Only active members can receive PhilHealth benefits. Active membership means meeting both of these two requirements:
- Qualifying contributions – Paid at least three monthly contributions within six months before the first day of availment/confinement
- Sufficient regularity of payment – Paid at least six monthly contributions preceding the three-month qualifying contribution payments within the 12 months immediately before the first day of availment/confinement.
Therefore, you should have paid a total of at least nine monthly contributions within the 12 months immediately before the first day of availment/confinement. The 12-month period includes the confinement month.
For example, if you’re confined from October 20 to 22, 2019, you should have paid PhilHealth contributions for at least nine months from November 2018 to October 2019 before you’re admitted to the hospital.
However, you won’t be allowed to claim PhilHealth benefits if you pay your contribution for the ninth month (within the 12-month period) on October 23 onwards (on the day of discharge or after confinement). This is due to the failure to comply with the three-month qualifying contribution rule before the first day of confinement.
As long as you meet both the qualifying contribution rule and sufficient regularity of payment rule, you may qualify for coverage even if you’ve skipped contribution payments for up to three months within the 12-month period. But it’s better not to miss any payment. You’ll never know when you’ll be hospitalized anyway.
The rule on sufficient regularity of payment doesn’t apply to all types of PhilHealth members. The following members are exempted:
- Senior citizens
- Lifetime members
- Women about to give birth
- Indigent members
- iGroup Program members
- Point of Service (POS) members, whether financially incapable or capable
Senior citizens and lifetime members can avail of PhilHealth benefits anytime, while OFWs and other member types listed above are covered within their membership validity period.
PhilHealth members who are newly registered for less than nine months are only required to pay at least three monthly contributions within six months before the first day of confinement.
Go back to the main article: How to Compute PhilHealth Contribution: A Complete Guide to Contribution Table and Payment