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BENEFITS
MEMBERSHIP
CLAIMS PROCESSING
CONTRIBUTIONS
CLAIM FORMS
Our eye
surgeons
are Philippine
Health Insurance Corporation (PHIC) Accredited Health Care
Providers.
We do
surgeries at the following Philhealth accredited centers:
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Hospitals
- Philhealth accredited
- Asian Hospital
and Medical Center
- The Medical City
- St.
Luke's Medical Center
- Sentro
Oftalmologico Jose Rizal - Philippine General Hospital
- Fatima
Medical Center
- Alabang
Medical Center
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Ambulatory surgical centers - Philhealth accredited
- Borough
Medical Care Institute
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Healthway Medical Clinic (Festival Mall)
- Q.C.
Eye Center
Note:
All our eye surgeons are Philhealth accredited. Each surgeon is
accredited in at least one of the listed hospitals and/or surgical
centers.
If you would like to take advantage of the
benefits of PhilHealth kindly click on the quicklinks. If you are already
a PhilHealth member, kindly make sure that all your requirements for filing are
complete, in order for you to be able to successfully process all claims for
ambulatory surgeries, admissions, and in-patient surgeries.
When availing of
PhilHealth benefits for elective surgeries, we require pre-processing of all
papers with the chosen ambulatory surgical center or hospital, in order to make
sure that claims would not be denied. This way, we are able to protect both our
clients and ourselves against unexpected claim denials.
If you are not
yet a PhilHealth member, and would like to be one, our PhilHealth coordinator
would be able to assist you in applying for membership.
PhilHealth
Coordinator
EYE
REPUBLIC Ophthalmology Clinic - Don Santiago Building, Manila
(632)
536-2398
Philippine Health
Insurance Corporation (PHIC)
Accredited Health Care Provider
Adapted verbatim
from
http://www.philhealth.gov.ph/benefits.htm
Effective December 1999, PhilHealth is implementing a unified
benefit package for all PhilHealth members. This benefit package includes the
following categories of personal health services:
Inpatient hospital care:
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Room and board;
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Services of health care professionals;
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Diagnostic, laboratory, and other medical examination
services; Use of surgical or medical equipment and facilities;
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Prescription drugs and biologicals, subject to the
limitations stated in Section 37 of RA 7875; and
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Inpatient education packages.
Outpatient care:
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Services of health care professionals;
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Diagnostic, laboratory, and other medical examination
services;
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Personal preventive services;
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Prescription drugs and biologicals, subject to the
limitations described in Section 37 of RA 7875; and
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Emergency and transfer services
UNIFIED MEDICARE BENEFITS
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For all Members and Dependents under the National Health Insurance Program
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ROOM AND BOARD |
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Not exceeding 45 days for each member & another 45 days to be shared by
his dependents
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DRUGS & MEDICINES |
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Per single period of confinement |
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a. Ordinary
b. Intensive
c. Catastrophic |
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X-RAY, LAB, ETC. |
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Per single period of confinement |
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a. Ordinary
b. Intensive
c. Catastrophic |
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PROFESSIONAL FEES |
P 150/day for General Practioner
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Per single period of confinement shall not exceed: |
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a. Ordinary
General Practitioner
Specialist |
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b. Intensive
General Practitioner
Specialist |
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b. Catastrophic
General Practitioner
Specialist |
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OTHERS |
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Operating Room |
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a. RVU of 30 and below
b. RVU of 31 to 80
c. RVU of 81 and above |
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Surgeon |
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Anesthesiologist |
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Compensable Outpatient Services: Chemotherapy, Radiotherapy,
Cataract Extraction, Hemodialysis, Minor surgical procedures done in an
operating room complex
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SURGICAL FAMILY PLANNING |
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Vasectomy |
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Tubal Ligation |
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Fig. 1 PhilHealth Benefits (Last Update: January 29, 2002)
Adapted verbatim from
http://www.philhealth.gov.ph/membership.htm
PhilHealth expanded its services
for members in the government sector in 1998 by assuming the complete range of
Medicare services previously provided by the GSIS. As such, during this year
the NHIP's membership framework was developed. The framework included the
procedures for registration and updating of membership records of employees in
the government sector.
Membership - Build-up of
the database for members in the government service commenced upon PhilHealth's
assumption of collection functions for government sector members on January
1,1998.
Breakdown of NHIP
Membership:
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COVERAGE
Who are covered by the
National Health Insurance Program (NHIP)?
The program covers the following:
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Employed Members - all those employed
in the government and private sector.
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Individually Paying Members -
self-employed, Overseas Filipino Workers, professionals in private
practice (doctors, lawyers, dentists, etc.)
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Non Paying Members - the following are
entitled to lifetime coverage:
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Retirees and pensioners of the GSIS and SSS
(including permanent total disability and survivorship pensioners of
the SSS) prior to the effectivity of RA 7875 in March 4, 1995.
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Members who have reached the age of
retirement and have paid at least 120 monthly contributions. Optional
Retirees (under RA 1616, PD 1146 or PD 1184) are not yet entitled to
lifetime coverage until they reach the age of retirement (60 years
old).
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Indigent Members - under the indigent
component of the NHIP
Who are the legal dependents
entitled to free coverage?
The following also enjoy coverage through
your membership without paying additional premium:
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Legitimate spouse, non-member
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Children (legitimate, illegitimate, adopted
and step child) below 21 years old, unmarried and unemployed
Note: Children
21 years or above but suffering from any congenital disability, either
physical or mental, or any disability acquired that renders them totally
dependent on the member for support are also given free coverage as
dependents provided your membership remains active.
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Parents 60 years old and above, not qualified
as Non Paying Members and wholly dependent on the member for support
Employed Sector - With
deductions for PhilHealth contributions already mandatory for those in the
private and government sectors, this program ensures that Medicare benefits
are enjoyed by employees, including our household help, when they are most
needed!
What You
Need to Submit to be a Member:
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M1a - (Member Data Record for
Employed Members)
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M1b - (Member Data Record for
Individually Paying Members)
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M1c - (Member Data Record for Non-Paying Members)
Note:
To download membership forms, please
go to http://www.philhealth.gov.ph/forms.htm. It can be
secured from any PhilHealth offices or from Information Service Desks in
your area.
How do I declare my legal
dependents?
You may declare your dependents by submitting
the following requirements to be attached to membership form:
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DEPENDENTS |
REQUIREMENT |
Spouse
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Copy of Marriage Contract |
Children below 21 years
of age
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Birth Certificate whether or
not the age is at the borderline
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ANY
OF THE FOLLOWING:
Birth Certificate
acknowledged by any of the parent-member
Notarized Affidavit of
Support
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ANY
OF THE FOLLOWING:
Legal adoption papers
Notarized Affidavit that
child is legally adopted
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ANY
OF THE FOLLOWING:
Birth Certificate
Baptismal Certificate
Affidavit of Support by his
mother or his step-father in the absence of the mother or vice versa.
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e) 20 years of age
(bordering the age of 21)
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Birth Certificate
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f) If 21 and above but
suffering from congenital illness or disabilities
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Doctor's certification to the
effect that the dependent child is disabled or suffering from congenital
illness |
Parents
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a) 60 years old and above
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ANY
OF THE FOLLOWING:
Birth Certificate
Affidavit of Two (2)
Disinterested Persons
Voter's Affidavit
Passport (page indicating
data of holder)
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Adapted verbatim from
http://www.philhealth.gov.ph/claims.htm
What You Need to Submit to Enjoy Your Benefits:
Fully-accomplished
PhilHealth Claim Form I, Form II and Form III -
http://www.philhealth.gov.ph/download/forms.pdf.
Adapted verbatim
from
http://www.philhealth.gov.ph/contribution.htm
The new task of collecting the premium contributions of
members in the government sector entailed the accreditation of banks to serve as
Accredited Collecting Banks (ACBs) - http://www.philhealth.gov.ph/acbanks.htm.
These are: Allied Bank, Asia Trust Bank, Asia United Bank, Bank of Commerce,
Bank One Savings and Trust Co., Bangko Pasig, Century Savings Bank, China Bank,
Citystate Savings Bank, Development Bank of the Philippines, Equitable-PCI Bank,
Export & Industry Bank, Global Bank, G7 Bank (Rural Bank of Nabua), Hermosa
Savings & Loan Bank, International Exchange Bank, Landbank of the Philippines,
Maybank, Merchant Bank, Metrobank, Philippine Business Bank, Philippine National
Bank, Philippine Postal Corporation (Philpost), Philippine Postal Savings Bank,
Philippine Veterans Bank, Planters Development Bank, Premier Development Bank,
Prudential Bank, RCBC, RCBC Savings Bank, Robinson's Savings Bank, Rural Green
Bank of Caraga, Union Bank & United Coconut Planters Bank. An interim
Contributions Department was likewise established to oversee and coordinate
contribution activities. A region-based remittance, reporting, monitoring, and
compliance campaign was also initiated in 1998.
Premium Contribution Schedule
For the Employed Sector
A. Effective January 1, 2004
The minimum Salary Base (SB) shall
be revised from P 3,000 to P 4,000 and the maximum SB shall be revised from
P 10,000 to P 15,000. The contribution schedule effective January 2004 shall
be:
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Total Monthly Contribution
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Personal Share (PS) (PS=SBx1.25%)
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Contributions from the public and private sector employers
should be remitted on or before the 10th day of the month
following the applicable month at any PhilHealth Offices or through Accredited
Collecting Agents and their branches nationwide.
Failure to deduct and/or consequently remit said
contributions shall make the employer liable under the penal provisions
provided in Article X of the National Health Insurance Act of 1995 (RA 7875).
In addition, to ensure proper and immediate posting of
employees’ contribution payments, employers should submit the Quarterly
Remittance Reports (using the RF-1 form or text file format) on or before the
15th day of the month following the applicable quarter.
Remittance of NHIP Premium Contributions Guidelines
How much to remit?
EMPLOYED SECTOR
Monthly contributions of members from the employed sector shall be dependent
on his/her salary and shall be according to the prescribed NHIP Premium
Contribution Schedule.
VOLUNTARY MEMBERS
Premiums of Individually Paying Members (IPMs) are fixed at Php 100 per
month.
EMPLOYED SECTOR
Contributions of members, from the employed sector, are automatically
deducted from their salaries. Total contributions for all employees shall be
computed and this, together with the employer counterpart, shall be
remitted, using the Contribution Payment Return Form (ME-5), by their
respective employers on or before the 10th day of the month following the
applicable month, at any PhilHealth Accredited Collecting Banks (ACBs).
VOLUNTARY MEMBERS
Voluntary or Individually Paying Members (IPMs) have the option to remit
premiums, using the Contribution Payment Return Form (MI-5) in a quarterly,
semi-annual or annual basis, the deadline of which shall fall on the Last
working day of the applicable quarter. Contributions of IPMs are, however,
non-retroactive.
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Last working day of the applicable quarter
Ex. Suppose payment is for the 3rd quarter 2002 (July - September)
Deadline : September 30, 2002
Suppose payment is for the 3rd & 4th quarter 2002 (July - December)
Deadline : September 30, 2002
Suppose payment is for the 3rd qtr 2002 until 2nd qtr 2003 (1 year)
Deadline : September 30, 2002
How to Report contributions?
EMPLOYED SECTOR
Reporting of contributions can be done through the submission of the
Employer's Quarterly Remittance Report Form (RF-1) or submission of text
file report using the PhilHealth Premium Remittance System (PPRS).
Remittance reports should be submitted on or before the fifteenth (15th) day
of the month following the applicable quarter to the Contribution Accounts
Management Department (CAMD) for NCR-based employers, PhilHealth Regional
Offices (PROs) for regional based employers, or through Drop Boxes located
at designated ACBs.
VOLUNTARY MEMBERS
IPMs shall submit the PHIC copy of the duly validated Contribution Payment
Return Form (MI-5) five (5) days after payment was made, to the CAMD, PROs
or through Drop Boxes located at designated ACBs.
How to avoid deficiencies?
To avoid deficiencies, always:
1. Supply complete and correct information in the remittance reports and
the ME-5.
2. Remit contributions according to the prescribed premium schedule.
3. Compute total contributions due for each month and ensure that
computations are correct.
4. Ensure that ME-5s are validated, or Official Receipts (O.R.) are
attached.
5. Prepare the
Quarterly Remittance Reports (RF-1) - http://www.philhealth.gov.ph/forms.htm#RF1Form. Accomplish all required
information.
6. Always indicate compensation of employees, otherwise, contribution shall
be computed based on the maximum salary bracket.
7. Attach the ME-5s to the corresponding RF-1s.3
8. Submit reports on or before the deadline to facilitate posting.
What if your company was notified?
Employers shall be notified by the CAMD (NCR-based employers) or by the PROs
(region-based employers) for the following reasons:
1. Under-remittance
An under-remittance is made if employee contributions
remitted are; less than the prescribed premium schedule; contributions of
some employees listed in the quarterly collection list, were not remitted;
and/or actual amount remitted is less than total amount of contributions to
be paid. (i.e., computation errors).
2. Non-remittance
Companies shall be classified as Non-remitting if they have not remitted
NHIP contributions, since the transfer of the Medicare program to the NHIP
or since the start of their operations
3. Delinquency
Employers are classified as "delinquent" if they have not remitted at least
three (3) monthly contributions, in behalf of all its employees, within the
last six (6) months from the current month and/or remittance (for periods
beyond the immediately preceding 6 months) are incomplete.
4. Deficiencies in the Remittance Report
If information required in the remittance reports (RF-1 or
PhilHealth Premium
Remittance System - PPRS) - http://www.philhealth.gov.ph/PPRS_Update.htm and the Contribution Payment Return Form
(ME-5) were not completely supplied, the CAMD or the PROs shall notify the
company of such deficiency/ies. To avoid inconvenience and delay in the
posting of reports, kindly submit the required information or documents,
together with the notice, immediately.
The following Forms
are available for download in Portable Document Format (PDF). To open a
PDF file, you must have the Adobe Acrobat Reader software installed on
your computer. You can download Acrobat Reader by clicking in this icon:
After you download the Adobe Acrobat Reader, you may come back to this
page and open the forms that you need by following the link provided.
Claim Form 1 - http://www.philhealth.gov.ph/download/cf1.pdf - Member's Data Record
Claim Form 2 - http://www.philhealth.gov.ph/download/cf2.pdf - Hospital Data Record
Claim Form 3 - http://www.philhealth.gov.ph/download/cf3.pdf - Patient's Clinical Record
There are several ways of reaching the ophthalmologists of EYE REPUBLIC Ophthalmology Clinic:
Hover note: Please place your mouse cursor over the red box
to click on the web and email links. For websites, a new browser
window will open. For emails, your default email program will
open. You may cut and paste the URLs or email addresses if you
prefer not to open new windows.
ONLINE ACCESS
WEBSITES.
http://www.EyeRepublic.com.ph - EYE REPUBLIC
Ophthalmology Clinic
http://www.OCP.com.ph - Ophthalmic
Consultants Philippines Co. -
http://www.LASIK.com.ph - Refractive
Surgery Resource
http://www.Cataract.com.ph - Cataract Surgery Resource
http://www.Eye.com.ph - Eye
Information Online
http://www.EyeDoc4Kids.com.ph - Eye Information for Kids
http://www.Retina.com.ph - Retina
Surgery Resource
http://www.Glaucoma.com.ph - Glaucoma
Online
http://www.Uveitis.com.ph - Uveitis Online
EMAIL. After writing down your comments,
suggestions, problems and/or questions, kindly tell us how
to get in touch with you by providing your name, email,
home/office numbers, and mobile phone.
General inquiries - help@EyeRepublic.com.ph
Refractive Surgery Service - refractive.surgery@EyeRepublic.com.ph
Glaucoma Service - glaucoma@EyeRepublic.com.ph
Cataract Service - cataract@EyeRepublic.com.ph
Doctors - eyemd@EyeRepublic.com.ph
Administrative - president@EyeRepublic.com.ph
Website - webmaster@EyeRepublic.com.ph
Newsletter -
newsletter@EyeRepublic.com.ph (receive
news and updates, discounts and promotions)
BLOG. Send us your comments.
EYE REPUBLIC
Ophthalmology Atlas
CLINIC INFORMATION
Mobile E-Yellow Pages. Via
SMS, text LUK4 EYEREPUBLIC
(send to 2851 for Globe and Sun Cellular, and 2951 for Smart). |
EYE REPUBLIC Ophthalmology Clinic
Manila
3/F Don Santiago Building Units 309-310
1344 Taft Avenue, Ermita
Manila, 1000 Philippines
Direct and Fax: +63(2) 536-2398
Trunk Line: +63(2) 523-8271 to 79 local 30
Mobile: +63(917) 899-2020
Map and directions
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EYE REPUBLIC
Ophthalmology Clinic
Asian Hospital
and Medical Center
5/F Medical Office
Building (MOB) Suite 509
2205 Civic Drive,
Filinvest, Alabang
Muntinlupa City,
1781 Philippines
Direct:
+63(2) 771-9253
Direct and Fax:
+63(2) 771-9254
Mobile: +63(917) 795-2020
Map and Directions
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EYE REPUBLIC Ophthalmology Clinic
Medical City
6/F Medical Arts Tower Inc (MATI) Suite 602
MERALCO Compound, Ortigas Avenue
Pasig City, 1604, Philippines
Direct and Fax: +63(2) 632-7846
Mobile: +63(917) 537-2020
Map and directions
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EYE REPUBLIC
Ophthalmology Clinic
St. Luke's
Medical Center
6/F
Cathedral Heights Building Complex (CHBC)
North Tower Suite 614
279 E. Rodriguez
Sr. Boulevard
Quezon City, 1102
Philippines
Direct and Fax:
+63(2) 407-3883
Mobile: +63(917) 855-2020
Map and directions
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CLINIC HOURS
First-Come, First-Served
Monday to Saturday 9:00 AM to 6:00 PM
All clinics are closed on Sundays and Holidays
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