ChroniclesPhilHealth

� e O� cial Newsletter of the Philippine Health Insurance CorporationIssue 02, 2015

By Emelita M. Retuta

Truly another feather on PhilHealth’s cap!

For consistently exhibiting exemplary customer services in compliance with the provisions of the Anti-Red Tape Act (ARTA), the Philippine Health Insurance Corporation (PhilHealth) was recently awarded the 2014 ARTA Breakthrough Agency Award by the Civil Service Commission (CSC).

� e award is given to the top � ve (5) agencies ranked along with 32 other

agencies based on two criteria, namely, percent of surveyed o� ces from 2011-2013 that were awarded with the CSC Seal of Excellence (70%); and percent of surveyed o� ces passing the ARTA-Report Card Survey from 2011-2013 (30%). � e Seal of Excellence is conferred to agencies that got ‘Excellent’ rating on ARTA-RCS.

� e ARTA-RCS measures an agency’s performance and client satisfaction in relation to frontline service and aims to improve the e� ciency in the delivery of government service to the public by reducing bureaucratic red tape, preventing gra� and corruption, and providing penalties. It also intends to obtain feedback on how agencies follow provisions in their Citizen’s Charter.

� e survey was conducted in 138 PhilHealth frontline areas nationwide wherein PhilHealth got a 47.83 percent excellent rate for its 66 branches. � e agency’s frontline service delivery, service quality, physical working condition, and overall client satisfaction were surveyed.

In the same league as CHED, LandBank, DTI and PAO

Also checked were the observance of the “No Noon Break” policy; no � xing activities, presence of a public assistance desk/center; wearing of nameplates of frontliners, availability of basic facilities such as comfort rooms; and special lane for persons with disabilities, pregnant women, and the elderly.

“We are very honoured for the trust and recognition given by CSC. As the biggest health insurer in the country, we always consider our members our priority. In support of this, we have long been committed to the culture of service excellence as we continue to set the highest standards for quality service to improve the quality of life of our members,” said Alexander A. Padilla, PhilHealth President and CEO.

PhilHealth hopes to sustain its excellent standing by implementing innovations and best practices such as special services for customer’s delight, service improvement, personnel empowerment and improving its frontline services.

Chief Management Executive Melinda C. Mercado (le� ) proudly presents the coveted awardChief Management Executive Melinda C. Mercado (le� ) proudly presents the coveted awardle� ) proudly presents the coveted awardle�

PhilHealth is 2014 ARTA Breakthrough Agency

CORPORATE NEWS

02

By Pinky G. Aragones

E�orts to simplify the process of applying for business registration in the country are being fully supported by PhilHealth through a Memorandum of Agreement that PhilHealth President and CEO Alexander A. Padilla recently signed, together with heads of other government agencies.

�rough the joint e�orts of the Department of Finance, Department of Trade and Industry, Department of Internal and Local Government, Securities and Exchange Commission, Bureau of Internal Revenue, Social Security System, PhilHealth, Home Development Mutual Fund, LandBank of the Philippines, Development Bank of the Philippines, National Competitiveness Council Philippines and the Quezon City

Two new TV commercials are now airing on major networks, namely “Sangla” and “Alagang PhilHealth.” “Sangla” is an institutional advertisement that emphasizes PhilHealth’s role in easing the �nancial burden of Filipinos who are coping with hospitalization expenses. “Alagang PhilHealth” on the other hand, features the testimonials of members from various categories on how PhilHealth was able to help them in times of medical needs. Both of these 30-second TVCs were produced under PhilHealth’s engagement with the Philippine Information Agency (PIA).

Ease of doing business

PhilHealth Taps BDO Unibank Inc. as Local Fund Manager

Two new TVCs released

government, the business registration process at the SEC for new corporations, partnerships and non-stock corporations were streamlined to six (6) steps and eight (8) days, down from the previous 16 steps and 34 days since April 15, 2015.

Online transactions for payroll-related payments to PhilHealth and Pag-IBIG shall also be in place to reduce the number of payments from 36 to 13 annually. �ese reforms are expected to boost the country’s rankings in the global competitiveness reports that will similarly impact heavily on the development of the capacity of the local micro, small-and medium-sized enterprises.

By Pinky G. Aragones

�e Philippine Health Insurance Corporation (PhilHealth) has tapped the Banco de Oro Unibank, Inc. (BDO) to be its �rst Local Fund Manager to help grow the health insurance fund and ensure its stability for the bene�t of PhilHealth’s 86 million bene�ciaries.

�e Investment Management Agreement was signed by PhilHealth President and CEO Alexander A. Padilla and Ador A. Abrogena, Executive Vice President of BDO Trust at the BDO’s o�ce in Makati City.

As local fund manager, BDO will manage P1 billion, which is only a small portion of PhilHealth’s investment reserve fund, and ensure that the fund grows so that PhilHealth can continue to provide for the health insurance bene�ts of its growing membership base. �e partnership is expected to further maximize the returns that PhilHealth generates from its current investments and pave the way for the attainment of the investment objective of optimizing growth and yield through active investments in the stock market through a disciplined stock selection process.

“We are very happy that BDO is our �rst local fund manager,” Padilla said. “We rely a lot not only on our collections of premium for the reimbursement of PhilHealth bene�ts but also in the investments that we do. So far, we have been performing well in investments but we are limited to �xed government securities as well as government bonds. Now that we partnered with BDO, we expect bigger returns in equities,” he added.

BDO Trust will manage the investment portfolio based on strict implementing directives stated in the Stock Investment Guidelines provided by PhilHealth. “PhilHealth has a huge responsibility of providing bene�ts to millions of our countrymen. It is therefore very important that we as fund managers make sure that we manage this fund with the highest degree of responsibility for the fund to perform its objective of providing universal health coverage for all of us. �at is the commitment of BDO,” said Abrogena.

PhilHealth shall continue to tap the services of four (4) more local fund managers through public bidding by the end of the year. (END)

NEW BENEFITS

03

By Dianna Marie S. Chua

Ebola Virus Disease (EVD) also known as Ebola Hemorrhagic Fever (EHF), or simply Ebola, is a disease of humans and other primates caused by ebola viruses. It can be transmitted through close contact with blood secretions, organs or other bodily � uids of infected animals, body � uids and stools of an infected person, through contaminated needles and soiled linen used by infected patients, or direct contact with the body of a deceased person.

Confi rmed Cases of Ebola Virus are Compensable

� ere is no proven treatment and vaccine yet available for EVD. Supportive care-rehydration and treatment of speci� c symptoms improve the survival of the patients.

Preventive measures include avoiding close contact with infected patients; avoiding consumption of the raw meat of possible infected animals like fruit bats, monkeys or apes; wearing of gloves and appropriate personal protective equipment when taking care of ill patients at home; and washing of hands a� er visiting sick relatives in the hospital and a� er taking care of ill patients at home.

Fully aware of the potential threat of the disease, PhilHealth announces its new bene� t package for con� rmed cases of EVD.

Con� rmed cases are those that have passed the con� rmatory tests of the Research Institute of Tropical Medicine. PhilHealth members and their dependents may avail themselves of the bene� t in any accredited Health Care Institution (HCI) with ample capacity and facilities to manage the disease. Non-PhilHealth members who will qualify for enrolment under point-of-care may also avail themselves of the EVD bene� t package.

� e Basic EVD package is Php 110,000.00 and shall be given to patients admitted at the HCI for seven (7) days or less. � e EVD Extended Package covers the next seven (7) days at Php 16,000.00 per day. � e said bene� t package covers reimbursement of laboratory tests, medicine, medical management, and hospital con� nement among others.

� e No Balance Billing (NBB) Policy also applies. � e co-payment of members not covered by the NBB policy shall not exceed 20% of the claimed EVD package. Compliance to the required qualifying contribution and 45 days bene� t limit are waived for availment of this bene� t. All admissions for EVD starting January 1, 2015 are covered.

04

By Pinky G. Aragones

Hats o� to sixty six (66) PhilHealth O� ces nationwide that were recognized by the Civil Service Commission (CSC) for having an “Excellent” rating in the Anti-Red Tape (ARTA) Report Card Survey (RCS) for the year 2014.

� e RCS is a client feedback survey used to check on government service o� ces’ compliance with the provisions of the Anti-Red Tape Act of 2007. � e survey provides a quantitative measure of user perceptions on the quality, e� ciency, and adequacy of public services. Apart from being a data collection exercise, the RCS also helps exact public accountability through media coverage and civil society advocacy that accompany the process.

Based on the assessment done by the CSC, PhilHealth got the following ratings: Excellent=47.83%; Outstanding=2.90%; Good=44.93%; Acceptable=2.17% and Failed=2.17%. Excellent rating is numerical rating of 90 to 100 with no failed/delinquent rating in any sub-area.

� e CSC Excellent Awards were given to PhilHealth’s 60 LHIOs, 3 Express O� ces, 1 Business Center and 2 Regional O� ces while Outstanding awards were given to 4 LHIOs. Good awards were conferred to 40 LHIOs, 11 Express O� ces, 6 Business Centers, and 4 Regional O� ces.

Featured on this spread are some of the award-winning teams with their proud smiles!

9 Certi� cates of Recognition for LHIOs of PhilHealth Regional O� ce VI

Winning team from Area II

Pride of Area III

All eight LHIOs of PRO NCR were rated Excellent

RVP Paolo Johann Perez receives � ve Certi� cates of Recognition for PRO IV-B

Showcasing Exemplary Frontline Services Nationwide

05

EVP-COO and CART Chair Ramon Aristoza Jr. (4th from right) with Area I Excellent Awardees

RVP Walter Bacareza (right) with PhilHealth Regional O� ce VIII Team

LHIO Catbalogan Team shows o� award and mock-up of cash prize

LHIO Mandaluyong Team with CSC ARTA Report Card

General Santos LHIO Head Nol Valila (center) shows o� the Certi� cate of Recognition

Romulo Lapuz Jr., Chief of LHIO Bukidnon receives plaque and Certi� cate of Recognition from RVP Datu Masiding Alonto Jr.

Members of LHIO Mandaue Team pose with their Recognition

Jubillant Area IV Excellent awardees

LHIO Zamboanga personnel are all smiles

LHIO Marawi personnel with CSC Marawi - Lanao del Sur Dir. Maribeth Alejo

PhilHealth Regional O� ce CAR with four Seal of Excellence Awards and P100,000 for each LHIO

06

NEW SERVICES

By Michelle S. Nisperos

Believing in the importance of education and the youth’s valuable contribution to society, PhilHealth, through its Social Health Insurance Academy (SHIA), developed a module that aims to institutionalize the principles of Social Health Insurance (SHI) into various educational systems in the country.

A�er a series of consultations, surveys and legwork, PhilHealth got an approval from Sultan Kudarat Educational Institution (SKEI), one of the �rst schools that o�ered midwifery and nursing courses in Tacurong City, to include the SHI module in the Primary Health Care 1 and 2 subjects of the Midwifery Course and in the Community Health Nursing subject for the Nursing course for 2

nd year students.

�e module is expected to be included in the SKEI Midwifery and Nursing courses for school year 2015-2016.

By Dianna Marie S. Chua

Members and their quali�ed dependents who may have unclaimed refunds for their hospital con�nements from 2007 to 2013 may now check on the PhilHealth website for their names and the next steps to follow to ensure immediate refund.

�e list may be accessed through www.philhealth.gov.ph/unclaimedrefunds and the link leads the site visitor to the

Members’ Guide for Unclaimed Refunds Now on Website

NHIP Module now in Midwifery, Nursing Courses

To formalize the partnership, PhilHealth and SKEI signed a Memorandum of Agreement in Koronadal City, South Cotabato. An orientation on the NHIP to SKEI and the Sultan Kudarat Doctors Hospital personnel was also conducted, through the Social Health Insurance Education Series which is regularly conducted in various provinces in the country.

hospitalization, and these have remained unclaimed by the members for some time now. �e unclaimed refunds have been retrieved by PhilHealth from the accredited hospitals for immediate return to the concerned members.

Unclaimed Refund webpage where basic information on the refunds is posted.

An unclaimed refund is a bene�t payment that must be reimbursed by the accredited hospital to the member for a speci�ed illness. �e refund results from either an under-deduction or non-availment of bene�ts at point-of-service due to various circumstances at the time of

07

NEW POLICIES

By Michelle S. Nisperos

Starting July 2015, employers in the government and private sectors are required to pay their premium contributions, including that of their employees, either through PhilHealth’s accredited collecting agents (ACAs) or e-payment facilities.

By Faudia H. Subillaga

� e updated version of Annex 2 of the previously published PhilHealth Circular 35 series of 2013 (ACR Policy No. 2 - Implementing Guidelines on Medical and Procedures Case Rates) is now posted in the corporate website for reference of members and health care providers.

Employers’ Premium Payments to ACAs

Updated Guide for All Case Rates Procedures

� rough PhilHealth Circular 009, s-2015, employers are mandated to remit their premium payments directly to ACAs of their choice and not to PhilHealth o� ces.

� e new policy will make payment more

Circular 008-2015 contains the updated version of compensable procedures for hospitals, ambulatory surgical clinics and selected facilities.

In particular, the updated Annex 2 covers the inclusion of titles and subtitles per procedure, amendments to package codes and descriptions, corrections to the typographical errors in some procedural descriptions, delisting of Relative Value Scale (RVS) codes based on previously published and approved

Circulars, changes in case rate amount, procedures with additional condition for claiming reimbursement, temporary delisting of selected RVS Codes and other supplementary guidelines for all case rates.

� is new development is aimed at harmonizing and consolidating the di� erent annexes into a single, more intuitive or user-friendly guide. � e updated list may also be accessed through the ACR Search Engine facility located in the homepage of www.philhealth.gov.ph.

convenient to employers and will prevent them from long queues in PhilHealth’s Local Health Insurance o� ces especially during payment periods.

� e new payment rule shall not apply to micro-� rms or businesses with less than 11 employees, including employers of kasambahays; employers located in geographically isolated areas with no

available internet service provider and with no ACAs; and employers located in areas with ACAs but have no available internet service providers.

� e new policy covers premium payment and remittance reports e� ective the applicable month of June 2015.

Senior Citizen na ako.Nakaseguro na ang kalusugan ko sa PhilHealth.

* Pilipinong nasa edad 60 taong gulang na walang kasalukuyan at aktibong coverage sa alinmang membership program ng PhilHealth

Para sa karagdagang impormasyon, tumawag sa:

Ayon sa Republic Act 10645, lahat ng Senior Citizens* ay dapat miyembro na ng PhilHealth.

Makipag-ugnayan sa OSCA Chapter sa inyong lugar, o sa tanggapang itinalaga ng local government para sa senior citizens’ concerns.

Dalhin ang kopya ng inyong Senior Citizen ID o anumang ID na magpapatunay ng inyong edad at pagkakakilanlan upang maging ganap nang Senior Citizen member ng PhilHealth.