Question & AnswerQ&A (PHILHEALTH CIRCULAR NO. 0003, S. 2014)
The No Balance Billing policy prohibits charging indigent patients any fees or expenses beyond the packaged rates paid by PhilHealth, ensuring they receive necessary services and complete quality care without out-of-pocket expenses.
Eligible patients include members and dependents categorized as Indigent (no visible or insufficient income), Sponsored (with contributions paid by an individual or government agency), Household Help as defined in RA 10361, and Group Gold members under existing Group Policy Contracts until their expiration.
NBB covers all case-based payments including standardized case rates, specific disease packages such as Leptospirosis, TB-DOTS, Outpatient Malaria, Animal Bite Treatment, Voluntary Surgical Contraception, Outpatient HIV/AIDS Treatment, SARS, Avian Influenza, and Intrauterine device (IUD) insertion among others.
All accredited government health care institutions including hospitals and various health facilities, and specific private facilities contracted for certain packages like Z Benefit Packages, ambulatory surgical clinics, freestanding dialysis centers, TB DOTS centers, birthing homes, and infirmaries/dispensaries under certain conditions.
Institutions must provide preferential access to social welfare funds for NBB patients, ensure complete and quality medical care without denying services, absorb the cost of medications or services when externally sourced, and not charge professional fees to NBB patients.
Verification must be done prior to admission through the Institutional Health Care Provider Portal, presentation of Member Data Record, PhilHealth Number Card, or Pantawid Pamilyang Pilipino Program ID, or through coordination with PhilHealth CARES or Local Health Insurance Offices.
Salaried physicians are prohibited from charging additional professional fees to NBB patients. Non-salaried physicians (consultants) cannot charge additional fees for patients admitted in ward-type accommodations.
Violations are dealt with under existing laws including RA 7875 as amended, PhilHealth's performance commitment terms, and may include sanctions imposed through validation visits, post-audit findings, and possible legal actions according to pertinent provisions.
PhilHealth conducts regular monitoring and post-audits of facilities, carries out exit interviews with patients, validates reports of violations through home visits, and processes complaints via PhilHealth CARES, corporate hotlines, and electronic communications.
Qualified NBB patients are covered for ward-type accommodations under the NBB policy. If ward accommodations are unavailable, providers must offer the next higher accommodation at no additional cost. Private accommodations are not covered by the NBB policy if chosen by the patient.