Republic of the Ptil/ip/tiiies' w\j,
Cilvstaie Cemie Building. 709 Shaw Boulevard. I'asig Cuy"|
Heallhlmc-I-U-7444 www nliilhcnlili gnv nh
PHILHEALTH CIRCULAR
No. Pfr.s 2012
FOR All PhilHcnllh -engaged Hcstkh Care Providers and All Others Concerned
SUBJECT Updated Guidelines on the Application of the Senior Citizens1 Discount
Relative Co PhilHeaUh Reimbursements
1 RATIONALE
Republic Act No. 7432 (RA 7432) entitled, " An Act to Maximize The Contribution of Senior
Citizens to Nation Building, Grant benefits and Special Privileges and for Other Purposes and
Republic Act No. 9257 (RA 9257) otherwise known as " Expanded Senior Citizens Act of 2003"
, have been amended by Republic Act No. 9994 known as the "Expanded Senior Citizens Act of
2010" to address the growing needs lor health services of the elderly population and provide
enabling mechanisms for them to have quality life.
This Circular is issued in support of DOH Administraove Order 2012-0007: Guidelines on the
Grant of Twenty Percent (20%) discount to Senior Citizens on Health Related Goods and
Services and for Other Purposes; and, to amend the PhilHcallh Circular 2, s. 2005 re: PhiJHealth
Guidelines for Members nnd Dependents to Implement the Relevant Provisions of Republic Act
9257, otherwise known as the ''Expanded Senior Citizen's Act of 2003'1.
[1. COVERAGE AND SCOPE
This Circular shall cover and apply to:
A. All hospital charges (including Professional Fees) of PhilHealth members and qualified
dependents who are sixty (60) years old or above including senior citizens of poor
families identified in the National Household Targeting System for Poverty Reduction
(NHTS-PR) under the Sponsored Program.
B All PhilHealth-engviged government and private health care providers (HCPs).
Ill GENERAL GUIDELINES:
A. The Senior Citizens' Discount (SCD) shall apply to private and non-priviue
accommodation, and shall be computed, as follows:
FEE FOR SERVICE
l.The PhilHealth-engnged IHCPs shall first deduct the twelve percent (12%) VAT
exemption from the total hospital charges; then deduct twenty percent (20%) SCD from the
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! @@.~.Knv----> rri.'Tc-npvdifference; then deduct the PhilHcalth Benefit" from [he remaining amount. The balance
(net of VAT exemption, SCD and PhilHealth Benehf) shall be the co-payment (should
there be any) of the senior citizen.
2. For the professional fce/s, the PhilHealth-engaged Professional Health Care Providers
PHCPs) shall first deduct the twelve percent (12%) VAT exemption from the total hospital
charges; then deduct twenty percent (20u/b) SCD from the difference; then deduct the
PhilHealth Benefit from the remaining amount. The balance [net of VAT exemption, SCD
and PhilHealth Benefit} shall be the co-payment (should there be any) of the senior citizen.
Fee for Service: Illustrative Computation
CASE RATES or BENEFIT PACKAGES
J.The PhilHealth-enguged IHCPs shall first, deduct the twelve1 percent (12%) VAT
exemption from the total hospital charges; then deduct twenty percent (20'Vo) SCD from the
difference.; then deduct the PhilHealth Benefit (including the professional fees) from the
remaining amount. The balance (net of VAT exemption, SCD and PhilHealth Benefit) shall
be the co-payment (should there be any) of the senior citizen.
2.Case Rates or Benefit Packages including Case Type Z Benefit Package shall be paid the
full case rate or package amount regardless of the Senior Citizens' Discount or P\VD
Discount. The PhilHealth benefit shall not be reduced due to the aforementioned discounts.
Case Rates or Benefit Packages: Illustrative Computation
less VAT exemption (12.'o)
less SC Discount (20/b)
less PhilHcalth Benefit (Pneumonia 1)
Co-payment of Senior Citizen Php 9,640
$Sl"I'H
13 llessVATexemption(12%)
lessSCDiscount(20%)
lessPhilHealthBenefit
Co-paymentofSeniorCitizen
Totalh
Php
Php
ospitillCharges
10,000
-1,200
S,8liO
-1,760
7,040
-5,000
2,040
Tota
Php
Php
Prof.Fees
5,00(1
-600
4,400
-8S0
3,520
1,200
2,320
TotalHos
(includi
Php
plt-.llCharges
ngPF)
35,000
-4,200
30,800
-6,160
24,640
15,000B.The applicable deduction/s (i.e., VAT exemption, SCD :ind PhilHcallh Benelit) shall be
reflected on the statement ot account ot the patient.
C.It" the senior citizen is also a Person With Disability (PWD), the senior citizen may opt to
use other the SCD or PWD discount.
iv. ADDITIONAL PROVISIONS ON THE GRANT OF TWENTY PERCENT
(20%) DISCOUNT TO SENIOR CITIZENS ON HEALTH RELATED GOODS
In line with the signed Performance Commitment of HCPs, particularly on the compliance
with all pertinent and applicable laws and regulations, the provisions of DOH
Administrative Order 2012-0007 shall form part of the undertaking of the engaged HCPS,
to wit:
A. PI-IILHEALTH-ENGAGED INSTITUTIONAL HEALTH CARE PROVIDERS
1.Phil Health-engaged government hospitals shall establish a senior citizen's ward. The
ward shall be for exclusive use ot the senior citizens who are in need of hospital
confinement. The ward may he used by patients other than the senior citizens in case of
public necessity or for emergency purposes, after which, it shall bd reverted to its original
purpose as a geriatric ward. Initially, if the hospital docs not haye enough space for a
geriatric ward, beds may be prioritized for the use of the senior citizen who will be admitted.
2.All PhilHealth-engaged government and private IHCPs shall display in a conspicuous
area the hospital room rates, laboratory and diagnostic tests fees, prices of medicines and all
oilier fees and rates in strategic places in the health facility (e.g., I admitting section, ER,
OPD, billing section, etc.). The fees, rates or price lists shall bd regularly updated and
submitted annually to the National Center for Health Facility Qcvelopment-DOH and
PhilHealth.
3.PhilHealth-cngaged government and private IHCPs shall set up a grievance mechanism
for senior citizens such as Public Assistance Complaints Units' (PACU) to entertain
questions/queries with regards to senior citizens benefit under RA' No. 9994. The PACU
concerned should inform in writing the actions taken on the complaint of the senior citizen,
and furnish a copy thereof to the DOH.
B PHILHEALTH-ENGAGED PROFESSIONAL HEALTH CARE PROVIDERS
1.PhilHealth-engaged PHCPs shall inform the scniou citizen of ljis regular fees for the
services required.;
2. PhilHealth-engaged PHCPs shall provide an official receipt (OR) for the professional
sei-vices rendered to the senior citizen, which states the regular fees, discounts (tax-
exempiions, senior citizens discount1) and applicable PhilHealth benefit deduction.
^/Itrtl/ /ft/MONITORING
Compliance of the engaged HCPs with the provisions ot this Circular, as well as, with
DOH the Administrative Order 2012-0007 shall be monitored in accordance with the
approved guidelines of the Corporation. The results of such' monitoring shall be
considered in the gran ting; of incentives or penalties/sanctions, whichever is applicable.
VI. REPEAJLING CLAUSE
All provision? of previous issuances that arc inconsistent with any provisions of this
Circular are hereby amended/modified or repealed accordingly,! while those that are
consistent shall remain in full force and effect.
VII. EFFECTIVITYJ
This Circular shall take effect fifteen (15) calendar days from publication in a newspaper of
general circulation and shall be deposited thereafter with the Nhitional Administrative
Register at the University of the Philippines Law Center.i
DR EBTJARDOP. BANZON
PresidfciHjmdiJIiO
Date signed:'t//t/ll
D:ite aigncd:_
PI-
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EALTH