Article 76Labor and Agrarian Laws and Social Legislation, p. 76

LABOR LAWS AND SOCIAL LEGISLATION SPECIAL LAWS AND IMPLEMENTING RULES AND REGULATIONS

h) Devolution — The Program shall be implemented in

consultation with local government units (LGUs), subject

to

the

overall

policy

directions set by the National

Government;

i) Fiduciary Responsibility — The Program shall provide

effective

stewardship,

funds

management,

and

maintenance of reserves;

j) Informed Choice — The Program shall encourage

members to choose from among accredited health care

providers. The Corporation's local offices shall objectively

apprise

its

members

of

the full range of providers

involved in the Program and of the services and privileges

to which they are entitled as members. This explanation,

which the members may use as a guide in selecting the

appropriate and most suitable provider, shall be given in

clear and simple Filipino and in the local languages that

is comprehensible to the member;

k) Maximum Community Participation — The Program

shall

build

on

existing

community

initiatives for its

organization and human resource requirements;

l) Compulsory Coverage — All citizens of the Philippines

shall

be

required

to

enroll

in

the

National

Health

Insurance Program in order to avoid adverse selection

and social inequity;

m) Cost Sharing — The Program shall continuously

evaluate its cost sharing schedule to ensure that costs

borne by the members are fair and equitable and that the

charges by health care providers are reasonable;

n) Professional Responsibility of Health Care Providers —

The Program shall assure that all participating health care

providers are responsible and accountable in all their

dealings with the Corporation and its members;

o) Public Health Services — The Government shall be

responsible for providing public health services for all

groups such as women, children, indigenous people,

displaced

communities

and

communities

in

environmentally endangered areas, while the Program

shall focus on the provision of personal health services.

Preventive

and promotive public health services are

essential

for

reducing

the

need

and

spending

for

personal health services;

p) Quality of Services — The Program shall promote the

improvement in the quality of health services provided

through the institutionalization of programs of quality

assurance at all levels of the health service delivery

system. The satisfaction of the community, as well as

individual beneficiaries, shall be a determinant of the

quality of service delivery;

q) Cost Containment — The program shall incorporate

features of cost containment in its design and operations

and provide a viable means of helping the people pay for

health care services; and

r) Care for the Indigent — The Government shall be

responsible for providing a basic package of needed

personal health services to indigents through premium

subsidy, or through direct service provision until such

time that the program is fully implemented.

SECTION 3. General Objectives . — This Act seeks to:

a)

provide

all

citizens

of

the

Philippines

with

the

mechanism to gain financial access to health services;

b)

create

the

National

Health

Insurance

Program,

hereinafter referred to as the Program, to serve as the

means to help the people pay for health care services;

c) prioritize and accelerate the provision of health services

to all Filipinos, especially that segment of the population

who cannot afford such services; and

d) establish the Philippine Health Insurance Corporation,

hereinafter

referred

to

as

the Corporation, that will

administer the Program at central and local levels.

ARTICLE II Definitions of Terms

SECTION 4. Definitions of Terms . — For the purpose of

this Act, the following terms shall be defined as follows:

a) Beneficiary — Any person entitled to health care

benefits under this Act.

b) Benefit Package — Services that the Program offers to

its members.

c) Capitation — A payment mechanism where a fixed

rate, whether per person, family, household, or group, is

negotiated with a health care provider who shall be

responsible for delivering or arranging for the delivery of

health services required by the covered person under the

conditions of a health care provider contract.

d) Contribution — The amount paid by or in behalf of a

member to the Program for coverage, based on salaries

or wages in the case of formal sector employees, and on

household

earnings

and

assets,

in

the

case

of

self-employed, or on other criteria as may be defined by

the

Corporation

in

accordance

with

the

guiding

principles set forth in Article 1 of this Act.

e) Coverage — The entitlement of an individual, as a

member or as a dependent, to the benefits of the

Program.

f) Dependent — The legal dependents of a member are: 1)

the legitimate spouse who is not a member; 2) the

unmarried

and

unemployed

legitimate,

legitimated,

illegitimate, acknowledged children as appearing in the

birth certificate; legally adopted or stepchildren below

twenty-one

(21)

years

of

age;

3)

children

who

are

twenty-one (21) years old or above but suffering from

congenital disability, either physical or mental, or any

disability acquired that renders them totally dependent

on the member of our support; (4) the parents who are

sixty (60) years old or above whose monthly income is

below an amount to be determined by the Corporation in

accordance with the guiding principles set forth in Article

I of this Act; and (5) parents with permanent disability

that render them totally dependent on the member for

subsistence. (National Health Insurance Act of 2013,

Republic Act No. 10606, [June 19, 2013])

g) Diagnostic Procedure — Any procedure to identify a

disease or condition through analysis and examination.

h)

Emergency

—

An

unforeseen

combination

of

circumstances

which

calls

for

immediate

action

to

preserve the life of a person or to preserve the sight of

one or both eyes; the hearing of one or both ears; or one

or two limbs at or above the ankle or wrist.

i) Employee — Any person who performs services for an

employer in which either or both mental and physical

efforts are used and who receives compensation for such

services,

where

there

is

an

employer-employee

relationship.

j) Employer — A natural or juridical person who employs

the services of an employee.

k) Enrollment — The process to be determined by the

Corporation in order to enlist individuals as members or

dependents covered by the Program.

l)

Fee

for

Service

—

A

fee

pre-determined by the

Corporation for each service delivered by a health care

provider based on the bill. The payment system shall be

based on a pre-negotiated schedule promulgated by the

Corporation.

(National Health Insurance Act of 2013,

Republic Act No. 10606, [June 19, 2013])

m) Global Budget — An approach to the purchase of

medical

services

by

which

health

care

provider

negotiations concerning the costs of providing a specific

package

of

medical

benefits

is

based

solely

on

a

predetermined and fixed budget.

n)

Government

Service

Insurance

System

—

The

Government Service Insurance System created under

Commonwealth Act No. 186 , as amended.

o) Health Care Provider — Refers to:

© Compiled By RGL

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