Dear PAO,
I was recently hospitalized. Prior to my confinement, I had already registered and obtained a PhilHealth ID, but I have not made any contributions. Upon my discharge, can the hospital still deduct PhilHealth benefits from my bill?
-Rowen
Dear Rowen,
Yes. As a rule, the hospital may still apply or deduct PhilHealth benefits — treating you as eligible at the point of service — because under the Universal Health Care law, presentation of a PhilHealth ID is not mandatory, and non-payment of premiums does not bar the availment of benefits.
The enactment of Republic Act (RA) 11223, or otherwise known as the Universal Health Care Act, provides for the automatic inclusion of all Filipino citizens into the National Health Insurance Program (NHIP), ensuring immediate eligibility and access to a comprehensive range of health services without the need for prior enrollment or presentation of a PhilHealth ID. Sections 5 and 6 thereof provides:
“SEC. 5. Population Coverage. – Every Filipino citizen shall be automatically included into the NHIP, hereinafter referred to as the Program.
“SEC. 6. Service Coverage. – (a) Every Filipino shall be granted immediate eligibility and access to preventive, promotive, curative, rehabilitative, and palliative care for medical, dental, mental and emergency health services, delivered either as population-based or individual-based health services: Provided, That the goods and services to be included shall be determined through a fair and transparent HTA process; xxx”
Section 9 of RA 11223 further provides that every member is entitled to immediate eligibility for benefits without the need to present a PhilHealth ID card, and non-payment of premiums does not preclude the enjoyment of benefits.
In the case of PhilHealth vs. Chinese General Hospital (G.R. No. 163123, April 15, 2005), penned by Chief Justice Renato C. Corona, the Supreme Court emphasized that the NHIP’s purpose is to give members immediate medical care with the least cash expended, so rigid technicalities should not defeat access:
“More important than mere technicalities is the realization of the state policy to provide Philhealth members with the requisite medical care at the least possible cost. Truly, nothing can be more disheartening than to see the Act’s noble objective frustrated by the overly stringent application of technical rules.”
Thus, your failure to pay premiums or contributions does not prevent enjoyment of NCIP benefits, and presentation of the PhilHealth ID is not even required to avail of the said benefits. Therefore, the hospital where you recently received treatment may apply PhilHealth benefits as a deduction in computing your hospital bill, assuming your confinement/service is within the covered package and the claim is properly processed.
We hope that we were able to answer your queries. This advice was based solely on the facts you have narrated and our appreciation of the same. Our opinion may vary when other facts are changed or elaborated.
Thank you for your continued trust and support.
Editor’s note: Dear PAO is a daily column of the Public Attorney’s Office. Questions for Chief Acosta may be sent to dearpao@manilatimes.net.
