SENIOR CITIZENS FUNDING

UPDATE

(for Information/Discussion)

1
 2015 GAA RA 10651
• President’s Veto Message to the special provision of 2015 GAA:
a. In pursuance of our health reform agenda on universal health
coverage, the implementation of additional beneficiaries and
amounts under DOH-OSEC, Special Provision No. 7, x x x
...shall be limited to indigent individuals not yet covered
under NHTS-PR x x x ...in accordance with Section 19 of RA
10606 (National Health Insurance Act of 2013).

b. With respect, however, to senior citizens beneficiaries, the

provision of RA10645 shall be applied..x x x... the additional
beneficiaries authorized under these provisions shall be
funded through the Unprogrammed Fund. In all instances,
the implementing agencies shall ensure that no overlapping
of beneficiaries under the NHIP takes place.

c. Unprogrammed Fund - P10.6B

2
Summary of Required Premium for SC:
Premium
Particulars Enrollees Contributio Amount
n

CY 2014 (Oct-Dec 2014) 3,528,816 600 2,117,289,600

CY 2015 5,435,438 2,400 13,045,051,200

Arrears for 2016 with no premium

2,612,386 2,400 6,269,725,200
allocation
Less: Released Add’l. Gov’t.
(334,368) 2,400 (802,483,200)
Subsidy (Dec. 2016) *

Balance 20,629,582,80

Note: * - Charged from the Continuing Appropriation for CY 2015 (GAA of CY 2015)
 What happened to the Unprogrammed Fund?
Date Particulars
August 5, DOH & PhilHealth joint letter to DBM for the release of 10.6 B
2015 unprogrammed appropriations for DOH pursuant to Special
Provision (12) of 2015 GAA to augment the 2015 Health
Facilities Enhancement Program. ( No mention about the
funding of SC)
August 6, DOH requested DBM the for release of 10.6B for the HFEP
2015 chargeable against the Unprogrammed Fund of CY 2015 GAA.
August 28, DOH letter to DBM clarifying the use of 10.6B: …” ….Senior
2015 Citizens and other indigent individuals not yet covered under
the NHTS-PR are enrolled to PhilHealth through the Point of
Care Enrollment Program, premiums will be paid from the
income of participating government hospitals or the Medical
Assistance Program. Also stated in the letter is DOH
requesting for immediate release of said amount to augment
the 2015 HFEP.
4
 What happened to the Unprogrammed Fund?
Date Particulars
September Based on DOH-PhilHealth request dated August 5, 2015
28, 2015 and DOH letter to DBM dated August 28, 2015, DBM says
that “there shall be no releases required for the health
insurance premiums of the SCs enrolled for CYs 2014-
2015... as both shall covered by POC and MAP.

This is reiterated by the DBM in its May 2, 2016 letter to

PhilHealth saying that “payment of premiums of SCs...
enrolled to the POC will be paid from the MAP.

5
FY 2018 NEP – Executive Review Board
Particulars Amount
Health Insurance Coverage Under The Sin Tax Law:

NHTS (@P2,400/annum) 37,060,440,000

Senior Citizens (@P3,120/annum) 16,958,567,000
Universal Health Coverage: Point-of-Service 3,000,000,000
Sub-total 57,019,007,000
Special Purpose Insurance Coverage :
PAyapa at MAsaganang PamayaNAn 54,034,000
Bangsamoro Program (@P2,400/annum) 54,501,000
Sub-total 108,535,000
Grand Total 57,127,542,000

6
End of Presentation

7
 Benefit Utilization
CY 2016 FILED PAID TOTAL AMOUNT
PATIENT CLAIMS PATIENT CLAIMS
MEMBER 878, 871 1, 590, 700 782, 198 1, 426, 229 16, 188, 230, 694. 42
GOVERNMENT 339, 258 449, 290 294, 631 382, 328 5, 185, 369, 603.66
PRIVATE 539, 549 1, 141, 308 487, 518 1, 043, 831 11, 001, 593, 450.76
NULL 64 102 49 70 1, 267, 640.00

DEPENDENT 33, 437 55, 117 29, 549 48, 490 536, 555, 422.40
GOVERNMENT 15, 259 19, 473 13, 366 16, 723 211, 568, 678.00

PRIVATE 18, 174 35, 638 16, 181 31, 763 324, 929, 404.40
NULL 4 6 2 4 57, 340.00

GRAND TOTAL 912, 308 1, 645, 817 811, 747 1, 474, 719 16, 724, 786, 116.82

14
 Senior Citizen Premium Requirement for 2015
On April 23 and 28, 2015, MMG sent billing statements to the DBM thru the
DOH for the 2015 premium to be charged against the unprogrammed
appropriations of the 2015 GAA. Said appropriation amounted to P10.6 billion
from the increment of Sin Tax collections. The billing statements specified the
following amount:

Particulars Members Premium (PhP)

4Q 2014 arrears for Senior Citizens

3,528,816 2,117,289,600
enrolled as of Dec 31, 2014

2015 premium based on enrolment as

4,212,632 10,110,316,800
of Apr 30, 2015
Total 12,227,606,400

15