Title
Recovery of Payments for Claims Without Contributions
Law
Philhealth Circular No. 003-2015
Decision Date
Feb 27, 2015
PhilHealth Circular No. 003-15 addresses the issue of employers failing to remit health insurance contributions, outlining penalties and reimbursement for non-compliant employers, and granting PhilHealth the authority to take legal action to enforce payment.

Law Summary

Penalties for Failure or Refusal to Register and Deduct Contributions

  • Employers or officers who fail or refuse to register or deduct premium contributions from employees' compensation face fines.
  • Fine amount: Not less than Php5,000 multiplied by the total number of employees in the firm.

Penalties for Failure or Refusal to Remit Contributions

  • Employers or officers who collect or deduct contributions but fail or refuse to remit them within 30 days from due date are subject to fines.
  • Fine range: Php5,000 to Php10,000 multiplied by the total number of employees.

Scope and Application of the Circular

  • Applies to claims paid by PhilHealth for employee-members and their dependents without corresponding qualifying contributions.
  • PhilHealth can recover claim payments, unpaid premiums, plus applicable interests and penalties.
  • Non-compliance permits PhilHealth to initiate legal actions against delinquent or non-complying employers.

Definitions of Employer Non-Compliance Categories

  • Delinquent Employers: Missed payment of monthly contributions for at least one month within six months.
  • Under-remitting Employers: Remit less than the prescribed premium or exclude some employees.
  • Non-remitting Employers: No premium payments since start of operations, or for six months or more.
  • Non-reporting Employers: Registered or unregistered employers who have not submitted reports for at least one month within six months, regardless of contribution remittance.

Legal Effectivity and Preservation of Prior Issuances

  • Circular takes effect 15 days after publication in a newspaper of general circulation.
  • The Circular is deposited with the National Administrative Register at the University of the Philippines Law Center.
  • Previous issuances consistent with this Circular remain valid and enforceable.

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