Question & AnswerQ&A (Republic Act No. 9241)
Republic Act No. 9241 amends Republic Act No. 7875 to enhance the National Health Insurance Program for all Filipinos and improve the Philippine Health Insurance Corporation for providing universal health insurance coverage.
A beneficiary is any person entitled to health care benefits under this Act.
Dependents include the legitimate spouse who is not a member; unmarried and unemployed children below 21 years old (including legitimate, illegitimate, adopted, or step-children); children 21 years and above with disabilities that render them totally dependent; and parents 60 years old or above with income below a threshold set by the Corporation.
Excluded services include non-prescription drugs and devices, alcohol abuse or dependency treatment, cosmetic surgery, optometric services, fifth and subsequent normal obstetrical deliveries, and cost-ineffective procedures, unless included after actuarial studies and approval by the Board.
It is composed of key government officials such as the Secretaries of Health, Labor and Employment, Interior and Local Government, Social Welfare and Development; president of the Corporation; representatives of labor, employers, health care providers, Filipino overseas workers, self-employed sector; SSS administrator; GSIS general manager; and Vice Chairperson for the basic sector of the National Anti-Poverty Commission.
A fine ranging from Five hundred pesos (P500) to One thousand pesos (P1,000) multiplied by the number of employees plus imprisonment from six months to one year.
Contributions are partially subsidized by the local government unit where the indigent resides, with counterpart financing by the Corporation, and the national government subsidizes up to 90% for lower-class municipalities until upgraded.
Health care providers operating for at least three years can apply; those operating less than three years can qualify if their managing professional has three years experience in an accredited institution, if they operate as a tertiary facility, serve areas lacking accredited providers, or meet other criteria set by the Corporation.
Congress shall conduct regular reviews of the Program's performance and impact, through legislative committees, with studies undertaken by NEDA, NSO, and NIH-UP funded by PhilHealth income.
Capitation is a payment mechanism where a fixed rate is negotiated with a health care provider, responsible for delivering or arranging health services required by covered persons under a health care provider contract.