MANILA - The Philippine Health Insurance Corp. (Philhealth) has paid over P4.5-billion worth in hospitalization and medical benefits to land-based overseas Filipino workers (OFWs) and their dependents since it absorbed the Medicare program of the Overseas Workers Welfare Administration (OWWA) in 2005.
“From 2005 to 2011, Philhealth actually returned to registered OFWs 100 percent of their premium contributions, plus more, by way of benefit payments. In 2011 alone, the utilization rate was 132 percent over premiums collected from OFWs the same year,” said Dr. Eduardo Banzon, Philhealth president and chief executive officer.
“We will be spending more aggressively for the health care of our OFWs and their family members here in the months ahead, as we expand coverage, jack up benefit payments and improve service delivery,” Banzon said in a news release.
Membership coverage
A 1995 Philippine law mandates compulsory Philhealth membership for all Filipino citizens, including OFWs, to ensure health insurance protection for all, and “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.
"To date, more than five million Filipinos and their dependents are registered under Philhealth's program for land-based OFWs,” Banzon said.
Since 2005, OFWs have been enrolled as Philhealth members through the Philippine Overseas Employment Administration’s Overseas Employment Certificate processing system.
“OFWs who left the country prior to 2005 are not automatically covered, but we have accredited partners overseas, as well as a virtual office, to process their membership, including renewal, and to provide support services," Banzon said.
Dependents
Qualified dependents of OFWs who are active Philhealth members are entitled to a separate coverage of up to 45 days hospital confinement per calendar year. The 45 days allowance is shared among all dependents.
Eligible dependents include the OFW’s 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 60 years old and above.
Claims availment
Banzon reminded covered OFWs that Philhealth reimburses them for overseas hospitalization and other medical expenses, even if they already enjoy health insurance benefits provided by their foreign employers.
Philhealth protection is "highly beneficial” to OFWs with dependents here at home, who are not normally covered by the health insurance provided by the foreign employer, he stressed.
“When it comes to low-skilled and extremely vulnerable OFWs such as domestic helpers and construction workers, the insurance provided by the foreign employer usually does not extend to the worker’s dependents here," Banzon said.
Currently, covered OFWs hospitalized abroad may file claims for reimbursement via an authorized representative, by submitting hard copies of the necessary paperwork within 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.
Banzon previously bared Philhealth’s plan to launch by next year a system that would enable OFWs to simply submit online their claims for repayment.
On the other hand, the Philippine-based dependents of covered OFWs automatically avail of benefits via accredited local hospitals and outpatient service providers.
Lifetime Members Program
Banzon also said covered OFWs will be fully protected by Philhealth for free once they reach 60 years old and stop paying premium contributions.
“Once an OFW turns 60, and has remitted a total of at least 120 monthly premium contributions, even if paid discontinuously, he or she will enjoy Philhealth coverage absolutely free for the rest of his or her natural life,” he said.
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, his/her spouse and other dependents. It is also covering an increasing number of outpatient services, including day surgeries and treatment of tuberculosis.
source: interaksyon.com
