Republic of the Philippines

PHILIPPINE HEALTH INSURANCE CORPORATION

Citystate Centre Building, 709 Shaw Blvd., Pasig City
Healthline (02) 441-7444 www.philhealth.gov.ph

PhilHealth CARES Report

PhilHealth Regional Office: NCR-North
Month: March
Issues and Concerns

Membership

Contribution

1. Member Data Records (MDR) still contain multiple errors and

discrepancies or not updated causing problems during benefit
availment.
2. Multiple declaration of dependent is still rampant.
3. Some dependents declared in the MDR have their own active
membership/PIN.
4. Still a lot of members have dual memberships and have 2 or
more PINs that are both active
5. NHTS-PR/LGU sponsored members experience inconvenience
in availing of benefits due to the delay in updating of their
membership validity. Members are required to go to the LHIO
to secure a copy of Certificate of Eligibility (CE1).These
members also experience inconvenience in availing of benefits
due difficulty of providing documents as a proof of relationship
to their dependents.
6. Unspecified sponsored and indigent membership categories on
the I-CARES system cause confusion during availment of
benefits.
7. Lifetime members are not aware of the need to change
member categories and assume that they will be automatically
enrolled as Lifetime Members.
1. Members have negative feedbacks/ reactions regarding the
increase in premium contributions. Some members verbalized
that they cant afford such cost due to limited financial
resources.
2. Employees both from the public and private sectors complain
about unposted contributions. Those who have been deducted
with contributions for many years are very unhappy that their
employers did not properly remit PhilHealth contributions.
3. Information dissemination to all accredited collecting agent
and also to members regarding the new premium contribution
to avoid over or under payments.
4. ACAs should avoid using thermal paper for their receipts since
printed data eventually fades.
5. Official Receipts issued by banks/ACAs to the member do not
reflect months and quarter paid or has a discrepancy.
6. Some accredited collecting agents are allowing retroactive
payment to those members without sufficient regularity

Health Care
Provider
Relations

Benefits

Others

1. It takes 7-8 months before the member get their

reimbursement in the hospital- Mandaluyong City Medical
Center
2. Requiring unnecessary documentary requirements during
availment Dr Jose Fabella Memorial Hospital
3. No outright deduction for Newborn Screening Test Ospital
ng Sampaloc
1. LGU Hospitals have long process of reimbursement (usually
takes a minimum of 6 months) to members who use their
PhilHealth Benefits.
2. Out-of-pocket expenses are paid by members in both
government and private hospitals even if the case rate amount
has not been exhausted.
3. A lot of members are complaining of why is direct filing is not
allowed anymore since some of them cannot comply with the
requirements during confinement.
No Balance Billing:
Hospitals that are not compliant with the NBB are as follows:
1. Ospital ng Sampaloc
2. Ospital ng Tondo
3. Ospital ng Maynila Medical Center
4. Dr. Jose Fabella Memorial Hospital
5. Justice Jose Abad Santos General Hospital
6. Valenzuela Medical Center
7. Sta Ana Hospital
8. Jose R. Reyes Memorial and Medical Hospital
9. Gat Andres Bonifacio Memorial Medical Center
10.Mandaluyong City Medical Center
11.Dr. Jose N. Rodriguez Memorial Medical Center
12.Tondo Medical Center
13.San Lazaro Hsopital
14.President Disodado Macapagal Memorial Medical Center
All Case Rates:
1. Many common medical cases are not included in the ACR or
cannot be availed from level 1 to 3 hospitals. A lot of members
turn irate when they discover that hospitalization is not
compensable. They accuse PhilHealth of not increasing
coverage after increasing premium rates.
2. Hospitals have difficulty adjusting but are willing to learn the
process under the ACR policy. Trainings, seminars and fora
about the subject of requested by hospital staff and doctors.
IHCP Portal (PBEF)
1. Hospitals are asking if the PBEF remains valid after the
patient has been discharged, particularly in instances wherein
the HCI portal could not be accessed on the date of discharge.
2. Hospitals still require MDR and CF1 even though the patient is
eligible based on the PBEF.
3. Hospitals are asking for the policy for patients who have had
PBEFs generated but due to valid concerns extended
confinement. Can they be allowed to edit the PBEF in this
case?
4. PBEF does not reflect the contribution in the treasury, it also
doesnt detect the declaration of a dependent to another

member.
5. Members of informal economy with NO eligibility but with
posted qualifying contributions in the I-CARES
6. Members who have no middle name registered in our system
cause problem since the system cannot detect the members
eligibility.
7. Guidelines concerning the implementation of PBEF as well as
orientation for CARES and the hospital staffs for more
clarification concerning IT, MEMSEC and BAS
Point of Care:
1. POC is suspended in Valenzuela Medical Center and Tondo
Medical Center starting March 2014 due to budgetary
constraint and Commission on Audit issues.
2. The system is unstable is some hospitals. Some encounter
technical problems which cause delay in the enrollment of
clients. There are also data inconsistencies between the ORE
system and iCARES.
3. The Medical Social Worker Service should be available 24/7 to
enroll patients who are admitted at night.
4. Patients who are enrolled under POC are not provided with
payment slip details and certification from the Medical Social
Worker Service which causes delays in confinement to other
hospitals.
Internal:
1. Pioneer CARES requesting for new set of uniforms.
2. Requesting for General assembly for updates regarding the
new policies.
3. Since there is no Hazard pay for CARES, they are requesting
to at least provide them with free flu vaccine.
4. Kindly inform the CARES ahead of time if there are
changes/updates on the policy/guidelines because sudden
change in policy will cause a lot of confusion to our
stakeholders. It would also be a great help for the front liners
to lessen their burden.

Commonly Violated PhilHeallth Circulars

Observed Hospital Practice/s
Not compliance with the NBB Policy

Prepared by:
Richard P. Sonsing
PMT-CARES

Noted by:

Circular/s
No. 11, s-2011
No. 22, s- 2012