Question & AnswerQ&A (EXECUTIVE ORDER NO. 192)
The main purpose of Executive Order No. 192 is to transfer the regulation and supervision over Health Maintenance Organizations (HMOs) from the Department of Health (DOH) to the Insurance Commission (IC) to streamline regulation, eliminate redundancy, and improve efficiency.
Under Article VII, Section 17 of the Philippine Constitution, the President has the power and control over executive departments, bureaus, and offices and the continuing authority to reorganize them.
An HMO is defined as a juridical entity legally organized to provide or arrange for the provision of pre-agreed or designated health care services to its enrolled members for a fixed pre-paid fee for a specified period of time.
The IC exercises functions such as issuing rules and guidelines on capitalization and qualifications, approving or revoking licenses, assessing fees, regulating operations, ordering examinations, imposing penalties, deputizing law enforcement, and formulating policies related to HMOs.
The Insurance Commission can approve, amend, renew, decline, suspend, or revoke any license, registration, or certificate of authority issued in favor of HMOs and requires all HMOs to procure a License to Operate from the IC.
Funds needed to carry out the provisions of the Order shall be taken from the current appropriations of the Insurance Commission, with subsequent funding requirements included in the IC’s annual budget proposals.
The DOH and IC may enter into inter-agency agreements, temporarily detail DOH personnel to the IC, and transfer all HMO-related documents, records, and pending matters to facilitate efficient transition.
The Oversight Committee is composed of the Secretary of Finance as Chairman, with the Secretary of Health and the Insurance Commissioner as members, tasked to ensure effective transfer of jurisdiction over HMOs to the IC until June 30, 2016.
All HMOs, whether investor-based, community-based, or cooperative, are required to comply with obtaining the License to Operate from the IC.
DOH personnel affected shall continue their service with the DOH but may be detailed to the IC temporarily for an efficient transition and effective discharge of functions related to HMO regulation.