What Does The Philhealth 9/12 Rule Entail?

The PhilHealth 9/12 Rule marks a significant adjustment in eligibility requirements for availing of PhilHealth benefits in the Philippines. This rule mandates that members must have paid at least nine (9) months of premium contributions within the preceding twelve (12) months of their hospital confinement request to qualify for full benefits. This development not only emphasizes the importance of consistent and regular premium payments but also seeks to maintain active membership status across the board.

Targeted at all members, with exceptions for sponsored members, land-based OFWs, and indigent members, the rule caters to a broad spectrum of the population, ensuring that a wider range of Filipinos remains covered. Members can expect a need for diligent payment tracking and regular contributions to remain eligible for benefits, underlining the initiative’s goal to bolster a culture of responsibility and proactive health insurance management within the community.

9-12 rule
Credits: Philhealth

What is the PhilHealth 9/12 Rule?

The 9/12 Rule is an important eligibility requirement for availing PhilHealth benefits in the Philippines. To qualify for full benefits during hospital confinement, a member must have completed at least nine (9) months of premium contributions within the twelve (12) months preceding their request for assistance. This rule encourages regular payment of premiums and ensures active membership status. If you have specific questions, consider reaching out directly to the agency or visiting their official website for the most up-to-date information.

The Transition from the Old to the New

Previously, the requirement was for members to have at least three (3) months of contributions within the six (6) months before hospital confinement. However, with the 9/12 Rule, the landscape has shifted. 

As such, members are now required to have nine months of contributions within the last twelve months, including the month of confinement. It’s important to note that these contributions do not need to be consecutive, offering some flexibility to the members.

Legal Grounding

This adjustment is backed by the Republic Act No. 10606, ensuring that members who have shown sufficient regularity in their premium contributions and are in good standing are eligible for benefits. This law underpins the importance of consistent contributions to avail of benefits and emphasizes the commitment to keeping members active and covered.

Who is Affected?

The 9/12 rule is applicable to all members, with specific exemptions for those like sponsored members, land-based Overseas Filipino Workers (OFWs), and indigent members, acknowledging the varied capacities and circumstances of its diverse member base.

Financial Aspects

  • Monthly premium for individual payers remains at Php 200 (for an annual contribution of Php 2,400) and Php 300 (for an annual contribution of Php 3,600), with specified increases for employees, seafarers, and household service workers.

Navigating Eligibility and Contributions

To be eligible under this rule, a member must ensure that they have paid premiums for at least nine months within the immediate twelve-month period before their hospitalization. This includes the month of confinement itself, thereby making regular payment necessary for maintaining eligibility.

Preparing for Compliance: A Step-by-Step Guide

  1. Review Your Payment History: Ensure you have at least nine months of contributions in the last twelve months.
  2. Regular Payment: Make contributions regularly to avoid lapses in coverage.
  3. Check Eligibility: Before any planned hospital visit, verify your eligibility status through the PhilHealth portal or contact centers.
  4. Update Your Information: Ensure your member details are current to avoid processing delays.
  5. Seek Assistance: For any confusion or clarification, reach out to PhilHealth offices or utilize their online platforms for guidance.

A Note on Immediate Compliance

It’s essential for members to understand that same-day settlements of contributions for the purpose of meeting the 9-month requirement will not be honored in cases of immediate confinement. This emphasizes the importance of regular and timely payment of contributions.

Moving Forward

The introduction of the 9/12 Rule signifies a step towards fostering a more responsible and regular payment culture among members, ensuring that everyone remains eligible for the benefits they may need during times of health emergencies. While the adjustment requires a shift in how members manage their contributions, it ultimately aims to strengthen the foundation of health coverage in the Philippines, ensuring that more Filipinos have access to necessary medical services when they need them the most.

This change underscores the need for every member to stay informed and proactive about their health insurance coverage, marking a collective effort towards a healthier and more secure future for all.

PhilHealth Circular No. 2019-0004: A Closer Look

Before and After: A Look at Eligibility Requirements

Initially, as per PhilHealth Circular No. 32, s. 2014, members needed to contribute at least three (3) months within the immediate six (6) months, including the month of confinement, to qualify for PhilHealth benefits. This was the foundation of what was known as the 3/6 rule.

The Concept of Sufficient Regularity

Sufficient regularity in premium contributions was defined as making payments for at least six (6) months before the three (3)-month qualifying contributions within a twelve (12)-month period leading up to the first day of confinement. This approach aimed to ensure members were consistently contributing, thereby establishing eligibility for benefits when needed.

Why Sufficient Regularity Matters

Incorporating sufficient regularity into the eligibility criteria aligns with the mandates of RA 10606. This law ensures that members who consistently contribute can avail themselves of PhilHealth benefits, provided they aren’t facing legal penalties. It’s a move to encourage regularity in contributions among members.

Grace Periods and Shifting Categories

Members transitioning from categories like OFWs, Sponsored, or Indigent memberships to the Informal Economy are given a grace period to adjust. They need to make at least one (1) month’s premium contribution during this period to maintain eligibility, highlighting the flexibility the agency offers to accommodate diverse member situations.

Exemptions to the Rule

Certain member categories, such as indigents, OFWs, and lifetime members, are exempt from the regularity requirement, reflecting the agency’s inclusive approach to coverage. This ensures that all members, regardless of their specific circumstances, have access to the benefits they need.

circ 2019-0004
Credits: Philhealth


Video: Philhealth 9/12 Rule | Philhealth

In this video, Philhealth Representative Mr. Mon Acoba shares important information about the implementation of the “9/12 Rule.” This new policy, which took effect on January 01, 2019, has significant implications for the public. Watch the video to learn more about this important update.


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