Mandatory PhilHealth Coverage

of Senior Citizens
Pursuant to Republic Act No. 10645

Sabtang National School of Fisheries

February 22, 2015

Source: TAMANG SAGOT PhilHealth Circular 33, s.2014

Implementing Guidelines for the Mandatory PhilHealth

Coverage of Senior Citizens pursuant to Republic Act No.

Mandatory PhilHealth Coverage

of Senior Citizens

TAMANG
SAGOT
PhilHealth Circular 33, s.2014

Implementing Guidelines for the Mandatory PhilHealth Coverage of Senior

Citizens pursuant to Republic Act No. 10645

1. What is RA 10645 all about?

RA 10645 amended a section in the Expanded Senior Citizens Act of 2010
That section now reads:

All senior citizens shall be covered by the national health insurance

program of PhilHealth. Funds necessary to ensure the enrollment of
all senior citizens NOT currently covered by any existing category
shall be sourced from the National Health Insurance Fund of
PhilHealth from proceeds of Republic Act No. 10351, in accordance
with the pertinent laws and regulations.

1. What is RA 10645 all about?

R.A. 10645
provided coverage for Senior
Citizens NOT currently covered
by any membership program of
the NHIP.

3. Who are the Senior Citizens?

The Senior Citizens or the Elderly are

Filipino Citizens

Philippines

aged

who are residents of the

AND

60 years old or above

3. Who are the Senior Citizens?

The Senior Citizens or the Elderly are

Dual Citizens

with proof of Filipino citizenship

AND

aged

60 years old or above

AND

at least 6 months of residency

have
Philippines

in the

4. In what membership category will PhilHealth

enroll senior citizens with no coverage?
A new member category was created:

Senior Citizen

This category is for a senior citizen who is

not yet issued with a PhilHealth Identification Number or

PIN;
a member in the formal or informal economy but has
no qualifying contributions to be entitled to the
Program benefits;

4. In what membership category will PhilHealth

enroll senior citizens with no coverage?
A new member category was created:

Senior Citizen

This category is for a senior citizen who is

not an identified indigent

under

NHTS-PR;

not currently a Sponsored Member;

not yet qualified as a Lifetime
Member;

5. Can a Senior Citizens member

declare dependents?

YES,

Just like any other PhilHealth Member.

DECLARATION OF QUALIFIED
DEPENDENTS

A Senior Citizen member may declare the following as

qualified dependents in the PMRF:
a. Legitimate spouse who is not enrolled under the NHIP;
b. Children, legitimate or illegitimate below 21 years of age,
who is unmarried and unemployed;
c. Children who is 21 years of age or above but suffering
from a congenital disability, either physical or mental, or
any disability that reders him or her totally dependent to the
member for support; and
d. Foster child

6. What if the dependent of a Senior

Citizen is a Senior Citizen as well?

Dependents of Senior Citizen members

who are senior citizens themselves, e.g.

legal spouses, can be enrolled as

Senior Citizen members too.

7. What if the senior citizen is a dependent of

a member who has an existing covergage?

Dependents who are senior citizens

can be enrolled as Senior Citizen

members.

8. What about senior citizens who are gainfully

employed? Will they continue to remit contributions?

YES

Senior Citizens who are gainfully employed

or remains to have a regular source of
income shall continue to contribute to the
NHIP.

9. Who will pay for the contributions of

the Senior Citizen members?
The premium contributions of those who will
be enrolled under the Senior Citizen category
shall be sourced from the proceeds of RA
10351, commonly known as the

Sin Tax Law

10. Is the Senior Citizen category the same

with the Lifetime Member category?

No

The LMP members need NOT pay contributions to be

eligible to the benefits.
The Senior Citizen members have premium contributions
which are paid from the proceeds of Sin Tax Law.

11. What will be the membership documents

that will be provided to Senior Citizens?

A PhilHealth ID Card and MDR (Membership

Data Record Form) shall be printed and given to
the Senior Citizen as proof of enrollment.
However, while IT system are being adjusted,
only the MDR shall be given.

12. What are benefit entitlements of

Senior Citizens?
Senior citizen members will be entitled to
benefits for inpatient hospital care,
day/ambulatory services, Z-benefits and
other special benefit packages.

BENEFITS AND ENTITLEMENTS

Upon the effectivity of RA 10645 (Nov 25, 2014).
Senior Citizen members and their qualified
dependents shall be entitled to the following
benefit packages under the NHIP:
a. Inpatient hospital care
b. Day/ambulatory services;
c. Special benefits from catastrophic cases referred to
as Z benefits;
d. TB-DOTS Packages

BENEFITS AND ENTITLEMENTS

Upon the effectivity of RA 10645 (Nov 25,
2014). Senior Citizen members and their
qualified dependents shall be entitled to the
following benefit packages under the NHIP:
e. Animal Bite Package;
f. Malaria package;
g. Outpatient HIV/AIDS Treatment Package;
h. Blood Transfusion Package;

BENEFITS AND ENTITLEMENTS

Upon the effectivity of RA 10645 (Nov 25, 2014).
Senior Citizen members and their qualified
dependents shall be entitled to the following
benefit packages under the NHIP:
i. Maternity and Newborn Package;
j. Normal Spontaneous Delivery Package;
k. Antenatal Care Package; and
l. Benefits for Voluntary Contraceptive Surgical
Procedure.

13. How will Senior Citizens avail of

the benefits?
Senior Citizens only need to present their
senior citizen card, MDR or any accepted
proof of identity and age (Birth Certificate,
Philippine assport, SSS/GSIS ID, etc.)

Mandatory PhilHealth Coverage

of Senior Citizens

ENROLLMENT
PhilHealth Circular 33, s.2014

Implementing Guidelines for the Mandatory PhilHealth Coverage of Senior

Citizens pursuant to Republic Act No. 10645

ENROLLMENT
Senior Citizen members shall be primarily enrolled in
coordination with the OSCA, or any office designated by
the Office of the Mayor, in the locality where they reside.
The OSCA maintains and regularly updates on a
quarterly basis the list of senior citizens of its locality. The
OSCA may submit, on a quarterly basis, to the LHIO the list
of senior citizens for enrollment to the NHIP as Senior
Citizens.

ENROLLMENT
The list must contain the following information
about the senior citizen:
a. Full Name
b. Birthdate
c. Sex
d. Address (must include the Barangay, Municipality,
Province)

ENROLLMENT
To expedite enrollment, processing and
validation, the list shall be submitted to the LHIO
in electronic format.
The file must be password-protected.
The list must be accompanied by a transmittal
letter from OSCA and the printed alphabetical
list of the names of the senior citizens.

ENROLLMENT
As
much as practicable, a duly accomplished
PhilHealth Member Registration Form (PMRF) shall
be submitted with the list of senior citizens from OSCA.
In cases where the OSCA, or the office designated by the
Office of the Mayor, cannot submit the list in electronic
format, the duly accomplished PMRFs of the senior
citizens may suffice.
These PMRFs shall be properly endorsed to the LHIO who
has operational jurisdiction over the locality.

ENROLLMENT
Enrollment shall be primarily in bulk utilizing
the list submitted on a quarterly basis by the
OSCA of each city and municipality.

ENROLLMENT
Individual (Walk-in) Enrollment of senior citizens
has the following requirements:
a. A duly accomplished PMRF;
b. A 1 x 1 photo taken within the last 6 months; AND
c. An acceptable proof of being a senior citizen

Encouraging individual enrollment of senior

citizens to the program is NOT RECOMMENDED.


DELA CRUZ

02-221935

JUAN

SABTANG,
Batanes

Sinak

Sabta

SR

National
Road
Batan

RIZAL

Filipi
no
Philippi

3904

0996552409

DIUS MAMAJES
Dinio Atavu!