Question & AnswerQ&A (ADMINISTRATIVE ORDER NO. 2018-0001)
All classified indigent patients in non-private or service settings in all PhilHealth-accredited government health care providers are entitled to No Balance Billing under this Order, which includes sponsored members, household help members, senior citizens, and indigents.
This Order applies to all PhilHealth-accredited health care providers catering to patients in non-private or service settings and all offices of DOH, PhilHealth, PCSO, and DSWD, excluding full complementation packages.
Case Rates refer to a payment scheme where a standard, pre-determined rate with a professional fee component is reimbursed to a healthcare facility for each episode of care provided to a patient.
Direct medical expenses shall be augmented by the Philippine Charity Sweepstakes Office (PCSO) and the Department of Health (DOH) Medical Assistance to Indigent Patients Program (MAIP), after PhilHealth's coverage under case rates and Z benefits.
The Department of Social Welfare and Development (DSWD) is responsible for covering non-medical expenses such as transportation costs, accommodation, and meals through its Assistance to Individual in Crisis Situations (AICS) program.
A Malasakit Center is an area within government health care facilities where various funding sources like PCSO ASAP desks and DOH MAIP desks are housed to streamline the process for patients in availing financial medical assistance.
If there are no available beds in non-private or service accommodation, the patient must be admitted to the next available private accommodation but still be charged at the hospital’s service (non-private) rates, assuring no additional out-of-pocket payments for NBB patients.
Complaints must be lodged through the Citizens’ Complaint Hotline 8888 and must include the complainant's name and address, name of offender/institution, a direct and concise statement of the offense, and the agency to which the relief is sought for action to be taken.
Patients who provide false information or misrepresent to unjustly avail benefits shall be denied future assistance and may face criminal or administrative charges. Healthcare providers who violate provisions causing unjustified claims can face administrative, civil, or criminal charges. Late filing or non-compliance to claims rules may also merit sanctions.
The order of charging is: first PhilHealth (case rates and Z benefits), second private health insurance if applicable, third mandatory discounts, fourth PCSO funds (EFP and IMAP), fifth DOH MAIP support, and lastly the healthcare provider’s MOOE/income as Quantified Free Services (QFS) for any remaining balance.
Patients who are PhilHealth and NBB eligible shall be assessed prior to availing services and provided with complete information about costs. The health care provider and medical social worker facilitate the upfront coverage by all involved funding sources with no direct reimbursement given to patients, ensuring zero out-of-pocket payments.
DOH leads implementation in DOH-licensed hospitals and supervises medical social workers; PhilHealth provides guidelines, case rate data, and manages data consolidation; PCSO funds the medical assistance programs and partners for ASAP desks; DSWD provides assistance through AICS to support NBB for non-medical expenses.
Administrative Order No. 2018-0001 repeals, amends, or modifies inconsistent provisions of Administrative Order 2017-0003 on the Guidelines for the Implementation of the 2017 Medical Assistance Program (MAP) in government hospitals and selected facilities, but leaves unaffected provisions valid and in effect.
Agencies shall enter into non-disclosure agreements (NDAs) when necessary for sharing sensitive and/or confidential data to support the implementation and monitoring of this policy, including fraud detection and sanctions enforcement.