Question & AnswerQ&A (Republic Act No. 11223)
Republic Act No. 11223 shall be known as the "Universal Health Care Act".
Every Filipino citizen shall be automatically included into the NHIP.
The Act seeks to progressively realize universal health care through a systemic approach and clear delineation of roles of key agencies and stakeholders, and to ensure that all Filipinos have equitable access to quality and affordable health care and are protected against financial risk.
Primary care refers to initial-contact, accessible, continuous, comprehensive, and coordinated care that is accessible at the time of need, including a range of services for all presenting conditions and the ability to coordinate referrals to other health care providers when necessary.
Preventive, promotive, curative, rehabilitative, and palliative care for medical, dental, mental, and emergency health services, delivered either as population-based or individual-based health services.
No co-payment shall be charged for services rendered in basic or ward accommodation, but co-payments and co-insurance for amenities in public hospitals shall be regulated by the DOH and PhilHealth.
They shall be punished by a fine of Two hundred thousand pesos (P200,000.00) for each count, suspension of contract up to three (3) months or the remaining contract period, or both, and criminal liability including imprisonment for six (6) months and one (1) day up to six (6) years, at the discretion of the court.
No more than seven and one-half percent (7.5%) of the actual total premium collected from direct and indirect contributory members during the immediately preceding year shall be allotted for administrative costs.
The Board has a maximum of thirteen (13) members: five ex-officio members (Secretaries of Health, Social Welfare and Development, Budget and Management, Finance, Labor and Employment), three expert panel members, and five sectoral panel members representing direct contributors, indirect contributors, employers, health care providers, and elected local chief executives.
The HTAC facilitates financing and coverage recommendations, oversees and coordinates the HTA process within DOH and PhilHealth, reviews and assesses existing benefit packages, and conducts transparent and evidence-based health technology assessments to guide policy and program development.
Emergency refers to a condition where, based on objective findings of a prudent medical officer, there is immediate danger and delay in treatment could cause loss of life, permanent disability, permanent injury or loss of unborn child, or in the case of a non-institutional delivery.
Appropriations come from total incremental sin tax collections, fifty percent of PAGCOR's national government share, forty percent of PCSO's charity fund, premium contributions of members, annual appropriations of the DOH, and the national government subsidy to PhilHealth included in the GAA.
The Special Health Fund pools and manages all resources intended for health services to finance population-based and individual-based health services, health system operating costs, capital investments, remuneration of health workers, and incentives.
They face fines of Fifty thousand pesos (P50,000.00) per affected employee or imprisonment of six (6) months up to one (1) year, or both, and officers responsible may be held liable. Unlawful deductions of employer contributions from employee compensation are punishable by a fine of Five thousand pesos (P5,000.00) multiplied by total affected employees or imprisonment, or both.
The Secretary of Health is an ex officio nonvoting Chairperson of the PhilHealth Board.
The DOH will transform its Health Promotion and Communication Service into a full-fledged Health Promotion Bureau to improve health literacy and mainstream health promotion and protection; schools under the Department of Education are designated as healthy settings, and local government units are directed to enact ordinances promoting health literacy and healthy lifestyles.