Bontoc, Mt. Province– A total of 8,801 families are enrolled under the National Health Insurance Program for indigent families in the province to have a better health care.
This was reported by PhilHealth-CAR regional office representatives Dr. Errol D. Ciano and Dr. Dominga A. Gadgad who attended the province’s regular monthly Provincial Health Board meeting held last May 8.
Of the total, 4,891 are regularly sponsored members. The premium contribution subsidy for these families is shared by the national government that provides 80 percent while the other 20 percent is shared equally by the provincial government and the municipal government where the beneficiaries reside.
Aside from the regular sponsored members, 1,999 families are also sponsored solely by the provincial government. There are also five local government units who have sponsored some indigent families in their own municipality like Bauko which has enrolled 549 families, Besao with 354, Barlig,280, Sabangan, 256 and Sagada, 198.
A total of 274 families are also sponsored by private individuals and institutions. Partial subsidy of 20 percent is provided by these sponsoring LGUs, individuals and institutions and the national government provides the 80 percent.
The health insurance of these sponsored members is valid only for one year. It will be a case to case basis if they will be reconsidered when their membership expires.
Sponsored members are entitled to a special Outpatient Consultation and Diagnostic Benefit Package (OPB) aside from the regular benefits provided to PhilHealth members. This is an additional benefit for sponsored members and their qualified dependents (enrolled under the PCSO II program are not included) which will be provided by government-owned RHUs/Health Centers duly accredited by PhilHealth to implement the OPB program.
They are entitled to avail of free primary consultations with general physicians; laboratory fees for chest X-ray, complete blood count, Fecalysis, Urinalysis and sputum microscopy; and preventing services such as health screening activities, health education and counseling.
Ciano explained that OPB benefits are not portable and may be availed only in the specific RHU/HC where the sponsored beneficiary is assigned.
In the event that RHU/HC where sponsored members are initially assigned is not accredited to provide the OPB, members shall be temporarily assigned to specific authorized hospital. Capitation amount shall be released to the authorized hospital thru the concerned city/municipal/provincial government.
In case of deficiency in medical equipment or temporary inability by the RHU to deliver chest X-ray services, the patient shall be referred to another accredited outpatient healthcare provider with an X-ray facility. The concerned RHU shall pay the provider the amount of not less than P70.00 for the service. Accredited hospitals with chest X-ray facilities shall initially be providers where RHUs may refer their patients.
Under the OPB program, PhilHealth gives a capitation fund of P300 per year to accredited RHU for every enrolled sponsored member.
The capitation fund that PhilHealth releases quarterly varies in the different RHUs because this depends on the number of enrolled sponsored family per municipality. (PIA-MP) by Juliet B. Saley