QuestionsQuestions (PhilHealth Circular No. 003-2015)
It is issued pursuant to Section 18(d) of the Revised Implementing Rules and Regulations (RIRR) of the National Health Insurance Act of 2013, particularly on the payment of premium contributions.
The employer becomes liable for reimbursement of payment of a properly filed PhilHealth claim when the concerned employee or qualified dependents avail of Program benefits, without prejudice to other penalties under the Rules.
It applies to claims duly paid by PhilHealth that are properly filed for employed members and/or their qualified dependents but without qualifying contributions.
PhilHealth may recover claim payments, including unpaid premiums, plus all applicable interests and/or penalties.
The claim must be properly filed and duly paid, but the employee/dependent availed benefits without qualifying contributions due to the employer’s failure to remit and/or report the proper contributions.
An employer who missed payment of monthly contributions for all its employees for at least one (1) month within a period of six (6) months.
Delinquent employers missed payments for at least one month within a six-month period for all employees, while under-remitting employers remitted less than the prescribed premium and/or failed to include all employees.
An employer who remitted and reported contributions for all its employees in an amount less than the premium prescribed by PhilHealth and/or employers who remitted the prescribed amount but did not include all employees.
An employer who has not remitted any premium contributions since the start of operations or has not paid any premium contributions for six (6) months or more.
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 a six (6) month period.
Section 178 (Failure or Refusal to Register/Deduct Contributions) and Section 179 (Failure or Refusal to Remit Contributions) are referenced.
A fine of not less than Five Thousand pesos (Php5,000.00) multiplied by the total number of employees of the firm.
A fine of not less than Php5,000.00 but not more than Php10,000.00 multiplied by the total number of employees of the firm.
After collecting or deducting monthly contributions due from employees, the employer/officer who fails or refuses to remit the contributions within thirty (30) days from the date they become due shall be penalized.
Yes. It specifically applies to claims duly paid for properly filed employee-member and/or qualified dependent claims, but without qualifying contributions.
Failure to comply authorizes PhilHealth to pursue appropriate legal action(s) against delinquent, under-remitting, non-remitting, and/or non-reporting employers.
It took effect fifteen (15) days after its publication in a newspaper of general circulation and was deposited with the National Administrative Register at the University of the Philippines Law Center.
All provisions of previous issuances which are consistent and were not affected by the Circular remain in full force and effect.