The 2012 General Appropriations Act provides a budget of P12.028 billion as subsidy for the health insurance premium of indigent families enrolled in the National Health Insurance Program.
It especially provided that the amount shall cover the national government subsidy for the health insurance premium of indigents under the National Household Targeting for Poverty Reduction of the Department of Social Welfare & Development.
Since all Pantawid Pamilyang Pilipino Program beneficiaries are included in the NHTS-PR list of poor households, they are provided PhilHealth coverage under the Sponsored Program.
Their membership under the Sponsored Program entitles them and their qualified dependents of special benefits under the Primary Care Benefit 1 Package through their respective rural health units, health centers or the outpatient department of government hospitals where they may be assigned. The package covers primary preventive services, diagnostic examinations and medicines for outpatient treatment of certain illnesses.
They can also avail of insurance coverage for hospitalization in PhilHealth accredited hospital and non-hospital facilities.
In addition, the Pantawid Pamilya beneficiaries, like all other sponsored members of PhilHealth, are entitled to the No Balance Billing Policy when admitted in non-private accommodation beds of government hospitals for any of the 23 cases covered under case payment; when availing of outpatient surgeries, hemodialysis and radiotherapy in non-hospital facilities; when availing of outpatient packages for tuberculosis, malaria, HIV/AIDS; and when availing of the services under the Maternity Care Package and Newborn Care Package in accredited birthing homes, lying-in clinics and other MCP providers.
The Pantawid Pamilya ID card shall be accepted in lieu of the PhilHealth ID card and/or the Member Data Record to establish a member’s eligibility to avail of PhilHealth benefits. For qualified dependents, supporting documents must still be presented to establish proof of eligibility. (PRO7)
