following benefit packages under the NHIP:

Animal Bite Package;Malaria package;Outpatient HIV/AIDS Treatment Package;Blood Transfusion Package;

BENEFITS AND ENTITLEMENTSUpon the effectivity of RA 10645 (Nov 25, 2014). Senior Citizen members and their qualified dependents shall be entitled to the following benefit packages under the NHIP:

Maternity and Newborn Package;Normal Spontaneous Delivery Package;Antenatal Care Package; andBenefits for Voluntary Contraceptive Surgical Procedure.

BENEFITS AND ENTITLEMENTS13. How will Senior Citizens avail of the benefits? Senior Citizens only need to present their senior citizen card, MDR or any accepted proof of identity and age (Birth Certificate, Philippine assport, SSS/GSIS ID, etc.)Mandatory PhilHealth Coverage of Senior Citizens

ENROLLMENTPhilHealth Circular 33, s.2014 Implementing Guidelines for the Mandatory PhilHealth Coverage of Senior Citizens pursuant to Republic Act No. 10645

ENROLLMENTSenior Citizen members shall be primarily enrolled in coordination with the OSCA, or any office designated by the Office of the Mayor, in the locality where they reside.

The OSCA maintains and regularly updates on a quarterly basis the list of senior citizens of its locality. The OSCA may submit, on a quarterly basis, to the LHIO the list of senior citizens for enrollment to the NHIP as Senior Citizens.ENROLLMENTThe list must contain the following information about the senior citizen:

Full NameBirthdateSexAddress (must include the Barangay, Municipality, Province)ENROLLMENTTo expedite enrollment, processing and validation, the list shall be submitted to the LHIO in electronic format.

The file must be password-protected.The list must be accompanied by a transmittal letter from OSCA and the printed alphabetical list of the names of the senior citizens. ENROLLMENTAs much as practicable, a duly accomplished PhilHealth Member Registration Form (PMRF) shall be submitted with the list of senior citizens from OSCA. In cases where the OSCA, or the office designated by the Office of the Mayor, cannot submit the list in electronic format, the duly accomplished PMRFs of the senior citizens may suffice. These PMRFs shall be properly endorsed to the LHIO who has operational jurisdiction over the locality.ENROLLMENTEnrollment shall be primarily in bulk utilizing the list submitted on a quarterly basis by the OSCA of each city and municipality.ENROLLMENTIndividual (Walk-in) Enrollment of senior citizens has the following requirements:

A duly accomplished PMRF; A 1 x 1 photo taken within the last 6 months; ANDAn acceptable proof of being a senior citizenEncouraging individual enrollment of senior citizens to the program is NOT RECOMMENDED.

DELA CRUZJUANSRRIZAL02-22-1935SABTANG, BatanesFilipinoSinakanSabtangBatanesPhilippines3904National Road

0996552409

DIUS MAMAJESDinio Atavu!