Question & AnswerQ&A (CIRCULAR LETTER NO. 2018-14)
The Insurance Commission has the authority to regulate and supervise HMOs, and to formulate, adopt, and implement rules, regulations, and issuances necessary for the effective implementation of Executive Order No. 192, s. 2015.
The Philippine Association of Health Maintenance Organization Companies, Inc. (PAHMOC) and the Association of Health Maintenance Organizations of the Philippines (AHMOPI) are the two recognized associations.
Complaints filed against HMOs are endorsed to AHMOPI if the HMO is its member, to PAHMOC if the HMO is its member, or handled directly by the Insurance Commission if the HMO is a non-member.
AHMOPI and PAHMOC are authorized to conduct mediation proceedings on complaints endorsed by the Insurance Commission against their HMO members.
Mediation proceedings must be concluded within thirty (30) days from receipt of the complaint endorsement from the Insurance Commission.
The endorsee must file a report and submit necessary documents to the Insurance Commission within five (5) days from the settlement of the complaint.
The endorsee must forward the complaint and all related records to the Insurance Commission within five (5) days from the termination of the mediation conference for appropriate action.
The Insurance Commission, through the Public Assistance and Mediation Division (PAMD), conducts mediation conferences for cases where mediation failed in AHMOPI or PAHMOC.
Yes, complaints against non-member HMOs are handled directly by the Insurance Commission through its Public Assistance and Mediation Division.
The Circular Letter took effect immediately upon its promulgation on January 30, 2018.