The national health insurer is looking for ways to enable overseas Filipino workers (OFWs) who are covered members to easily file their claims via the Internet so they may obtain quick reimbursement of hospital bills incurred abroad.
This is one of the highly aggressive new strategies the Philippine Health Insurance Corp. (Philhealth) is pursuing to deliver greater value to its members who work overseas.
“We want covered OFWs to receive immediate financial relief in the event they become ill and seek hospitalization in their host countries,” said Dr. Eduardo Banzon, Philhealth president and chief executive officer.
“Our plan is to install by next year a system that will allow OFWs to simply submit online their individual claims for repayment,” Banzon said.
He also said Philhealth is considering the possibility of contracting primary care physicians abroad to care for covered OFWs.
“We hope to start doing this in selected foreign cities with large concentrations of OFWs,” Banzon said.
At present, covered OFWs hospitalized abroad may file claims for reimbursement only by submitting hard copies of the necessary paperwork inside six months to the Philhealth office nearest their Philippine residence.
The papers to be submitted are Philhealth Claim Form 1; a photocopy of the claimant’s latest Member Data Record, or contribution payment receipt; a medical certificate with complete diagnosis, period of confinement and services rendered; and a hospital statement of account and/or official receipts with itemized charges and other supporting documents in English.
The Philippine-based dependents of OFWs may readily avail of benefits via accredited local hospitals and outpatient service providers.
Philhealth helps pay for the room and board, medicines, laboratory exams, as well as operating room and professional fees for every hospital confinement of not less than 24 hours of the OFW’s spouse and other dependents.
Qualified dependents of OFWs who are active Philhealth members are entitled to a separate coverage of up to 45 days confinement per calendar year. The 45 days allowance is shared among all dependents.
Eligible dependents include the OFW’s legal spouse who is not a Philhealth member, or whose membership is inactive; the OFW’s children below 21 years of age, unmarried and unemployed; and the OFW’s parents who are 60 years old and above.
The spouses and children of male OFWs also receive ample medical subsidy in the form of prenatal, maternity and newborn care benefits.
A 1995 law requires all citizens of the Philippines “to enroll in the National Health Insurance Program in order to avoid adverse selection and social inequity.”
Under the law, compulsory coverage is based on community spirit and social solidarity, which call for risk-sharing among diverse income and age groups, persons of varied health status, and those residing in different locations.
“We at Philhealth are duty-bound to carry out the law, which mandates compulsory membership and coverage of all Filipinos, including to our OFWs,” Banzon said.
“Even if we wanted to, we are not in a position to exempt our OFWs from compulsory coverage and contributions. Otherwise, we will be remiss in the performance of our duties,” he added.
Philhealth now covers some 2.52 million OFWs plus 2.48 million of their dependents.
To enlarge benefit payments and cope with the rising cost of hospitalization and out-patient services, Philhealth has adjusted annual premium contributions.
In the case of OFWs, their more than 10-year-old annual premium of P900 (or P2.50 per day) has been revised in phases to P1,200 (or P3.30 per day) effective January 1, 2012, and to P2,400 (P6.55 per day) starting January 1, 2013.
“The cost of all goods and services has drastically gone up over the years. This includes the cost of health care paid for by Philhealth,” Banzon pointed out.
“The fine-tuning is long overdue and reasonable, considering it merely reflects over a decade of health care cost inflation, and in view of the expanded benefits Philhealth has been rolling out as we speak,” he said.