Question & AnswerQ&A (Republic Act No. 10606)
The short title is the National Health Insurance Act of 2013.
The policy is to adopt an integrated and comprehensive approach to health development to make essential goods, health and social services available to all at an affordable cost and to provide free medical care to paupers.
Legal dependents include children, spouse, parents who are 60 years or older with low income, and parents with permanent disability totally dependent for subsistence on the member.
An indigent is a person who has no visible means of income or whose income is insufficient for the subsistence of his family, identified by the Department of Social Welfare and Development (DSWD) based on specific criteria.
A Lifetime Member is a former member who has reached retirement age under the law and has paid at least 120 monthly premium contributions.
Yes, all citizens of the Philippines are mandatorily covered by the National Health Insurance Program.
Minimum benefits include inpatient hospital care (room and board, health professional services, diagnostic tests, surgical equipment use, prescription drugs), outpatient care, emergency and transfer services, and other cost-effective services determined by the Corporation and the DOH.
Retirees and pensioners of SSS and GSIS prior to the effectivity of this Act and Lifetime Members need not pay monthly contributions.
PHIC supervises health benefits, sets standards, negotiates contracts with providers, inspects facilities, manages health insurance funds, maintains electronic databases, conducts information campaigns, imposes penalties for violations, and performs other acts for program enforcement.
Violations by providers may lead to fines from P50,000 to P100,000, suspension of accreditation for three months up to the full term, or permanent revocation of accreditation for recidivists.
Members committing violations may be fined not less than P5,000 or suspended from NHIP benefits for not less than three months but not more than six months, or both.
Employers are fined at least P5,000 multiplied by the total number of employees, and failing to remit contributions within 30 days is presumed misappropriation.
Sponsored members include orphans, abandoned minors, out-of-school youths, PWDs, senior citizens, and others under DSWD care with premium contributions paid by DSWD, LGUs, or other sponsoring entities.
Yes, LGUs provide basic health services, invest capitation payments in health infrastructure, and may fully fund premiums of barangay health workers and volunteers.
Applicants must submit proof or certificate of PhilHealth premium payments before issuance or renewal, overriding any conflicting laws.