Updated Guidelines on the Application of the Senior Citizens' Discount Relative to PhilHealth Reimbursements

November 16, 2012

PHILHEALTH CIRCULAR NO. 056-12

 

I. Rationale

Republic Act No. 7432 (RA 7432) entitled, "An Act to Maximize the Contribution of Senior Citizens to Nation Building, Grant benefits and Special Privileges and for Other Purposes and Republic Act No. 9257 (RA 9257) otherwise known as "Expanded Senior Citizens Act of 2003", have been amended by Republic Act No. 9994 known as the "Expanded Senior Citizens Act of 2010" to address the growing needs for health services of the elderly population and provide enabling mechanisms for them to have quality life.

This Circular is issued in support of DOH Administrative Order 2012-0007: Guidelines on the Grant of Twenty Percent (20%) discount to Senior Citizens on Health Related Goods and Services and for Other Purposes; and, to amend the PhilHealth Circular 2, s. 2005 re: PhilHealth Guidelines for Members and Dependents to Implement the Relevant Provisions of Republic Act 9257, otherwise known as the "Expanded Senior Citizen's Act of 2003".

II. Coverage and Scope

This Circular shall cover and apply to:

A. All hospital charges (including Professional Fees) of PhilHealth members and qualified dependents who are sixty (60) years old or above including senior citizens of poor families identified in the National Household Targeting System for Poverty Reduction (NHTS-PR) under the Sponsored Program.

B. All PhilHealth-engaged government and private health care providers (HCPs).

III. General Guidelines

A. The Senior Citizens' Discount (SCD) shall apply to private and non-private accommodation, and shall be computed, as follows: CHIScD

Fee for Service

1. The PhilHealth-engaged IHCPs shall first deduct the twelve percent (12%) VAT exemption from the total hospital charges; then deduct twenty percent (20%) SCD from the difference; then deduct the PhilHealth Benefit from the remaining amount. The balance (net of VAT exemption, SCD and PhilHealth Benefit) shall be the co-payment (should there be any) of the senior citizen.

2. For the professional fee/s, the PhilHealth-engaged Professional Health Care Providers (PHCPs) shall first deduct the twelve percent (12%) VAT exemption from the total hospital charges; then deduct twenty percent (20%) SCD from the difference; then deduct the PhilHealth Benefit from the remaining amount. The balance (net of VAT exemption, SCD and PhilHealth Benefit) shall be the co-payment (should there be any) of the senior citizen.

Fee for Service: Illustrative Computation

	Total Hospital	Total Prof. Fees
	Charges
	Php10,000	Php5,000
less VAT exemption (12%)	-1,200	-600
	–––––––––	–––––––––
	8,800	4,400
less SC Discount (20%)	-1,760	-880
	–––––––––	–––––––––
	7,040	3,520
less PhilHealth Benefit	-5,000	-1,200
	–––––––––	–––––––––
Co-payment of Senior Citizen	Php2,040	Php2,320
	========	========

 

Case Rates or Benefit Packages

1. The PhilHealth-engaged IHCPs shall first deduct the twelve percent (12%) VAT exemption from the total hospital charges; then deduct twenty percent (20%) SCD from the difference; then deduct the PhilHealth Benefit (including the professional fees) from the remaining amount. The balance (net of VAT exemption, SCD and PhilHealth Benefit) shall be the co-payment (should there be any) of the senior citizen.

2. Case Rates or Benefit Packages including Case Type Z Benefit Package shall be paid the full case rate or package amount regardless of the Senior Citizens' Discount or PWD Discount. The PhilHealth benefit shall not be reduced due to the aforementioned discounts.

Case Rates or Benefit Packages: Illustrative Computation

	Total Hospital Charges
	(including PF)
	Php35,000
less VAT exemption (12%)	-4,200
	–––––––––
	30,800
less SC Discount (20%)	-6,160
	–––––––––
	24,640
less PhilHealth Benefit (Pneumonia 1)	-15,000
	–––––––––
Co-payment of Senior Citizen	Php9,640
	========

 

B. The applicable deduction/s (i.e., VAT exemption, SCD and PhilHealth Benefit) shall be reflected on the statement of account of the patient.

C. If the senior citizen is also a Person With Disability (PWD), the senior citizen may opt to use either the SCD or PWD discount.

IV. Additional Provisions on the Grant of Twenty Percent (20%) Discount to Senior Citizens on Health Related Goods

In line with the signed Performance Commitment of HCPs, particularly on the compliance with all pertinent and applicable laws and regulations, the provisions of DOH Administrative Order 2012-0007 shall form part of the undertaking of the engaged HCPS, to wit:

A. Philhealth-Engaged Institutional Health Care Providers

1. PhilHealth-engaged government hospitals shall establish a senior citizen's ward. The ward shall be for exclusive use of the senior citizens who are in need of hospital confinement. The ward may be used by patients other than the senior citizens in case of public necessity or for emergency purposes, after which, it shall be reverted to its original purpose as a geriatric ward. Initially, if the hospital does not have enough space for a geriatric ward, beds may be prioritized for the use of the senior citizen who will be admitted.

2. All PhilHealth-engaged government and private IHCPs shall display in a conspicuous area the hospital room rates, laboratory and diagnostic tests fees, prices of medicines and all other fees and rates in strategic places in the health facility (e.g., admitting section, ER, OPD, billing section, etc.). The fees, rates or price lists shall be regularly updated and submitted annually to the National Center for Health Facility Development-DOH and PhilHealth.

3. PhilHealth-engaged government and private IHCPs shall set up a grievance mechanism for senior citizens such as Public Assistance Complaints Units (PACU) to entertain questions/queries with regards to senior citizens benefit under RA No. 9994. The PACU concerned should inform in writing the actions taken on the complaint of the senior citizen, and furnish a copy thereof to the DOH.

B. Philhealth-Engaged Professional Health Care Providers

1. PhilHealth-engaged PHCPs shall inform the senior citizen of his regular fees for the services required.

2. PhilHealth-engaged PHCPs shall provide an official receipt (OR) for the professional services rendered to the senior citizen, which states the regular fees, discounts (tax-exemptions, senior citizens discount) and applicable PhilHealth benefit deduction.

V. Monitoring

Compliance of the engaged HCPs with the provisions of this Circular, as well as, with DOH the Administrative Order 2012-0007 shall be monitored in accordance with the approved guidelines of the Corporation. The results of such monitoring shall be considered in the granting of incentives or penalties/sanctions, whichever is applicable. TDcEaH

VI. Repealing Clause

All provisions of previous issuances that are inconsistent with any provisions of this Circular are hereby amended/modified or repealed accordingly, while those that are consistent shall remain in full force and effect.

VII. Effectivity

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

 

(SGD.) DR. EDUARDO P. BANZONPresident and CEO