At 20, PhilHealth is nearing the attainment of its vision to make sure that every Filipino has social health insurance

coverage. The stars have apparently aligned to make the environment conducive to the pursuit of this noble goal so that every Filipino is able to entrust his health to the national government’s program that has spanned two full decades of consistent public service. The anniversary celebration was low-key but meaningful. Activities included a conference that generated insights on the four main tracks used to pursue the goals of NHIP; an anniversary program where the newest benefit package for the less privileged was introduced; a nationwide simultaneous run that brought together at least 50,000 runners; massive tree-growing and nurturing in four major sites in Mindanao; fun outdoor games for employees; and a simple but elegant awards

ceremony to salute outstanding employees. Other initiatives pursued during the entire February, which is National Health Insurance Program Month, were standard fare such as blood donation sessions, media briefings, hospital visits, lecture sessions with senior citizens, and simple rites to acknowledge outstanding institutional partners. Indeed, the celebration was kept to a minimum, but the impact that these endeavors brought, especially to the lives of those that the NHIP caters to, was much more important. As it begins its journey towards the next 20 years, PhilHealth is optimistic that its enrolment targets will be met sooner than expected; the electronic highway that will make transactions faster is conveniently in place; and more importantly, its benefit packages spell true financial risk protection for its members. Inspired by the gains over the last 20 years, PhilHealth is more than ready to conquer what the future holds.

ChroniclesPhilHealth

The Official Newsletter of the Philippine Health Insurance CorporationIssue 01, 2015

One of the highlights of the 20th Anniversary program was the awarding of the Certificate of ISO Registration to PhilHealth by AJA Registrars, the third party evaluator that recommended the immediate certification as early as December 2014.

AT least 14,900 victims of typhoons Yolanda and Ruby from Coron, Palawan in Region 4B, Camarines Norte, Camarines Sur, Catanduanes, Masbate and Albay in Region 5, Negros Occidental in Region 6, North Cebu and Bohol in Region 7

The ISO 9001:2008 is for PhilHealth’s Head Office, Regional Office IV-A and Local Health Insurance Office – Calamba. It will enable PhilHealth to demonstrate its ability to consistently provide quality service to meet its commitment to customers. It has to effectively apply the system, undertake continual improvement and prevent occurrence of non-conformities to standards. 

 Sure steps to ISO Certification For PhilHealth, the journey to ISO Certification began early last year through Office Order No. 51 which approved the implementation of mandatory procedures on Documents and Records Control, Control of Non Conformities, Corrective and Preventive Actions. It also included the conduct of Internal Quality Audit. By July, the Philippine Social Health Insurance Management System, or PSHIMS, was officially adopted, covering mandated functions on member coverage, benefit delivery and provider management, and the accompanying management and support processes. 

 Now ISO certified In his Anniversary Message, PhilHealth President and CEO Alexander A. Padilla said that  “our journey towards becoming world-class is embodied in our recent adoption of our own QMS. We want to be ISO-certified and we are taking sure steps towards this goal and we have set our sights for the rest of the PhilHealth organization to be ISO-certified as well.”

ISO 9001:2008 Certification Gainedby Amelita L. Buted 

Coverage for 14,900 Typhoon VictimsBy Faudia H. Subillaga

and Ormoc, Samar, and Tacloban in Region 8 will be given social health insurance coverage soon.

Through a grant agreement between PhilHealth and the International Labour Organization (ILO), the typhoon victims will be provided with a three-

month PhilHealth coverage under the ILO’s Sustainable Livelihood Recovery Program. Total worth of coverage is Php9,208,200.00. The enrolled beneficiaries shall be enlisted under the Sponsored Program and will be entitled to PhilHealth’s full range of benefits including inpatient benefits, special benefit packages, primary care, and the Z benefits, and to the “No Balance Billing” policy for confinements in government hospitals. The PhilHealth-ILO partnership started last year with 5,162 typhoon victims being provided with PhilHealth coverage under the Cash for Work Program. The initial ILO grant amounted to Php3, 097, 320.74.

JUST A NOTE:Thank you for reading PhilHealth Chronicles’ first issue. This is one way of sharing with our dear readers the latest news on PhilHealth benefits and services. Send us your feedback through actioncenter@philhealth.gov.ph. Story suggestions are welcome at varlezm@philhealth.gov.ph or retutae@philhealth.gov.ph.

CORPORATE NEWS

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Confirmed cases of Middle East Respiratory Syndrome – Corona Virus, or those that have been tested at the Research Institute for Tropical Medicine (RITM), are compensable.

“Tamang Serbisyo sa Kalusugan ng Pamilya” (Tsekap)” is a benefit package that is an expansion of the Primary Care Benefit Packages 1 and 2 that were implemented in 2012 and 2014, respectively. It shall be initially rolled out to the indigent and sponsored members, but eventually it will be offered to all other sectors.

Included in the Tsekap are drugs and medicines for ten (10) common conditions that can be managed at a primary care set up such as asthma, acute gastroenteritis, upper respiratory tract infection, pneumonia, urinary tract infection, diabetes mellitus, hypertension, dyslipidemia, deworming and ischemic heart disease. Also available are comprehensive health profiling upon enlistment, consultations, regular blood pressure and body measurement, periodic clinical breast examination, cervical cancer screening, digital rectal examination, risk profiling for hypertension and diabetes, counselling for smoking cessation and lifestyle modification and oral check-up and prophylaxis for children 12 years old and below. Indigent and Sponsored members may choose either a private or public Tsekap provider that is most accessible to them. The chosen provider shall enlist the family and make the individual health profiling, which is an essential component, to

or institutional workers of a health care institution, whether located in the Philippines or abroad, that cared for or had close contact with a MERS CoV patient and may have contracted the infection while performing such duty. The amount includes payments for room and board at P1,500/day or up to a maximum of P10,000; professional fee of attending physician at P1,500/day up to a maximum of P15,000 and P30,000 for non-health and health workers, respectively. Coverage for medicines, laboratory tests, personal protective equipment as well as ambulance is pegged at P25,000 for non-health workers. Health workers may avail themselves of up to P30,000 for the

same benefit items. Non-members availing themselves of the benefit must fill out the PhilHealth Member Registration Form and submit it to PhilHealth for evaluation. Those who qualify shall be enrolled under the point-of-care program. The No Balance Billing (NBB) policy applies to indigent and sponsored members. Compliance to the required qualifying contribution and 45 days benefit limit are waived for availment of this benefit since MERS CoV is considered as an emerging disease. This benefit may be availed of for all admissions starting January 1, 2015.

ensure that the health status of the eligible PhilHealth beneficiary is established and monitored. The No Balance Billing shall also apply both in private and public facilities where the Tsekap services are provided. Among Tsekap’s unique properties is the use of the EMR or Electronic Medical Records that will be generated by the provider-facilities whose IT systems should be in sync with PhilHealth.

Tsekap Package for Indigent and Sponsored Membersby Pinky G. Aragones

By Emelita M. Retuta

Confined forMERS CoV?PhilHealth Compensates

NEW BENEFITS

PhilHealth members, whether health or non-health workers, may avail themselves of the benefits in an accredited healthcare institution that has the capabilities and facilities to manage MERS CoV such as those with negative isolation rooms and respirators. Non-health workers can avail themselves of up to P50,000, while health workers can get as much as P100,000.00. Health workers are employees

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MEMBERS of PhilHealth may now check on the accuracy of their member data records through the Member Inquiry facility that can be found on the homepage of www.philhealth.gov.ph.

To access their records, members must first register by following the standard steps indicated in the facility. Once the registration is completed, they can log in using their PhilHealth Identification Numbers and the password that will be sent to their email addresses.  The Member Inquiry facility allows members to verify the accuracy of the information reflected in their membership profiles such as name, date of birth, address, employer, names of dependents, and other pertinent personal details.  It also allows members to check on their posted premium contributions.  Should members see that there are months or years without posted contributions, they should immediately check with their employers, or check on their personal files of official receipts of premium payments made, or  better yet, call the Action Center at (02) 441-7442 to report any discrepancy

Serving as the electronic gateway, the Health Care Institution Portal simplifies filing of PhilHealth claims and availment procedures by reducing documentary requirements. The PhilHealth Benefit Eligibility Form (PBEF) which the portal generates, effectively replaces the Member Data Record, and ascertains the eligibility of the member or his dependent to avail of the benefits at point-of-service. How does the HCI portal work?With a reliable internet connection, the HCIs can access a member’s records through the PhilHealth Benefit Verification Module. Once a member is admitted for confinement, a hospital staff member keys in to the portal vital information about the member and verifies the following: PhilHealth membership or dependency, premium contribution and compliance to the 45 days benefit limit. Once the portal yields a YES for an answer, then the member is eligible to avail of PhilHealth benefits for the said confinement. If the portal says NO, the member will be asked to provide the PhilHealth Claim Form 1, MDR, and proof of dependency if the patient is a qualified dependent. These documents shall be attached to the PBEF and will be submitted to PhilHealth once the hospital files for claim reimbursements. With eligibility checking already transferred to the hospital, the procedure somehow gives HCIs some form of assurance that the claimant is indeed eligible since the transaction was already approved by PhilHealth through the PBEF. Since new policies and advisories are being disseminated through the HCI Portal, it also serves as the hospital’s information source.

in the information that they see on their profiles. Members who need to update their PhilHealth profiles must fill out the PhilHealth Member Registration Form which can be downloaded from the website, and bring it to any of the nearest Local Health Insurance Office in their localities.

Member Inquiry Facility

HCI Portal: Benefit Availment Made Easierby Pinky G. Aragones

NEW SERVICES

PhilHealth moves a step forward by introducing a user-friendly web facility known as the All Case Rates Search Engine, wherein members and even non-members can easily search for the rates that it pays for every compensable medical or surgical case.

ACR Search Engine FacilityBy Michelle S. Nisperos

of case rates. International Statistical Classification of Diseases and Related Health Problems Tenth Revision (ICD 10) and Relative Value Scale (RVS)

are codes used by PhilHealth in identifying specific rates for every reimbursable medical condition and procedure. The new facility also provides full description of the case, breakdown of fees/rates being paid for by PhilHealth to its accredited hospitals and physicians, categories of hospitals where a certain case may be availed of and even the compensable illnesses under the second case rates.

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The facility is easy to use. A member only needs to key in the name of the medical or surgical condition and the case rates will automatically be displayed. The searchable field for the case rates is positioned at the right side of the enhanced PhilHealth Corporate Website Homepage. The web user may either search by case (description), by ICD 10 or by RVS codes to show the entire range

EMPLOYEES in the government and private sectors including kasambahays and family drivers, as well as self-earning individuals must have paid at least three months’ premium contributions within the immediate six-month period before the first day of confinement so they can avail themselves of their benefits from the Philippine Health Insurance Corporation (PhilHealth).

Starting April 1, vacationing OFWs or balik-manggagawa returning to their destinations overseas, must proceed to the PhilHealth counters at the POEA in Ortigas EDSA, Mandaluyong City to pay their premium contributions. Upon recent advice by the POEA, payments for Overseas Employment Certificates (OECs) will no longer include PhilHealth premium contributions. To avoid the long queue, OFWs should pay their PhilHealth premiums first before going to POEA to get their OECs. Premium payments may be made at designated PhilHealth Counters at the Balik-Manggagawa Center, or through any of our accredited collecting partners nationwide. The list of ACAs authorized to collect OFW premium contributions can be found on www.philhealth.gov.ph/ advisories/2014/adv12-03-2014.pdf.

NEW POLICIES

The qualifying six month-period includes the month of confinement. This new development is contained in PhilHealth Circular 32, s.2014 and now makes it possible for members in the Formal and Informal Economies, except land-based OFWs, to catch up on their premium contributions before the first day of hospitalization.  The policy also applies to qualified dependents of members. However, payments made on

Payment of premium contributions of migrant workers effectiveApril 1, 2015

Further inquiries regarding this matter may be referred to the Overseas Filipinos Program Office at (+63917) 5129149, (+632) 441-7444 ext. 7416 or through ofp@philhealth.gov.ph.

3-over-6 months premium payments needed before first day of confinementby Faudia H. Subillaga

 

admission date, during the confinement period or after the member or dependent is discharged from the health care institution, will not be counted as qualifying contributions. The new policy took effect for all admissions starting January 1, 2015.

NEW POLICIES

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Two major activities held during our 20th Anniversary were demonstrations of our corporate social responsibility, in a bid to inculcate among our colleagues the value of paying it forward, of being more for others. In these pages, we chronicle snapshots of the 2nd Simultaneous Nationwide Run and the Massive Tree-Growing activities that took place in February.

“PhilHealth: Ready, TSeKaP, Go!” About 50,000 runners from all walks of life gathered in 13 sites nationwide in the wee hours of February 15, 2015 to run for a noble cause. The running event, the second of its magnitude that we have organized, took place in the cities of Quezon, Baguio, Dagupan, Olongapo, Lucena, Batangas, Naga, Iloilo, Cebu, Tacloban, Davao, Koronadal and Tuguegarao. It was a run to help those in need - the elderly, the children and sick. It was also a run to help increase public awareness on the benefits and services that we provide to our members.

Tree Growing Activity In Zamboanga City, 5,000 seedlings of mangrove were planted in Sitio Asinan in Barangay Talon-talon. A Memorandum of Agreement was also signed among PhilHealth, Barangay Talon-talon and the Department of Environment and Natural Resources to ensure coastal protection and conversion of marine biodiversity in the area. In Butuan City, more than 1,000 individuals joined PhilHealth’s “Plant a Million Trees Program” in partnership with the City Government to grow and sustain a PhilHealth forest park in the city. PhilHealth is the first among agencies to establish a Forest Park through multi-sectoral efforts, to promote inter-generational responsibility in caring for the environment. A tree-growing activity was also held in Sitio Cala-cala in Barangay Macasandig in Cagayan de Oro City to protect and restore Mother Earth. It was in 2011 when Typhoon Sendong directly hit the city and thousands of lives were lost. Near Lake Lanao National High School in Barangay Sugod, Marawi City, 450 seedlings were also planted.

Corporate Social Responsibility in Actionby Michelle S. Nisperos

PCEO Padilla takes on the 5K run.

Participants gather in run sites nationwide.

Stretching before the run starts.

And off they go.....

EVP/COO Ramon F. Aristoza Jr welcomes participants in NCR

Enjoying the Zumba session before the awarding ceremony (Cebu)

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20th Anniversary CSR Activities Through Our

Lenses

PRO XI RVP Dennis Adre ready to fire the first gun start

PhilHealth President and CEO Alexander A. Padilla expresses his gratitude for the

outpouring support from the public.

Binibining Pilipinas Universe MJ Lastimosa poses with the run beneficiaries in Batangas City.

The run finishers

Starting them young. This parent instills the value of health and fitness with his little girl

Fireworks display to kick-off the start of the event in Koronadal.

Disability did not hinder this young girl from joining the event in Iloilo.

PRO ARMM RVP Khaliquzzaman M. Macabato with uniformed personnel of the government

PCEO Padilla takes part in the tree planting and growing activity in Butuan and named the tree after his parents

PRO IX RVP Romeo Alberto delivers his message of thanks to all supporters of the tree growing activity

Planting mangrove seedlings in Sitio Asinan in Talon-talon, Zamboanga City

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