Implementing Rules and Regulations of Republic Act 7875 As ...

1 Implementing Rules and Regulations of Republic Act 7875 As Amended Otherwise Known As the National Health Insurance Act of 2013 Implementing Rules and Regulations of Republic Act 7875 As Amended Otherwise Known As the National Health Insurance Act of 2013 Implementing Rules and Regulations of Republic Act 7875 As Amended Otherwise Known As the National Health Insurance Act of 2013 The Revised Implementing Rules and Regulations of the National Health Insurance Act of 2013(RA 7875 as amended by RA 9241 and 10606)2013 EditionImplementing Rules and Regulations of Republic Act 7875 As Amended Otherwise Known As the National Health Insurance Act of 2013 MESSAGE from the Secretary of Healthand Chairperson of the Board The Aquino government has consistently demonstrated its commitment to Universal Health Care or Kalusugan Pangkalahatan (KP).

2 This priority reform is supported by increasing budget for health as well as the passage of the Sin Tax Reform Law, which will ensure the sustainability of resources for health. Under KP, all Filipinos must be accorded financial risk protection, especially the poor and marginalized. Thus, effective implementation of the National Health Insurance Program is imperative to make universal care a reality in our country. The timely amendment of the National Health Insurance Act of 1995 (RA 7875) with the National Health Insurance Act of 2013 (RA 10606), and its Implementing Rules and Regulations ensures that the aspirations of Kalusugan Pangkalahatan will become a reality. The new Implementing Rules streamlines the PhilHealth membership experience, from assurance of full premium payment for the poor families identified by the Department of Social Welfare and Development to simplify the requirements when availing their benefits.

3 Moreover, the new Rules also established simpler procedures in accrediting health care providers to promote greater access to health services across the country without sacrificing the quality of care. This IRR also highlights the new role of the Local Government Units in Implementing the National Health Insurance Program as well as the enhanced powers of PhilHealth in Implementing the Program. The new IRR will serve as a guidepost in ensuring viability, adequacy and continued responsiveness of PhilHealth towards the achievement of Universal Health Coverage and enhancing the country s performance in achieving the targets for health-related Millennium Development Goals. Through the support of all partners in the health sector, both in government and private sectors, the vision of Bawat Pilipino, Miyembro.

4 Bawat Miyembro, Protektado. Kalusugan Natin Segurado. will soon become a reality. ENRIQUE T. ONAI mplementing Rules and Regulations of Republic Act 7875 As Amended Otherwise Known As the National Health Insurance Act of 2013 MESSAGE from the President and CEO Only recently, President Benigno S. Aquino III, approved and signed into law, Republic Act No. 10606, otherwise referred to as the National Health Insurance Act of 2013 , and thus marked an unprecedented milestone in the annals of the nation s social health insurance program. The new PhilHealth law is the embodiment of government s unwavering commitment to the attainment of Universal Health Care or Kalusugan Pangkalahatan . Some of the law s salient features includes the dramatic shift from premium sharing between the national and local governments to that of full national subsidy of the indigent sector as defined and listed by the DSWD s Listahanan.

5 Having enrolled over million families or more than half of the population in 2014, the government has exhibited its steadfast commitment to the poorest of the poor who shall now be able to avail of quality health care at no or very little cost. Coupled with primary care benefit packages initially intended for them as well, PhilHealth is now investing in the future by providing for preventive health care services so as to lessen the costs of more expensive curative treatments. Priority is also given to the health care needs of the underprivileged, the elderly, persons with disability, abandoned and neglected children including those who are not regularly employed in the informal sector. Coverage being made compulsory, social health protection is now extended to the project based or contractual employees who were previously not considered part of the workforce.

6 Documentary requirements have been reduced to a minimum thus facilitating membership as well as benefit availment procedures. PhilHealth has likewise been periodically upgrading and expanding its benefits to include catastrophic benefit packages. With the all case rate regime and the no balance billing , we not only increase the Corporation s support value to its members but hopefully ascertain that indeed the benefits are impacting on the members themselves, now the focus of our attention. PhilHealth believes that every Filipino should have the opportunity to access quality health care because health is a matter of entitlement and right and not merely a privilege bestowed upon or removed at the whim of others. Thus, with the timely publication and dissemination of the law s Implementing Rules and Regulations (IRR), one that was forged through years of experience and upon valued consultations from concerned stakeholders, the circle is now complete for the full attainment of the promise of Universal Health Care.

7 As PhilHealth moves steadily forward with Kalusugan Pangkalahatan, we are again reminded of our mission statement which succinctly describes what financial risk protection is all about; Bawa t PILIPINO, MIYEMBRO; Bawa t MIYEMBRO, PROTEKTADO; KALUSUGAN Natin, po ang PhilHealth, Mabuhay po ang bansang Pilipinas. ALEXANDER A. PADILLAI mplementing Rules and Regulations of Republic Act 7875 As Amended Otherwise Known As the National Health Insurance Act of 2013 HISTORY The National Health Insurance Program (NHIP) administered by the Philippine Health Insurance Corporation (PhilHealth) was established in 1995 with the passage of Republic Act (RA) 7875. PhilHealth took over the Medicare functions previously administered by the Philippine Medical Care Commission (PMCC) since 1972.

8 PhilHealth s mandate is to provide health insurance coverage to all Filipinos. In 1997, it assumed Medicare functions for government workers from the Government Service Insurance System (GSIS) and a year later, for the private sector workers, which was previously administered by the Social Security System (SSS). In the same year, PhilHealth started the Indigent Program. In partnership with Local Government Units (LGUs), PhilHealth has enrolled millions of families who otherwise have no access to health services. Since then, this program has been at the heart of PhilHealth s program and now forms the bulk of membership. To date, all families in the DSWD s National Household Targeting System for Poverty Reduction (NHTS-PR) are covered by PhilHealth.

9 For 2014, million families are being enrolled through full National Government subsidy. The provision of full National Government subsidy was made possible by an amendment introduced in RA 10606 enacted into law in 2013. In 1999, PhilHealth started covering self-employed and the informal sector and in 2005, PhilHealth assumed Medicare functions from the Overseas Workers Welfare Administration (OWWA) for Overseas Filipino Workers. Now on its 19th year, PhilHealth has improved the way health services are delivered, financed and regulated. It has introduced a primary and catastrophic benefit package as it had shifted to an all case rates system from the previous inflationary and ineffective fee for service which has been in place since Medicare.

10 PhilHealth endeavors to cover the financing of every Filipino s health needs, from preventive primary to hospital care including catastrophic conditions. With Kalusugan Pangkalahatan as the overall sectoral agenda, PhilHealth is committed to en-sure a coordinated and intensified effort towards its end goal of Bawat Pilipino, Miyembro, Bawat Miyembro, Protektado, Kalusugan Natin Segurado . Implementing Rules and Regulations of Republic Act 7875 As Amended Otherwise Known As the National Health Insurance Act of 2013 TABLE OF CONTENTSI mplementing Rules and Regulations of Republic Act 7875 as AmendedOtherwise Known as the National Health Insurance Act of 2013 TITLE IGUIDING PRINCIPLES AND OBJECTIVESS ection 1 Declaration of 2 General IIDEFINITION OF TERMSS ection 3 Definition of IIIMEMBERSHIP AND CONTRIBUTIONSRule ICoverageSection 5 Nature and IIGeneral Provisions Concerning All MembersSection 7 PhilHealth Identification Number and Health Insurance ID 8 Replacement of Health Insurance ID 9 Requirements for Registration of Members and t ion 10 Emancipated Individual of Single 11 Remittance of Premium.