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Sunday, July 18, 2010

Is PhilHealth Insurance Important for an OFW?



Hindi narin siguro bago sayo bilang isang OFW ang pagbayad ng PhilHealth bilang isa sa mga requirements kapag nagprocess ka ng documents sa POEA. Ito ay dahil sa bisa ng pag amyenda ng Executive Order No. 182 .Kung saan naging mandatory na ang pagbayad ng PhilHealth sa lahat ng mga land-based OFWs.Saklaw nito yung mga Pilipinong ang trabaho ay may kaakibat na kontrata sa isang overseas-based employers.Pero marahil marami sa atin ang nagbabayad nito na hindi parin lubasang naiintidihan o alam ang kabuuang benepisyo dito.Minsan nga may mga naririnig pa ako habang nakapila sa POEA na nagrereklamo dahil parang dagdag gastos lang daw ito.Sa post na ito ay sisikapin kong ilatag ang mga importanteng impormasyon hinggil sa PhilHealth.Nawa ay makapagbigay ng konting liwanag ang mga ito upang kahit paano ay maintindihan natin ang kahalagahan nito hindi lang sa atin kundi lalo na sa ating mga mahal sa buhay na naiiwan sa Pinas.

Sa 900 pesos na bayad, katumbas nito ay isang taon na medical insurance coverage para sayo at sa iyong naideklarang dependents.Ito'y maaring binubuo ng iyong asawa at mga anak para sa mga married status.Sa mga single status naman, tanging magulang lamang na may edad 60 pataas ang allowed para maideclare na dependents.Para sa kompletong detalye ng mga maaring ma-declare na dependents, narito po ang  listahan.

Legal spouse (non-member or membership is inactive)

Legal na asawa na hindi kasalukuyang miyembro or inactive ang membership status.Malinaw po ah, legal na asawa, kasi baka mag-claim si kulasisi (kung meron man)... hehehe :)

Child/ren - legitimate, legitimated, acknowledged and illegitimate (as appearing in birth certificate) adopted or step below 21 years of age, unmarried and unemployed. Also covered are child/ren 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.

Anak o mga anak na lehitimo or naging lehitimo sa pamamagitan ng legal na proseso. Maaari ring mga hindi lehitimo pero kinikilala mong anak.Sa madaling salita mga anak sa labas pero ikaw ang nakalagay na tatay sa birth certificate. Kasama rin ang mga adopted or step-children.Subalit-datapwat, kailangan ang edad ay below 21, hindi kasal, at walang trabaho. Siguro pwedeng sabihin na ito eh yung mga Palamunin pero normal ang kundisyon physically at mentally. Kasi pwede parin silang maging dependent kahit na edad 21 and above na kung merong deperensya either mentally or physically o acquired disability na talagang matatawag na dependent sayo at hindi na kayang mamuhay ng mag-isa.

Parents (non-members or membership is inactive) who are 60 years old, including stepparents (biological parents already deceased) and adoptive parents (with adoption papers).

Magulang na hindi rin miyembro or inactive ang status na may edad 60 years old pataas (senior citizen). Kasama rin ang mga stepparents or yung mga nagtayong magulang sayo kung lubusang ulila ka na. Pwede rin ang mga adoptive parents pero kailagan suportado ng adoptive papers.

Important Note:
Your dependents need to be declared and/or updated with PhilHealth to include them in your Member Data Record or MDR, your official membership profile with PhilHealth. Your updated MDR will make your benefit availments easier and convenient.

Ngayon, ito ang malaking tanong:

ANO NGA BA ANG PAKINABANG KO SA PHILHEALTH?

Bago ang lahat, ang PhilHealth ay isang Health Care Benefit or Medical Insurance.Ngayon, kung sakaling hindi  ka pa nakagamit or nakagawa ng claim; sa tingin ko ay dapat MAS LALONG MATUWA ka.. Ibig sabihin walang nagkakasakit sa mga dependents mo. Pero kung sakali man na sa hindi inaasahang pagkakataon ay nangangilangan ka or ang dependents mo ng medical assistance, narito ang mga benefits na maari mo at mga nakadeklarang dependents mo na matanggap sa PhilHealth.

Inpatient coverage:

PhilHealth provides subsidy for room and board, drugs and medicines, laboratories, operating room and professional fees for confinements of not less than 24 hours.

The following are the maximum allowances or ceilings to be applied per single period of confinement** effective April 5, 2009 admissions onwards.

* Not to exceed 45 days for each calendar year.

** Refers to a confinement or series of confinements of the same illness not separated from each other by 90 days within a calendar year. In this case, a member or beneficiary is not entitled to another set of benefits until after 90 days. They can only avail of the unused portion of the benefits and the room and board fees until the 45 days allowance is exhausted.
Source: www.philhealth.gov.ph

However, a member can avail of new set of benefits if succeding confinements are of different illness

Outpatient coverage:

Day surgeries, dialysis and cancer treatment procedures such as chemotheraphy and radiotheraphy in accredited hospitals and free-standing clinics.

Special benefit packages:

Enhanced Outpatient Benefit Package
Coverage for up to the fourth normal delivery!
Newborn Care Package
TB treatment through DOTS
SARS and Avian Influenza Package
Influenza A (H1N1) Package

Ito naman ang mga hindi saklaw ng PhilHealth:

The following shall not be covered except when, after actuarial studies, PhilHealth recommends their inclusion subject to approval of its Board of Directors:

Fifth and subsequent normal obstetrical deliveries
Non-prescription drugs and devices
Alcohol abuse or dependency treatment
Cosmetic surgery
Optometric services
Other cost-ineffective procedures as defined by PhilHealth

Ngayon ang tanong: Panghihinayangan mo pa ba ng 900 pesos mo?

Sandali lang... nabanggit ko na ba na meron ka nang lifetime coverage kapag umabot ka ng retirement age (60) basta't meron kang at least 120 months worth ng contributions?
Para sa kumpletong detalye ng mga benepisyo paki-download NITO
Maiigi ring bumisita ka sa website ng PhilHealth. www.philhealth.gov.ph

12 comments:

  1. what i have learned from my ROTC training in college was: "follow the orders first before you complain", these creed (or mantra?) does applies not only on PhilHealth but to other laws of the land too! I religiously do paying my PhilHealth premiums on or before its expiry and as of late it pays-off, i mean, being a philhealth member, and my mother as my beneficiary, she enjoys the benefit of it. For several times she's been using my philhealth both in the private & government hospitals (as long as they are accredited by philhealth), not that much though, however it helps to augment the burden, monetarily (financially).

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  2. Bosing ,
    ask ko lang po wala akong ka idea dito sa OWP ng PhilHealth.ng Nasa Pinas pa ko yung employer ko mandatory kinakaltas na agad sa sahod yung SSS , PhilHealth,etc.. more than 2 yrs na ko dito sa UAE pero hindi ko pinapansin ang Philhealth o SSS dahil ang mindset ko gastos lang at pahirapan ang pag avail ng mga benefits nila.paki enlighten nga po ako ..bak kc dumating ang panahon na pagsisihan ko na wala akong SSS o Philhelath,,kung sakali man mag decide ako na ituloy ibig sabihin nun may mga retropayments bako nung 2 taon na hindi ko pagbabayad..salamat po sa pag share ng kaalaman at patuloy na agtulong sa mga OFW : )

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  3. Hi Sir,

    Thanks for visiting my blog and offering your effort to support it. Regarding po sa inquiry nyo pwede pa kayong magre-activate ng SSS nyo kaso yung pwede nyo mahabol is yung ngayong taon (2010) yung 2009 kasi lagpas na ang grace period.. Pwede mong bayaran ang buong 1 yr ng 2010 mo hanggang 10th of January of succeeding year (2011). Kailangan mo munang update ang status mo from covered employee to OCW.. Kung meron malapit na SSS office jan sa dubai kailangan mong mag fill-up ng form OW-1. regarding the amount pwede kang mag start muna sa 520 per month. Kasi medyo malaki aabutin kung babayaran mo ang buong 1 yr (6,240 pesos). Ngayon once na updated na yung status mo to be OCW pwede mong bayaran online pra di kna gumastos sa remittance charge.. diba meron ka kamong RCBC account.. Ako dun na ako nagbabayad using din mg RCBC account..Yung steps ng pagbayad online andun sa blog ko... Uulitin mo lang yung steps for each month na babayaran mo... Para malaman mo ang status sa SSS,register ka narin sa SSS online inquiry.. Yung registration process andun rin sa blog ko.. Makikita mo pati lahat ng contributions mo since nag start kang maging member..

    Regarding naman sa PhilHealth bale medical insurance sya so yearly ang renewal. If gusto mong mag re-activate pwede rin..kung meron malapit na PhilHealth office jan sa inyo.. Ako kc agency ko na sa Pinas ang nagrerenew ng PhilHealth ko.. binabayaran ko na buong 1yr (900 pesos). If ever abangan mo yung upcoming posts ko about benefits sa SSS.. Thanks ulit and Goodluck...

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  4. hi angelo! follow-up question lang from wolf's query. planning din ako kase i-continue ang SSS ko. You suggested na mag-start sa 520 per month for the whole year, pwede ba yun taasan sa mga susunod na taon? para diba mas malaki rin amount ng benefits kung sakali? thanks in advance sa pagsagot. thanks sa pag-put up ng ganintong blog which will help all of us ofws arounf the globe :)

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  5. @Leelou

    Opo pwede mo upgrade yung contribution, may fill-up ka lang na ammendment form para mag declare ng Salary. Then after nun pwede kana maghulog sa bracket na mas mataas.

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  6. Through this blog, perhaps i could get a "clearer" view of my concern regarding PhilHealth's medical insurance coverage for us OFWs while fulfilling our obligations overseas. Here in Saudi Arabia (I presume) that every one of us are covered by saudi medical insurance, in varying levels and coverage though as per company's insurance progamme for its employees, never the less, every one is covered. In my case (as per my company's insurance programme) i am covered as level 2 (Class B) and according to this coverage I have to shell out or pay 20% from my own funds out of the total medical/hospital bills (i.e., a maximum of SAR.50.00 when the bill reaches SAR.250.00). My concern is: Does the SAR.50.00 i am paying with the hospital/clinic here in saudi arabia could be refunded through PhilHealth? Further, my clinic/hospital bill is purely medical check-up, clinical/lab. tests and medicines only.

    Kindly enlighten, thank you.

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  7. @ Frank .. thank you for visiting my blog.. About your inquiry, the answer is NO. PhilHealth outpatient coverage only covers treatment for cancer such as chemotherapy, radiotheraphy, and kidney dialysis. However, the government is now looking on the matter to expand the outpatient coverage of PhilHealth. You can visit this site to read this news: "http://www.mb.com.ph/node/316396/outpatient-coverage-mulled". There is a PhilHealth office in the Embassy who can cater reimbursement once this has been materialized. Hope this help.

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  8. Hi, Sir ask ko lng po kung covered ng philhealth ko ung MRI ng anak ko. currently im working her in bahrain mag ee expired ung philhealth ko by january 2012 pa. Nakit ko lng kc na covered is x-ray and others, it is MRI included to the others? please i wait your advised, so that i can advised too to my wife, thanks..

    Edwin

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  9. Gusto ko lang pong ibahagi, sa ngayon po, since halos lahat tayo ay may facebook account na, isang malaking tulong po ang OWP-PhilHealth PAGE para sa mga OFW members.Ang PAge na ito ay sumasagot sa mga katanungan ng ibat ibang OFW's patungkol sa PhilHealth.Sa PAGE na ito ay agaran ding ma uupdate ang mga OFW members sa mga bagong programa ng PhilHealth para sa mga OFW members.

    Kung kayo po ay OFW at mayroon naman kayong facebook account Paki LIKE po ANG OWP-PhilHealth Page. i-search lang po ito at i click ang like...ITo po ay para rin sa inyong mga OFW members.Maraming salamat po.

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  10. Domestic helper ..breast cancer stg 2a po aq at on going for radiotherapy dto sa singapore,,sence covered ng insurance q ang surgery at radiotherapy kaya ngdecide employer q na gawin dto ,,unfortunately ang chemotherapy ay di covered ng ava insurance pauuwiin na aq ng amo q to continue my therapy ...ask q f covered ba sa phil health q ang therapy ? Tnx

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  11. @Anonymous s Singapore.. Opo covered po as per sa website nila ang chemotherapy.. ito nakalagay:

    "Outpatient Coverage
    Day surgeries, dialysis and cancer treatment procedures such as chemotherapy and radiotherapy in accredited hospitals and free-standing clinics"

    Ito ang website nila:
    http://www.philhealth.gov.ph/members/overseas_workers/coverage.html

    ito ung list ng mga accredited centers/clinics: http://www.philhealth.gov.ph/members/overseas_workers/OPB_DOH_Hospitals.pdf

    ReplyDelete