Tuesday 4 September 2012

This is all about PhilHealth for OFW

When I opened my FB account, the first thing that I saw is the post from PEBA,INC (Pinoy Expat / OFW blog awards) shared by the GLOBAL OFW Voices, about PhilHealth giving benefits of only 100 pesos worth of medicine. There are at least considerable numbers of comments, reactions expressing their disappointments. WHY is that only 100 pesos? They said. 

Well either these people are misinformed or ignorant. The only 100 pesos news from Philhealth is the increase of its contributions, from a previous of 100 pesos of  Philhealth contribution, it was increased to 200 pesos, it is a 100% increased. This is to cover the Philhealth expansions (services) but the member will had to pay this for two years. In short the Philhealth member will pay just 1,200 annually.
 
All I can say is that this GLOBAL OFW Voices are peddling wrong information to the public, especially to the OFWs who are giving sacrifices to work abroad, away from their families and loved ones. ( "Kawawa naman ang OFW na binigyan ninyo ng maling information, malayo pa sa pamilya, lolokohin nyo pa).  As a result for this crab mentality attitude, the OFWs can lost their sense of security, to its self and to his / her family.

To the GLOBAL OFW VOICES or whoever person peddling these wrong information by posting this to FB page is IGNORANT and have a TOTAL CRAB MENTALITY. You better check the source of your NONSENSE information, before you shout your untune VOICES. (Kung ganyan tayo ng ganyan kailan man hindi aasenso ang Pilipinas, puro negative ang nasa utak.). MORE FUN IN THE PHILIPPINES.



NOTE: I am not Pro-Politician, I am Pro-FILIPINO. and I am NOT from PhilHealth.

 The Philippine Health Insurance Corporation (PhilHealth) was created in 1995 to create an universal health coverage for the Philippines. It is a tax-exempt, government-owned and government-controlled corporation (GOCC) of the Philippines, and is attached to the Department of Health. It states its goal as insuring a sustainable national health insurance program for all. In 2010, it claimed to have achieved "universal" coverage with 86% of the population, although the 2008 National Demographic Health Survey showed that only 38 percent of respondents were aware of at least one household member being enrolled in PhilHealth. Nevertheless, this social insurance program provides a means for the healthy to pay for the care of the sick and for those who can afford medical care to subsidize those who cannot. Both local and national government allocate funds to subsidize the indigent.

There are five PHILHEALTH patient groups,  the FORMAL, INDIGENT, RETIREE, NON-POOR and others, and OFW.

In the FORMAL groups, the premium is in the employer and worker each will pay half, up to 2.5% of income of up to 30,000 pesos. The enrollment is as of the hiring date. The payment date is up to 3 months.

For the INDIGENT the premium is 1,200 pesos annually. The local government will handles the enrollment annually.

For the RETIREES the premium is free, and for the age of 60 the enrollment of premium payments is on 10 years.

For the NON POOR there are no subsidy for the Premium.

For the OFW we have 1,200 pesos annual premiums or 2,400 pesos every two years. The enrollment is the date of your emigration and we have no subsidy from the government.

For the OFWs can be a Qualified Member if he/she is an Active land-based Overseas Filipino Workers (OFWs) who underwent the normal process of registration as an OFW at Philippine Overseas Employment Administration (POEA) Offices. IF the OFWs is currently abroad but are not yet registered with PhilHealth. Sea-based (SEAMEN) OFWs are considered locally Employed Members so must apply as Employee under FORMAL GROUP.

Who Are Qualified As OFW PHILHEALTH Dependents

You are qualified as PHILHEALTH OFW DEPENDENTS that can enjoy PhilHealth coverage without addition premiums if you are a Legal spouse (non-member or whose membership is inactive). If you are Child or children legitimate, legitimated, acknowledged and illegitimate (as appearing in birth certificate) adopted or stepchild or stepchildren below 21 years of age, unmarried and unemployed. Child or children 21 years old or above but suffering from congenital disability, either physical or mental, or any disability acquired that renders them totally dependent on the member for support. If you are Parents (non-members or membership is inactive) who are 60 years old and above, including stepparents (biological parents already deceased) and adoptive parents (with adoption papers). A Qualified dependents shall be entitled to a separate coverage of up to 45 days per calendar year. However, the 45 days allowance shall be shared among them. A Qualified dependents must be declared by the principal member. Their names must be listed under the principal member's Member Data Record (MDR) to ensure hassle-free benefits availment.

Benefit Availment Conditions.

If you have the Eligibility Requirements mentioned above. Availment must be within the validity period as stated in the OFW's PhilHealth Member Registration Form (PMRF) or in the payment receipt. The OFW-member's 45 days allowance per year for hospital room and board and the separate 45 days allowance shared among the dependents have not been consumed yet.

Post Availment Reminders.

After the automatic deduction or reimbursement of benefits, PhilHealth will send the Benefit Payment Notice or BPN to the address indicated in the member's claim form. The BPN is a report of actual payments made by PhilHealth relative to the member's the confinement/availment. Should there be discrepancies between the amounts reflected in the BPN and in the member's final billing statement issued by the hospital, or if the member has other concerns pertaining to benefit availment, he may contact PhilHealth or the health care provider. The member must bring the BPN as reference document.

Benefit Availment Procedures VERY EASY and SIMPLE.

Outright/Automatic Deduction Of Benefits need to be Submited to the billing section prior to discharge from the hospital. Requirements are the Duly accomplished PhilHealth Claim Form 1 (original) and Clear copy of Member Data Record (MDR). If MDR is not available, submit official receipt of applicable premium payment. If qualified dependent is not listed in the MDR, submit applicable proof of dependency. The Agreed payment for your attending physicians on how much is left to be paid for their services over the professional fee (PF) benefit. Upon submission of all applicable documents, the billing section will compute and deduct your benefits from your total hospital bill.

For Direct Filing/Reimbursement.

Submit the following to PhilHealth or through the hospital in addition to the documents mentioned earlier within 60 calendar days after discharge.The PhilHealth Claim Form 2 (to be filled up by the hospital and attending physicians).The Official receipts or hospital and doctor's waiver.The Operative record for surgical procedures performed.

If you are Confine Abroad.

Submit the following within 180 days after discharge. The Overseas confinements shall be paid based on Level 3 hospital benefit rates. The PhilHealth Claim Form 1, The MDR or supporting documents, The Proof of applicable premium payments, The Original official receipt or detailed statement of account (written in English),The Medical certificate (written in English) indicating the final diagnosis, confinement period and services rendered. You can ask for help in you embassy.

IF THESE QUESTIONS IS IN YOU HEAD RIGHT NOW

Why do you have to renew your PhilHealth membership every time you leave the country and work as an OFW?  It is not actually renewal of the membership but an updating of your premiums, which shall be equivalent to the length (in years) of your fresh contract. It will also ensure your continuous eligibility to PhilHealth benefits.

If you are already an immigrant in the US,UK,CANADA or any other countries,  you can still continue paying for your PhilHealth coverage as an Individually Paying Member and not as an Overseas Worker Member.
If you are currently abroad and your coverage is about to expire. How can you continue paying for my PhilHealth in case that there are no available payment centers of where you are. You may ask your relatives in the Philippines to pay your premiums on your behalf to avoid any lapses or delays. They only need to present a valid ID & an authorization letter from you as the member and any document that would attest that you are still an active OFW.

OWWA Contributions and PhilHealth Premiums are different. OWWA contributions serve as a life insurance of the OFW abroad, while PhilHealth premiums ensure the health benefits of the OFW and his/her dependents in case of illness or injury requiring hospitalization.

The Premium Contribution of OFW members are required to pay the one-year premium of Php1,200.00 for CY 2012. However, they may pay more than one year depending on the number of years provided in their contract.

In the absence of the MDR, there are substitute document that your family back in the Philippines could use if someone gets sick?

In case the Member Data Record ( MDR) is not available or not yet updated and someone among of your dependents gets sick, the following documents must be submitted. E-Receipt as proof of applicable premium payment. (You can ask this from PhilHealth Office ask for a print copy). Clear copy of the following. Spouse - Marriage Contract/Certificate, Child/children - Birth Certificate, Parents Birth Certificate of Member (YOUR) and any proof of the parents' date of birth.

If you are scheduled for confinement abroad for an operation, this confinement covered by PhilHealth. Confinement due to sickness or for an operation is compensable with PhilHealth even if it is done abroad. You have 180 days or 6 months within which to file your claim for reimbursement at any PhilHealth office near your local residence. The following documents must be submitted for your claim processing. PhilHealth Claim Form 1 accomplished and signed by the member or his authorized representatives, Photocopy of MDR or latest receipt, Medical certificate with complete diagnosis, period of confinement and services rendered, Statement of Account and/or Official Receipts with itemized charges; and other supporting documents. (these should be translated in ENGLISH). If you were not given an official receipt for the payment you made for the hospital bill and professional fee, you may submit instead a copy of your Statement of Account. It must contain the breakdown of charges for room and board, medical supplies, laboratory procedures, operating room fee and professional fee.

To avail of PhilHealth benefits if you or my dependents are confined in the Philippines. PhilHealth benefits can be availed of through outright/automatic deduction from hospital bills. Submit the following documents to the hospital, PhilHealth Claim Form 1 accomplished and signed by the member or its immediate family member, Photocopy of MDR or latest receipt and other supporting document if the patient is not reflected as dependent in the MDR.

If you are currently working abroad, who can sign in your behalf on PhilHealth Claim Forms? If you are noy available to sign the forms when reimbursing with PhilHealth, a married member may let his/her spouse sign in his/her behalf or his/her children as long as they are at least 18 years old or the parents in the absence of his/her spouse and children. Meanwhile a member who is single can let his/her parents sign in his/her behalf, or any authorized representative as long as the representative has an authorization letter from the member and a photocopy of his/her 2 valid IDs as well as 2 valid IDs of the member.

How can you avail the Out-Patient Benefit Package (OPB) for OFWs? Simply present a photocopy of your Member Data Record (MDR) or latest receipts and supporting documents (for dependents who are not listed in the MDR) to any of the 42 participating DOH hospitals in the Philippines.

MY VIEW
I make this post to stop people directing other people which are more worthy specially the OFWs into a ravine of disappointments and discouragements which make them more worried for their families BACK HOME?
I did experienced the benefits of Philhealth on the first hand when a member of my family was admitted to the hospital. Because I have PHILHEALTH I enjoyed the nearly fifty percent discount of the TOTAL HOSPITALIZATION COST.