Law Summary
Excluded Personal Health Services
Certain services are excluded from coverage unless actuarially studied and approved by the Board:
- Non-prescription drugs and devices
- Alcohol abuse or dependency treatment
- Cosmetic surgery
- Optometric services
- Fifth and subsequent normal obstetrical deliveries
- Cost-ineffective procedures designated by the Corporation Actuarial studies must be conducted within three years and periodically reviewed to ensure financial sustainability for inclusion.
Board of Directors Composition and Governance
The Corporation is governed by a Board consisting of:
- Secretaries of Health, Labor, Interior, Social Welfare or their representatives
- President of the Corporation
- Representatives from labor, employers, health care providers, SSS, GSIS, basic sector, Filipino overseas workers, and self-employed The Secretary of Health is ex officio Chairperson; the Corporation’s President is Vice Chairperson.
Appointment and Terms:
- Appointed by the President upon recommendation and consultation
- Terms last four years, renewable once, except for ex-officio members
- Vacancies filled similarly with unexpired term only
Meetings:
- At least monthly regular meetings
- Special meetings called by Chairperson or majority
- Majority presence constitutes quorum
Allowances:
- Per diems given for attendance consistent with budget and law.
Payment of Indigent Contributions
- Indigent contributions are partially subsidized by the member’s local government unit (LGU).
- The Corporation matches the LGU subsidy.
- For lower-income municipalities (4th to 6th class), the National Government subsidizes up to 90% of the indigent contributions until upgraded.
- LGU share is progressively increased to equal the National Government’s share.
Accreditation Eligibility for Health Care Providers
- Providers operating at least three years are eligible to apply for accreditation.
- Providers with less than three years may qualify if:
- The managing health professional has three years’ experience in an accredited institution,
- They operate as a tertiary facility or equivalent,
- They serve areas lacking adequate accredited providers,
- Or meet other Corporation-defined criteria.
Penal Provisions for Employer Violations
- Failure or refusal to deduct or remit employee contributions results in:
- A fine of P500 to P1,000 multiplied by number of employees
- Imprisonment of 6 months to 1 year
Congressional Oversight and Review
- Congress shall conduct regular reviews of the Program’s performance and impact.
- Reviews are conducted by relevant Senate and House Committees.
- Studies to validate achievements will be undertaken by the National Economic and Development Authority, with the National Statistics Office and University of the Philippines’ National Institutes of Health.
- Funding for studies comes from PhilHealth income.
Separability Clause
- If any provision is declared unconstitutional or invalid, unaffected provisions remain effective.
Repealing Clause
- Existing inconsistent laws, decrees, orders, and regulations are repealed, amended, or modified.
Effectivity
- The Act takes effect 15 days after publication in at least three national newspapers.