Article 77Labor and Agrarian Laws and Social Legislation, p. 77

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

(1) a health care institution, which is duly licensed and

accredited devoted primarily to the maintenance and

operation of facilities for health promotion, prevention,

diagnosis, treatment, and care of individuals suffering

from illness, disease, injury, disability or deformity, drug

addiction or in need of obstetrical or other medical and

nursing care. It shall also be construed as any institution,

building, or place where there are installed beds, cribs, or

bassinets for twenty-four hour use or longer by patients in

the

treatment

of

diseases,

injuries,

deformities,

or

abnormal physical and mental states, maternity cases or

sanitarial

care;

or

infirmaries,

nurseries, dispensaries,

rehabilitation centers and such other similar names by

which they may be designated; or

(2) a health care professional, who is any doctor of

medicine, nurse, midwife, dentist, or other health care

professional or practitioner duly licensed to practice in

the Philippines and accredited by the Corporation; or

(3) a health maintenance organization, which is an entity

that

provides,

offers,

or

arranges

for

coverage

of

designated health services needed by plan members for

a fixed prepaid premium; or

(4) a community-based health care organization, which is

an association of indigenous members of the community

organized for the purpose of improving the health status

of that community through preventive, promotive and

curative health services.

p)

Health

Insurance Identification (ID) Card — The

document issued by the Corporation to members and

dependents

upon

their

enrollment

to

serve

as the

instrument for proper identification, eligibility verification,

and utilization recording.

q) Indigent — A person who has no visible means of

income,

or

whose

income

is

insufficient

for

the

subsistence of his family, as identified by the Department

of Social Welfare and Development (DSWD) based on

specific criteria set for this purpose in accordance with

the guiding principles set forth in Article I of this Act.

(National Health Insurance Act of 2013, Republic Act No.

10606, [June 19, 2013])

r) Inpatient Education Package — A set of informational

services made available to an individual who is confined

in a hospital to afford him with knowledge about his

illness and its treatment, and of the means available,

particularly lifestyle changes, to prevent the recurrence or

aggravation of such illness and to promote his health in

general.

s) Member — Any person whose premiums have been

regularly paid to the National Health Insurance Program

who may be a paying member, a sponsored member, or a

lifetime member. (National Health Insurance Act of 2013,

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

t) Means Test — A protocol administered at the barangay

level to determine the ability of individuals or households

to pay varying levels of contributions to the Program,

ranging from the indigent in the community whose

contributions

should

be

totally

subsidized

by

the

government, to those who can afford to subsidize part

but not all the required contributions for the Program.

u) Medicare — The health insurance program currently

being

implemented

by

the

Philippine Medical Care

Commission. It consists of:

(1) Program I, which covers members of the SSS and GSIS

including their legal dependents; and

(2) Program II, which is intended for those not covered

under Program I.

v) National Health Insurance Program — The compulsory

health

insurance

program

of

the

government

as

established in this Act, which shall provide universal

health

insurance

coverage

and

ensure

affordable,

acceptable, available and accessible health care services

for all citizens of the Philippines.

w) Pensioner — An SSS or GSIS member who receives

pensions therefrom.

x) Personal Health Services — Health Services in which

benefits

accrue

to

the individual person. These are

categorized into inpatient and outpatient services.

y) Philippine Medical Care Commission — The Philippine

Medical Care Commission created under Republic Act No.

6111 , as amended.

z) Philippine National Drug Formulary — The essential

drugs list for the Philippines which is prepared by the

National Drug Committee of the Department of Health in

consultation with experts and specialists from organized

professional medical societies, medical academe and the

pharmaceutical industry, and which is updated every

year.

(aa) Portability — The enablement of a member to avail of

Program benefits in an area outside the jurisdiction of his

Local Health Insurance Office.

(bb)

Prescription

Drug

—

A

drug

which

has

been

approved by the Bureau of Food and Drug and which can

be dispensed only pursuant to a prescription order from a

physician who is duly licensed to do so.

(cc) Public Health Services — Services that strengthen

preventive and promotive health care through improving

conditions in partnership with the community at large.

These

include

control

of

communicable

and

non-communicable diseases, health promotion, public

information

and

education,

water

and

sanitation,

environmental

protection,

and

health-related

data

collection, surveillance, and outcome monitoring.

(dd) Quality Assurance — A formal set of activities to

review

and

ensure

the quality of services provided.

Quality

assurance

includes

quality

assessment

and

corrective actions to remedy any deficiencies identified in

the quality of direct patient, administrative, and support

services.

(ee) Residence — The place where the member actually

lives.

(ff) Retiree — A member of the Program who has reached

the age of retirement as provided for by law or who was

retired on account of permanent disability as certified by

the employer and the Corporation.

(National Health

Insurance Act of 2013, Republic Act No. 10606, [June 19,

2013])

(gg) Self-employed — A person who works for himself and

is therefore both employee and employer at the same

time.

(hh) Social Security System — The Social Security System

created under Republic Act No. 1161 , as amended.

(ii) Treatment Procedure — Any method used to remove

the symptoms and cause of a disease.

(jj) Utilization Review — A formal review of patient

utilization

or

of

the

appropriateness

of

health care

services, on a prospective, concurrent or retrospective

basis.

(kk) Rehabilitation Center — Refers to a facility, which

undertakes rehabilitation of drug dependents. It includes

institutions, agencies and the like which have for their

purpose, the development of skills, or which provides

counselling, or which seeks to inculcate, social and moral

values to clientele who have a drug problem with the aim

of weaning them from drugs and making them drug

free, adapted to their families and peers, and readjusted

into the community as law-abiding, useful and productive

citizens.

(ll) Home Care and Medical Rehabilitation Services —

Refer to skilled nursing care, which members get in their

homes/clinics for the treatment of an illness or injury that

severely affects their activities or daily living. Home care

and medical rehabilitation services include hospice or

palliative care for people who are terminally ill but does

not

include

custodial

and non-skilled personal care.

(Amendment to R.A. No. 7875, Republic Act No. 9241,

[February 10, 2004])

© Compiled By RGL

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