·.

Republic of tile Plll/ipplnes

PHILIPPINE HEALTH INSURANCE CORPORATION
Citystate Centre. 709 Shaw Boulevard, Pasig City
Call Center (02) 441-7442 Trunkline (02) 441-7444
www.philhealth.gov.ph

PHIL~?)l;TH CIRCULAR
No. 'LO - ca II
TO ALL GOVERNMENT HOSPITALS AND OTHER HEALTH
CARE FACILITIES, PHILHEALTH OFFICES AND ALL
OTHERS CONCERNED

SUBJECT Guidelines on the Implementation of Point of Service (POS)

I. RATIONALE

Republic Act 10924, otherwise known as tbe General Appropriations Act of Fiscal Year
2017 (GAA 2017), specifically under Title XXXVI on Budgetary Support to Government
Corporation, Special Provision No. 3 on tbe Attainment of Universal Coverage under
Phi!Healtb, provides, to wit:

To attain· Universal Healtb Coverage, tbe amount of Three Billion Pesos

. (P3,000,000,000) appropriated herein shall cover all Filipino citizens xxx.

The Filipino citizens who will be covered under this provision, tluough a Point of
Servic~ (POS) Program, must be classified as financially incapable to pay his/her
PHILHEALTH membership according to tbe DOH classification on indigence.
PHILHEALTH shall bill, on a quarterly basis, tbe Departtnent of Budget and
Management of tbe ac~al cost of availment, chargeable against tbe amount herein
appropriated. Members availing of this Program shall be included in tbe
PHILHEALTH membership data base for possible inclusion in the list of
beneficiaries whose premiums are to be shouldered by tbe National Government.

Filipino citizens who are financially capable shall be assessed and shall be enrolled
based on tbeir financial capability at tbe Point of Service to be covered as regular
contributing PHILHEALTH member. They shall be included in tbe
PHILHEALTH membership data base and shall be billed annually.

XXX.

This Circular provides guidelines for tbe implementation of tbe Point of Service (POS)
Program in compliance witb GAA 2017 and as approved by the Phi!Healtb Board in
Resolution No. 2210 s. 2017.

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 II. DEFINITION OF TERMS

A. Point of Service (POS Program) -refers to the program provided by the GAA 2017
to register non-Phi!Health members into the NHIP thereby providing them immediate
entitlement to Phi!Health benefits.

B. POS Patient- refers to the patient or, in cases where patient is a minor, the parent or
guardian who is not yet a Phi!Health member and is classified as financially incapable.
He/she shall be registered into the NHIP by the government facility.

C. National Government Facility (NGF) - refers to health facilities owned by a

national government agency which includes DOH-retained hospitals, Philippine
National Police (PNP) hospitals, Department of National Defense (DND) hospitals
and Corporate-Specialty hospitals.

D. Onsite Rapid Enrollment (ORE) System - refers to the IT system deployed by

Phi!Health in health care institutions/ facilities which allow membership registration
into the NHIP.

E. Medical Social Welfare Officer (MSWO) -refers to the DOH-trained social worker
assigned in NGFs and tasked to conduct the assessment tool in the identification of
qualified POS Patients.

F. Social Welfare Development Officer (SWDO) - refers to the DOH-trained social

worker assigned in LGU-owned hospitals/ facilities and tasked to conduct the
assessment tool in the identification of qualified POS Patients.

III. COVERAGE

A. Under this Program, a POS Patient, or in cases where patient is a minor, his/her
guardian, if assessed as financially incapable by the MSWO/SWDO, shall be qualified
to avail of Phi!Health benefits on the following conditions:

1. The patient and his/her parent or guardian are Filipino citizens;

2. The patient is assessed and admitted in a ward type of accommodation of a

government facility, or referred to a private healthcare institution (HCI) after
assessment by a government facility; and

3. The patient is not a registered Phi!Health member or dependent at the time of

availment.

B. For those who are assessed to be financially capable, eligibility to benefits at the point
of availment shall be subject to V. B. 9 of this Circular and to existing rules on
qualifying contributions and entitlement to benefits.

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IV. PARTICIPATION OF HEALTH CARE FACILITIES

A. All NGFs, Local Government Unit (LGU) facilities, and other government hospitals
and facilities shall be entitled to participate in the POS Program subject to the
following conditions:

1. Submit a duly accomplished Phi!Health Online Access Form (POAF) (Annex A)

and Non-Disclosure Agreement (NDA) (Annex B) to the nearest Phi!Health
Office.

2. Ensure availability of a dedicated desktop computer and reliable internet

connection that will connect to the IHCP Portal and ORE System;

3. Assign an LT. personnel who will provide technical support to the staff assigned in
the implementation of the Program;

4. Assign a dedicated staff, trained or who shall undergo training in the membership
and eligibility verification, enrollment using the ORE System, and other activities
required for the operation of the Program;

5. Ensure availability of personnel, e.g. MSWO /SWDO, trained by the DOH on the
administration of the DOH Means Test.

B. Availment of benefits under this scheme shall be allowed in private facilities subject to
appropriate referral by a government facility.

V. PROCEDURES

A. Identification of Qualified POS Patients

1. PhiiHealth membership status of a patient - or his/her parent or guardian if

patient is a minor- for admission in ward type of accommodation shall be subject
to verification through the IHCP Portal whether or not he/she is already a member
or dependent and eligible to avail of benefits.

2. Non-Phi!Health members shall be interviewed and assessed by the Medical Social

Welfare Officer (MSWO) for NGFs, or by the Social Welfare Development
Officer (SWDO) for LGU facilities, using the assessment tool prescribed by the
DOH.

3. Non-Phi!Health member patient classified as financially incapable and his/her

parent or guardian shall qualify for POS and may immediately avail of benefits.

B. Registration

1. POS Patients shall accomplish and sign the Phi!Health Member Registration Form
(PMRF).

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2. The MSWO/SWDO or hospital-designated personnel shall register POS Patients

through the ORE System within 72 hours upon date of admission but prior to
discharge.

3. In case the ORE System is not available or not functioning (ex: connection
problem), the MSWDO/SWDO shall manually submit to PhilHealth the duly
accomplished PMRF and assessment tool, labeled ''POS Patient'' on the upper
right hand of each form, together with Benefit Claim application.

4. Should a patient be admitted on a weekend, holiday or outside the working hours

or schedule of the MSWO/SWDO, the patient shall immediately be assessed upon
return of the MSWO/SWDO and registered in the Program the next working day
of the MSWO/SWDO but prior to discharge.

5. Patients who are below 21 years old shall be declared as dependent of the parent.
Women about to give birth shall be registered in accordance with Phi!Health
Circular No. 025 - 2015: Social Health Insurance Coverage and Benefits for
Women About to Give Birth Revision 1.

6. A patient below 21 years old who is an undeclared dependent shall require updating
of Member Data Record (MDR) of parents to include the patient as dependent.

7. Orphaned and abandoned children and mentally-ill vagrants shall be registered as

principal members. The PMRF shall be accomplished and signed by the guardian
or the MSWO/SWDO.

a. In case of abandoned patients with unknown address, the address of the

hospital shall be used.

b. In case of vagrant/ street dwellers, the address where they were found shall be
used.

8. Upon registration in the ORE, the system will prompt the PRO Membership
Section or LHIO to conduct validation and PIN assignment. PINs of newly
registered POS Patients shall be emailed/transmitted to the HCis.

The MSWO /SWDO shall advise POS Patients or their respective representatives
to collect their MDRs at the nearest Phi!Health office.

9. Patients classified as financially capable shall be registered in the ORE System but
shall have the following options:

a. Pay the prescribe annual premium to immediately avail of benefits; or

f b. Not pay the annual premium and just be advised on regular premium payments

t:~
I for future benefit availment.

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•.

C. Entitlement to Benefits

1. POS Patients and their dependents shall immediately be entitled to Phi!Health

benefits, to wit:

a. In-patient/Out-patient All Case Rates;

b. Z Benefits; and

c. No Balance Billing (NBB)

2. POS Patients shall remain entitled to the benefits mentioned in C.l above within
the calendar year.

3. Patients who are financially capable shall be eligible to avail of benefits except NBB
upon payment ofimnual premium as prescribed by the Corporation.

4. Financially capable patients who paid the prescribed annual premium shall be
covered and entitled to benefits within 12 months from the confinement month.

5. Existing Phi!Health members shall be subject to current eligibility rules on benefit

availment.

D. Claims Filing

1. Only claims for POS Patients registered in ORE/Phi!Health with PIN shall be
submitted for processing. The PIN shall be indicated in the Claims Form 1.

2. Duly accomplished and signed PMRF and MSS intake form/ assessment tool shall
be additional requirements for claims.

3. All other rules and requirement in benefit availment shall apply.

E. Sustainability of Coverage

Phi!Health shall endorse to the DSWD on a quarterly basis the list of POS registered
patients for assessment. Those assessed as poor shall be included in the Listahanan by
the DSWD for coverage as Indigent Members in the succeeding years.

F. Monitoring and Evaluation

The Corporation shall device a mechanism for monitoring and evaluation of the
Program based on benefit utilization and other pertinent statistics.

FUND SOURCE

Phi!Health shall bill the Department of Budget and Management (DBM), on a quarterly
basis, the actual cost of availment of POS Patients as provided in the GAA 2017.

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VII. REPEALING CLAUSE

All previous issuances that are inconsistent with any provision of this Circular are hereby
amended, modified or repealed accordingly.

VIII. EFFECTIVITY

This Circular shall take effect fifteen (15) days after publication in any newspaper of
general circulation and shall be deposited thereafter with the National Administrative
Register at the University of the Philippines Law Center.

DR. CELESTINA MA. JUDE P. DE LA SERNA

Interim/OIC President and CEO

-f-J I D
Date signed: - - - ' - - - -

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 AnnexA

0 No. • Registration Date:

PHILHEALTH ONLINE ACCESS FORM
~1 (POAF) Form No. 005

Name of Online Partner PhiiHealth Registration Number

• Hospital Name:

D Check if applying to participate In Point of Service

• Business Address: ("Province, • Municipafity/City, Barangay, Zip Coda)

UserProfifil
"LAST, • FIRST MIDDLE, SUFFIX • Signature:

"Position: "Emall Address: • Moblle No.:

D Medical Social Wor1<er
0 Admitting Cieri(
D PhliHeatth Clerk
0 Other.>. Please specify:

• Approved by: • Designation: • Date Signed:

To be fifl!'d out by Phi/Health

Installation Date: ReglonalfBranch Office: Email Address:

Usemame: Password:

Processed by: Signature: Date Processed:

Approved by: Signature: Date Signed:

.. lristftutlon_al (Partner) Conflnnatio.n

Confumed by: Date Confirmed:

• Required Field

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AnnexB

NON-DISCLOSURE AGREEMENT

- - - - - - - - - - - - - - - is given the facility to connect to the PhilHealth network

and access applicable services offered by it, subject to the provisions of a digital certificate to be
issued by Phi!Health. In addition to the duties and responsibilities provided under the digital
certificate, acknowledges the importance of its legal
obligation to protect the information that it receives from Phi!Health. In this regard,
_______________ hereby agrees to the following non-disclosure policies:

1. It shall not give or provide access to any information received or generated in the course
of utilizing the Phi!Health Online Access System to any unauthorized individuals.

2. It shall store the digital certificate only in specific designated computers within its
premises access to which shall be restricted to persons duly authorized by the hospital
and Phi!Health. Any changes in the designated computers as well as the authorized
persons shall take effect/be implemented only upon approval by Phi!Health.

3. It shall use the digital certificate only for business purposes and will utilize all resources
and capabilities available to prevent any unauthorized access.

4. It shall keep in utmost confidentiality the digital certificate and any other form of security
token/ device issued or provided by PhilHealth.

5. It shall similarly bind its employees under a binding formal contract wherein the latter
shall undertake to observe the confidentiality and non-disclosure undertakings of the
health care provider.

6. It shall formulate/implement guidelines and systems to ensure confidentiality and non-

disclosure.

7. It shall acknowledge liability of any breach of the non-disclosure agreement by any of its
employees.

_______________ , through the herein duly authorized representative,

hereby enters into this agreement voluntarily and with full knowledge of its meaning and legal
implications.

Health Care Provider Director or Administrator

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