The Senior Citizen Philhealth Membership Explained

08 - 29

My mom is a senior citizen enjoying all perks and privileges offered by our government to citizens her age.  She gets to beat long lines at grocery stores and rest rooms, watches movies for free at the mall at least once a week, and gets discounts when dining out.

As her designated carer, my major concern is her health.  Because of her age and deteriorating immune system, she now easily catches minor illnesses like cough and colds.  Lately, she has been complaining of a nagging pain in her right eye; sometimes, it would radiate to her right temple and then progress to a full-blown headache.  In times like these, we are thankful that our senior citizen mom is covered by Philhealth.  We are assured of assistance if only with her hospital bills.

If you are caring for a senior parent or grandparent, it is important that you are well-versed with the Philhealth’s medical assistance coverage for the elderly.  I have summarized the following information about senior citizens’ automatic membership with the Philhealth; this has helped me and my siblings understand and appreciate Philhealth’s efforts at providing much-needed assistance in our parents’ medical needs.

Read and share!

In what membership category will Philhealth enroll senior citizens with no coverage?

The Senior Citizen category shall be for a senior citizen who is:

  1. Not yet issued with a Philhealth Identification Number or PIN;
  2. A member in the formal or informal economy but has not qualifying contributions to be entitled to the Program benefits;
  3. Not an identified indigent under the National Household Targeting Systems for Poverty Reduction (NHTS-PR) or listahan of the Department of Social Welfare and Development (DSWD);
  4. Not currently a Sponsored Member;
  5. Not yet qualified as a Lifetime Member; and
  6. A qualified dependent of an NHIP member who has been declared in Philhealth’s membership database.

Can a Senior Citizen member declare dependents?

Yes, just like any other Philhealth Member.

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.

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.

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 the Sin Tax Law.

What are the 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.

Starting January 2015, Senior Citizen members along with the Lifetime Members and those registered as Kasambahays aged 60 years old and above shall also be entitled to the Primary Care Benefit Package: Tamang Servisyo sa Kalusugan ng Pamilya (Tsekap).

Will Senior Citizen Members be entitled to the No Balance Billing Policy of Philhealth?

Yes, along with Lifetime Members and those registered as Kasambahays aged 60 years old and above.

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; provided the hospital has an HCI Portal installed.

A PBEF that says “YES” – the patient is entitled to the benefits shall serve as a basis for automatic deduction.

In case the hospital has no portal installed, the PBEF says ‘NO’, or the senior citizen was not able to enroll before discharge, then the following may be attached to the usual claims documents:

  1. duly accomplished Philhealth Member Registration Form (PMRF); and
  2. an acceptable proof of status as senior citizen including but not limited to the Senior Citizen’s Identification Card and Birth Certificate.

Source: http://www.philhealth.gov.ph

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6 thoughts on “The Senior Citizen Philhealth Membership Explained

  1. Hi Thank you for this article. My wife and I live in Canada and her parents are in the Philippines and are both over 60. Her Uncle recently passed away after having a heart attack and being in the hospital for almost a week. The family is asking us to help with the medical bills and are saying that hospital will not release the body until the bills are paid. I’m trying to get a better understanding of what Philhealth will cover and how much for the elderly? I’m worried that as her parents get older we might get stuck with some huge medical bills if Philhealth only covers a small portion. Also wondering if it would be worthwhile to look into Private Insurance on top of Philhealth for them?

    1. Philhealth cover only a certain portion of the total bill not the whole medical expenses unless they go to a government hospital. getting them an insurance or HMO will be a good help.

      1. San po makikita ang mga list na cover ng philhealth sa bill ng isa senior pag confine sa private hospital? at my list po ba kau ng mga government hospital kung san pde ipa check up o confine ang isang senior pra la na po byaran?LUNg problem po ang case ng patient, laki2 po kc ng bill pinaabot pa kami in 6 1/2 days sa hospital grabe tapos ganon lng kaliit ang bawas ng philhealth, d nman po ganon kalala case ng father q s lungs nya,😰😰😰

  2. Hello, thanks for the information. But I just want to have clarification if you can tell me more please. My mother is not a member of philhealth and she just turned 60years old on September 13, 2017. Recently, my sister told me that her abdomen is getting bigger as if something is growing inside. Now my question is, will she be able to use or avail philhealth benefits right after she enrolled in philhealth without contribution? I will gladly appreciate your answer back. Thank you.

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