Question & AnswerQ&A (Republic Act No. 10606)
The short title is the National Health Insurance Act of 2013.
The State adopts an integrated and comprehensive approach to health development, providing essential goods and health services at affordable cost and free medical care to paupers, with priority to the underprivileged, sick, elderly, PWDs, women and children.
Dependents include legal dependents such as children, parents aged 60 and above with low income, and parents with permanent disability dependent on the member for subsistence.
An indigent is a person with no visible means of income or whose income is insufficient for family subsistence, identified by DSWD based on specific criteria.
All citizens of the Philippines are mandatorily covered under the Program irrespective of existing LGU-based health insurance programs.
Members and dependents are entitled to inpatient hospital care, outpatient services, emergency and transfer services, and other health care services as determined appropriate and cost-effective by the Corporation and DOH.
Penalties include fines from Php 50,000 to Php 100,000, suspension of accreditation from 3 months to the term of accreditation, or both, with recidivists disqualified permanently from accreditation.
Members must have paid premium contributions for at least three months within six months prior to availment, with contributions made regularly.
The Board includes Secretaries of Health, Labor and Employment, Interior and Local Government, Social Welfare and Development, Finance, President and CEO of the Corporation, Administrators of SSS and GSIS, representatives of various sectors including migrant workers, informal and formal economy members, employers, health care providers, elected local chief executives, and an independent director.
Mechanisms include fee-for-service, capitation, case-based payment, global budget, and other payment methods determined by the Corporation.
The national government fully subsidizes the premium contributions of indigents as identified by DSWD.
Complaints are filed with the Corporation, referred to the Grievance and Appeal Review Committee which must resolve within 60 days; appeals from its decision must be filed with the Board within 30 days.
LGUs shall provide basic health care services, invest capitation payments in infrastructures, professional fees, drugs and IT, and maintain these funds in a special trust fund for mandated purposes.
Composed of member contributions, government appropriations, donations, and accruals; its management adheres to public fund rules, with investment limits and provisions for reserve and special funds managed under actuarial sound principles.
Employers face fines of not less than Php 5,000 multiplied by the total number of employees, and are presumed to have misappropriated funds if they fail to remit deductions within 30 days of due date.