Coverage of Dependents of Deceased Members
PhilHealth Circular No. 058-12, issued on November 23, 2012, outlines provisions for the dependents of deceased members of the National Health Insurance Program (NHIP). It ensures that qualified dependents can continue to access NHIP benefits for the unexpired portion of the deceased member's coverage. This applies to all NHIP members, including those in the Individually Paying Program (IPP) and Organized Groups (i-Groups). The surviving spouse must register as the principal member to maintain coverage for dependents, following existing rules and guidelines. The circular is retroactively effective from the dates specified in previous PhilHealth circulars.
November 23, 2012
PHILHEALTH CIRCULAR NO. 058-12
| TO | : | All Members of the National Health Insurance Program (NHIP), Accredited Healthcare Providers, Philhealth Central Office, Philhealth Regional Offices (PROS) and All Other Concerned Offices and Personnel |
| SUBJECT | : | Coverage of Dependents of Deceased Members |
I. Rationale
This Circular is issued to ensure that qualified dependents of deceased members, who died within the coverage period, are able to avail of NHIP benefits during unexpired portion of the coverage.
II. Coverage
This Supplemental Circular shall cover all NHIP members including IPMs under the Organized Groups (i-Groups) subject to PhilHealth Circular No. 020, s. 2012 and members under the OWP covered by Office Order No. 0060, s. 2012. aDcTHE
III. Implementing Guidelines
Rule IV, Section 27 of the Revised Implementing Rules and Regulations (RIRR) of R.A. 7875 (as amended) on the Specific Provisions Concerning Indigent Members provides that "[i]n case of death of the member, the dependents of the deceased indigent member shall continue to avail of NHIP benefits for the unexpired portion of the coverage."
This Supplemental Circular adopts the entitlement provision applicable to indigent members and extends its application to identified members in the Individually Paying Program (IPP) including Organized Groups (i-Groups) under PhilHealth Circular No. 020, s. 2012 and members under the OWP pursuant to Office Order No. 0060, s. 2012, subject to the following terms and conditions:
1. Qualified dependents of the deceased member shall continue to be entitled to benefits availment for the remaining unexpired portion of the coverage;
2. The unexpired portion of the coverage should be based on the last premium payment prior to the death of the member or validity to membership for Sponsored and OWP members;
3. To ensure eligibility of dependents of deceased members beyond the coverage period, the surviving spouse shall accomplish and submit the PhilHealth Member Registration Form (PMRF), including photocopy of documentary requirements, to the nearest PhilHealth Office to register as principal member and transfer said qualified dependents under his/her membership coverage.
4. All existing rules and policy guidelines on qualifying contributions and benefits availment shall still apply accordingly.
IV. Effectivity
This Circular shall have retroactive application reckoned from the effective dates of PhilHealth Circular No. 020, s. 2012 for the IPP and Office Order No. 0060, s. 2012 for the OWP.
This Circular shall take effect immediately after due publication in any newspaper of general circulation and deposited with the National Administrative Register at the University of the Philippines Law Center. dctai
(SGD.) DR. EDUARDO P. BANZONPresident and CEO