Coverage of Dependents of Deceased Members

November 23, 2012

PHILHEALTH CIRCULAR NO. 058-12

 

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