PhilHealth extends ‘No Balance Billing’ policy to Kasambahays

By on July 3, 2014


PhilHealth. Photo courtesy of doh.gov.ph
PhilHealth. Photo courtesy of doh.gov.ph

MANILA — In order to provide more Filipinos with adequate financial protection against health risks, the Philippine Health Insurance Corporation (PhilHealth) has extended its “No Balance Billing” (NBB) policy to household helpers or “Kasambahays” as defined in Republic Act 10361 or the “Kasambahay Law.”

PhilHealth President and CEO Alexander A. Padilla said that this move to expand the NBB policy will surely help members truly appreciate their PhilHealth coverage, adding “every person has the right to access adequate health care and we want that dream of universal health care for all Filipinos fulfilled through NBB.”

“Kasambahays” are persons engaged in domestic work within an employment relationship such as, but not limited to general househelp, nursemaid or “yaya”, cook, gardener or laundry person.

Any person who performs domestic work only occasionally or sporadically and not on an occupational basis are excluded from the definition of Kasambahay.

Prior to this development, the NBB was already available to the poorest of the poor specifically the Indigent and Sponsored members, as well as the iGroup Gold members with existing Group Policy Contract (GPC) until the contract with PhilHealth expires.

PhilHealth issued Circular No. 03 in January this year to strengthen and improve the enforcement of the “NBB” policy, which guarantees qualified members that they will no longer have to pay any amount beyond what PhilHealth pays for when admitted in ward-type accommodation in government hospitals.

The policy is pursuant to Section 43 of the Implementing Rules and Regulation of Republic Act No. 10606 (National Health Insurance Act of 2013) which states that,”No other fee or expense shall be charged to the indigent patient, subject to the guidelines issued by the Corporation. All necessary services and complete quality care to attain the best possible health outcomes shall be provided to them”.

As full-fledged PhilHealth members, Kasambahays are entitled to substantial coverage when seeking treatments in accredited hospitals, especially if they or any of their dependent gets admitted in government facilities, where the NBB is implemented.

With PhilHealth’s complete shift to case based payment for claims, Kasambahays now know how much they are entitled to in terms of benefit payments.

These can be availed of in any accredited health care institution and other health facilities like ambulatory surgical clinics, freestanding dialysis clinics, infirmaries, dispensaries, birthing homes and DOTS Centers, among others.

Under the case rate payment mechanism, if a Kasambahay is confined in a government hospital due to High Risk Pneumonia, the member may avail himself of a benefit package worth P32,000.00 for the treatment of the illness.

A member who gives birth in a non-hospital facility is entitled to a benefit package of P8,000.

On the other hand, Normal Spontaneous Delivery (NSD) in accredited Levels 2 to 4 hospitals entitles members to a benefit package of P6,500.

Kasambahays are advised to update their Member Data Records to ensure that all their legal dependents are included. Employers of Kasambahays must promptly remit their monthly premium contributions to ensure hassle-free availment of benefits.