Question & AnswerQ&A (PhilHealth Circular No. 003-2015)
PhilHealth Circular No. 003-2015 addresses the recovery of payments for properly filed claims by employed members but without qualifying contributions, and the liabilities of employers who fail to remit required premium contributions.
Section 18(d) of the Revised Implementing Rules and Regulations (RIRR) of the National Health Insurance Act of 2013 states that failure of the employer to remit required contributions and submit remittance lists makes the employer liable for reimbursement of properly filed claims.
Under Section 178 of the RIRR, any employer or officer who fails or refuses to register/deduct contributions shall be fined not less than Php5,000 multiplied by the total number of employees.
Section 179 of the RIRR provides a fine of not less than Php5,000 but not more than Php10,000 multiplied by the total number of employees for employers who fail or refuse to remit collected contributions within 30 days of their due date.
This Circular applies to claims paid by PhilHealth for employee-members and/or qualified dependents but without qualifying contributions.
PhilHealth is empowered to recover claim payments, unpaid premiums, and applicable interests/penalties from delinquent, under-remitting, non-remitting, and/or non-reporting employers.
A delinquent employer is one who has missed payment of monthly contributions on behalf of all its employees for at least one month within a period of six months.
An under-remitting employer remits and reports contributions that are less than the prescribed premium or does not include all its employees in the remittance.
A non-remitting employer is one who has not remitted any premium contributions on behalf of its employees from the start of operations or has not paid any premiums for six months or more.
A non-reporting employer is a registered or unregistered employer who may or may not have remitted contributions but has not submitted any reports for at least one month within six months.
The Circular took effect fifteen (15) days after its publication in any newspaper of general circulation.
PhilHealth may pursue appropriate legal action against delinquent, under-remitting, non-remitting, and/or non-reporting employers to recover payments and penalties.