PhilHealth, pay for the time you been overseas or not, to continue?

[Gator]

10 hours ago, Dave Hounddriver said:

I think its the same for a vehicle registration.  Even if you put it up on blocks on your own property they demand that you pay all the missed years plus penalty if you ever want to put it back on the road.  Crazy rules.

Not sure about cars, but at least in my case not so for a motorbike. The registration expired on my bike in December of 2020. Renewed it via the Honda dealer in Dau (Angeles City) this past February and didn't get charged for the 14 months it was “up on blocks” inside my apartment. 

[OnMyWay]

On 7/7/2022 at 6:20 PM, CebuAndy said:

Been overseas 2+ years, so when I return, if I want to continue PhilHealth do I have to catch up and pay for the time I was away?

Pre-covid I was away for 8 months and when I came back in country and to PhilHealth office, I show my passport and stamps from Thailand, they wanted full payment for the time I was overseas, to 'continue coverage'. Wasn't given the option to start fresh new membership. That was then I hope.

Paying for 2+ years I was not in PH, is not going to happen.

Any actual experience with similar situation? Apply at another office or city? Or pay up or forget PhilHealth?

Have top expat insurance with deductible in addition, but prefer small claims minus 30%+-  PhilHealth discount paid by myself

So how would Philhealth (or any insurer) handle a new claim by you when they allow you to restart your coverage without catching up on your premiums?  For instance, you are out of the country for 2 years and don't pay your premiums, return in January, get restarted for free, then in February you get hit by a truck.  You think they should pay up?  Insurance doesn't work like this.

You are lucky that Philhealth doesn't just cut you off when you stopped paying the premiums and they let you catch up.  Commercial insurers would just cancel you and all paid premiums would be lost.

OFWs have to keep paying and/or catch up when they come back.  System would work if they didn't.

I pay my U.S. Medicare every month even though I don't live in the U.S. and the closest place I could use it is Guam.  Pay it or loose it.

I'm not sure I understand what you mean by using Philhealth for small claims.  Generally speaking, Philhealth usually comes into play when hospitalized.

[CebuAndy]

4 hours ago, OnMyWay said:

So how would Philhealth (or any insurer) handle a new claim by you when they allow you to restart your coverage without catching up on your premiums?  For instance, you are out of the country for 2 years and don't pay your premiums, return in January, get restarted for free, then in February you get hit by a truck.  You think they should pay up?  Insurance doesn't work like this.

 

"Get restarted for free" are something you made up yourself. Kindly read my post again. I never said that.

HERE's my first paragraph:

Quote: Been overseas 2+ years, so when I return, if I want to continue PhilHealth do I have to catch up and pay for the time I was away? End quote.

Normally a commercial insurance company would replied like this:

"due to lack of payment of premium, your policy was cancelled when payment was due and not received within 14-30 days. You are welcome to apply again for a new policy and make first payment of premium according to the options we have. You will not be able to take advantage of your new policy the first 90 days, as are standard for all customers.

Example: Sign up 1 january and make payment. Claims will be covered from 1 April onwards.

No sane person pay for a service he couldn't take advantage of during 2+ years when overseas. Commercial insurance understand this and cancel policy - Philhealth don't and in the end they lose customers.

Compare philhealth vs commercial insurance companies in the country, and also all other aspect like coverage percentage and premium. Steep increase of premiums in Philhealth from year 2024, Philhealth will become a thing of the past anyway.

Don't have further to reply to your post when you put ideas into your post, that I never wrote.

[Mike J]

I am not aware of any national single payer type health insurance plan that DOES NOT require the policy holder to "catch up" missed payments.  Private plans that allow you to drop and restart coverage, will exclude any "pre-existing conditions not covered" for a year or so.  That is the only way to prevent people dropping coverage, then starting coverage when they get a serious injury, expensive sickness (cancer, etc.), or the spouse gets pregnant.  "Fairness" has nothing to do with it, they do it in order to stay in business.   Auto insurance is a bit difference, you stop paying and they cancel coverage.  You want new insurance, you send send them current pictures of all four sides (or the selling agent does an inspection) to show no damage and you start a new policy.

That is the way it should work, otherwise there would either be no health insurance at all or the rates would absolutely skyrocket as people jumped in and out of the plan.

[CebuAndy]

2 hours ago, Mike J said:

I am not aware of any national single payer type health insurance plan that DOES NOT require the policy holder to "catch up" missed payments. 

Can you name 1 commercial insurer in country, that DOES NOT CANCEL any policy that wasn't paid shortly after due date, except Philhealth?

Link please.

 

2 hours ago, Mike J said:

Private plans that allow you to drop and restart coverage, will exclude any "pre-existing conditions not covered" for a year or so.  

My OP does not concern exclusion time, it do concern the possibility to continue to be a Philhealth member, or start a new policy with them.

Start from scratch and Philhealth has 3 months after first payment before claims are accepted. For pregnancy I think it was 6 months.

[hk blues]

My tuppence for what it's worth (probably less than tuppence)

According to Philhealth rules, you can (surely mean must but hey, we're in the land of ambiguity to allow local interpretation!) make up missed premiums and once you do so you can make a claim provide you've made 75% of required contributions. Seems fair enough on the face of it. But...

That said, trying to compare a national health system with a commercial business is wrong IMO. The system is not for profit and is there to offer locals a minimum level of care at an affordable cost. Us foreigners are kinda lucky we can coat tail on that in some circumstances.

If we take the UK as an example - spend 6+ months out of the country (or is it 3?) and you're out of the NHS coverage (I'm not going to debate the actual application of this rule as we've been there and done that). If you return you're back in but have to serve a waiting period (again I'm unsure if it's 3 or 6 months). There is no option to buy back in, it's a resident system not premium payment system. If a foreigner joins their partner via visa they must make a lump sum payment to the system.

End of the day, given the flow of folk in and out of the country it's understandable the rule they've made otherwise the system would simply be screwed ( even more than present) and the reimbursement would greatly reduce making it a redundant system.

I totally get the point that folk are unhappy at having to make up payments for a service they didn't get, and wish they'd scrub that based on certain criteria (I.e. maximum repayment amount and waiting period) but the system is designed for 'normal ' situation and certain folk are simply collateral damage. 

In short, I agree with the basic backbone of the current system but think some tweaks could be made to fine-tune certain elements. 

 

[CebuAndy]

I always do my best to forget western logic, common sense and accept the often strange ways they do things here in Asia.

However .... to pay nearly 1,000 $ to continue membership, when only get a tiny 30-35% discount at hospitals according to expat friends, it's beyond stupid to continue then, isn't it?

Back in my country our health care system cover 100% - same do my commercial insurance policy. While philhealth just cover 1/3 in many cases, and lack any flexibility.

I accept to disagree with some, and continue only with my commercial insurance company.

[Mike J]

2 hours ago, CebuAndy said:

Can you name 1 commercial insurer in country, that DOES NOT CANCEL any policy that wasn't paid shortly after due date, except Philhealth?

Link please.

Perhaps my post was not clear.  I was referring to single payer government type insurance.  USA - Medicare, Philippines - PhilHealth, European Health Insurance, etc., not commercial insurance which cancels for nonpayment.   Single source government insurance, often referred to as Universal Coverage, all require (to the best of my knowledge) members to pay any missed fees if they want their coverage back.   By law they have to allow coverage to citizens, it only makes sense that they cannot have people popping in and out of coverage based on current health.  I am not suggesting that is what you are doing.  I am saying that is what people will do if they did not have to pay missed premiums.  

[OnMyWay]

10 hours ago, CebuAndy said:

 

"Get restarted for free" are something you made up yourself. Kindly read my post again. I never said that.

HERE's my first paragraph:

Quote: Been overseas 2+ years, so when I return, if I want to continue PhilHealth do I have to catch up and pay for the time I was away? End quote.

Normally a commercial insurance company would replied like this:

"due to lack of payment of premium, your policy was cancelled when payment was due and not received within 14-30 days. You are welcome to apply again for a new policy and make first payment of premium according to the options we have. You will not be able to take advantage of your new policy the first 90 days, as are standard for all customers.

Example: Sign up 1 january and make payment. Claims will be covered from 1 April onwards.

No sane person pay for a service he couldn't take advantage of during 2+ years when overseas. Commercial insurance understand this and cancel policy - Philhealth don't and in the end they lose customers.

Compare philhealth vs commercial insurance companies in the country, and also all other aspect like coverage percentage and premium. Steep increase of premiums in Philhealth from year 2024, Philhealth will become a thing of the past anyway.

Don't have further to reply to your post when you put ideas into your post, that I never wrote.

I did not misquote you.   I said "For instance" to describe a scenario where allowing people to opt out then opt back in would not work.   Others also described why.

Although Philhealth doesn't pay a lot it does help keep hospital bills down.  They review the bills and have some caps on costs.  

"No sane person pay for a service he couldn't take advantage of during 2+ years when overseas.". I guess I'm insane for paying my U.S. Medicare every month while living in the Philippines.  It's called "insurance". 

https://www.investopedia.com/terms/i/insurance.asp

[CebuAndy]

1 hour ago, OnMyWay said:

I did not misquote you.  

 ....