Constitutional and statutory rationale
- Section 11, Article XIII of the 1987 Constitution requires the State to adopt an integrated and comprehensive approach to health development to make essential goods, health, and other social services available to all at affordable cost.
- Republic Act 7875 institutes the National Health Insurance Program (NHIP) and provides the statutory basis for health insurance coverage.
- The circular implements coverage for barangay officials, personnel, and volunteers under the formal or employed sector of the NHIP.
- The circular is tied to arrangements made through DILG Memorandum Circular No. 2002-66 on enrollment of barangay officials, personnel, and volunteers into NHIP.
Coverage persons and roles covered
- The guidelines prescribe coverage for the following barangay officials and personnel:
- Punong Barangay.
- Seven (7) Sangguniang Barangay Members.
- Sangguniang Kabataan Chairperson.
- Barangay Secretary.
- Barangay Treasurer.
- Coverage extends to the Lupong Tagapamayapa.
- Coverage extends to Barangay Tanod Brigades.
- Coverage extends to Other Barangay Volunteers.
Legal character of barangay officials and personnel
- Barangay officials are treated as public officials/employees under Section 2(d) of Republic Act No. 8291 (New GSIS Act), covering a person receiving compensation by election or appointment, including barangay officials.
- The circular applies the definition of government coverage under Rule 1, Section 1 of the Implementing Rules and Regulations of Republic Act No. 6713, which covers all officials and employees in government, elective and appointive, permanent or temporary, whether career or non-career service, including personnel whether or not they receive compensation regardless of amount.
- The circular ties barangay roles to barangay governance under the Local Government Code of 1991 (Republic Act No. 7160), including:
- Section 387 on the composition of barangay officials and inclusion of Lupong Tagapamayapa.
- Section 388 classifying certain barangay volunteers/tanods as persons in authority in their jurisdictions and as agents of persons in authority for maintenance of public order, protection, and security of life and property.
- Section 396 on appointive barangay officials governed by the Local Government Code and other laws or ordinances.
Enrollment scheme and premium classification
- Barangay officials, Lupong Tagapamayapa, barangay tanods, and volunteers are covered under the Medicare for the Employed Government Sector, with the barangay as LGU-employer.
- Persons receiving income of less than P3,500 are covered under the Medicare for the Employed as Bracket 1 of the approved NHIP Monthly Premium Contribution Schedule for the formal sector.
- Persons receiving income of P3,500 and above must pay the corresponding counterpart reflected in Annex “A”.
- The premium income ceiling of P3,500 is subject to any changes as may be prescribed by the PhilHealth Board.
Enrollment procedures and required submissions
PhilHealth informs the barangay (LGUs) of the guidelines for coverage of barangay officials and personnel under NHIP, in coordination with the Department of Interior and Local Government (DILG).
The barangay (LGU) adopts NHIP coverage by passing an Ordinance (Annex “C”) specifying the allocation of funds for enrollment using barangay funds.
Barangay enrollment submissions to PhilHealth include the following:
Employee Data Record requirements
- M1a Form (Annex “D.1”) is accomplished in duplicate copies by barangay officials, personnel, and volunteers not yet registered with PhilHealth, regardless of sector (Individually Paying, Non-Paying and Formally Employed Sector).
- Those declaring dependent/s must submit applicable supporting documents required under Section 10 of the Revised Implementing Rules and Regulations of R.R. 7875.
- M2 Form (Annex “D.2”) is accomplished in duplicate copies by those already registered in other sectors (Individually Paying and Non-Paying Members) and who have an existing PhilHealth Identification Number (PIN).
- M2 Form is used to request change of sector for the individually paying member and to update other member data records if needed.
- Persons classified as Non-Paying prior to serving the barangay must remain classified under the Non-Paying sector.
- Barangay officials/personnel previously registered in the employed sector before joining the barangay must accomplish M2 Form to reflect change of employer and update other member data records if needed.
Employer Data Record requirement
- ER1 Form (Annex “E”) is accomplished by the barangay, as employer, or its authorized representative only if the barangay is NOT yet registered with PhilHealth.
Report of Employee Members requirement
- ER2 Form (Annex “F”) is accomplished by the barangay, as employer, in duplicate copies, enumerating and certifying the employees included in the submitted M1a Form.
- ER2 must be signed by the Punong Barangay or its duly authorized representative.
Billing statements and when they issue
- Billing statements are issued only when there are arrears, under-remittance, or no-remittance of premium contribution by the barangay-employer.
- Billing statements follow Office Order No. 54, s. 2002 and PhilHealth Circular No. 15, s. 2002.
- The billing references use Annex “G.1”, “G.2” and “G.3”.
Premium sharing, remittance, and payment deadline
- Premium payments for the formal sector are shared between:
- the barangay as employer, and
- the barangay official/personnel as employee.
- The premium payment equivalent to the Employer Counterpart is sourced from barangay funds.
- The barangay may opt to shoulder the entire premium contribution when expressly provided for in a Barangay Ordinance.
- The LGU-employer must remit to PhilHealth the total monthly premium contribution through various PhilHealth accredited banks.
- Payment is due on the 10th day following the applicable month.
Monitoring, reporting, and evaluation duties
Barangay quarterly implementation reports
- Barangays must submit a quarterly report of program implementation using the Quarterly PhilHealth Monitoring Report Form (Annex “H”) to the National Barangay Operations Office (NBOO) of DILG.
- The report is copy furnished to the concerned PhilHealth Regional Office (PRO).
- These barangay reports are included in the regular reports submitted by PROs to PhilHealth Central Office.
Barangay quarterly remittance reporting
- Barangays must accomplish and submit an Employer’s Quarterly Remittance Report using the RF1 Form (Annex “I”) every quarter ending March, June, September, and December.
- The RF1 submission is made together with the corresponding copies of the validated ME-5.
- For NCR payors, the validated documents are submitted to the Contributions and Accounts Management Department.
- For payors outside NCR, the validated documents are submitted to Philhealth regional offices or service offices.
- Submission is due on the 15th day of the month following the applicable quarter.
DILG field officer functions
- DILG field officers consolidate quarterly program implementation reports of covered barangays for submission to regional/central offices.
- DILG field officers maintain a masterlist of covered barangay officials based on RFI Form and update it in coordination with PhilHealth.
- DILG field officers assist NBOO in program evaluation in coordination with PhilHealth.
PhilHealth program evaluation
- The Program Management Group of PhilHealth regularly conducts program implementation evaluation in coordination with the National Barangay Operations Office (NBOO) of DILG.
Existing rules for other enrollment schemes
- Enrollment of barangay officials and volunteers under the Indigent Program or the Individually Paying Program is governed by existing rules and/or separate issuances promulgated by PhilHealth.
Effectivity
- The circular takes effect immediately.