Article 78Labor and Agrarian Laws and Social Legislation, p. 78

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

(mm) Abandoned Children — Children who have no

known family willing and capable to take care of them

and are under the care of the DSWD, orphanages,

churches and other institutions.

(nn) Case-based Payment — Hospital payment method

that reimburses to hospitals a predetermined fixed rate

for each treated case or disease; also called per case

payment.

(oo) Health Technology Assessment — A field of science

that investigates the value of a health technology such as

procedure, process, products, or devices, specifically on

their quality, relative cost-effectiveness and safety. It

usually

involves

the

science

of

epidemiology

and

economics. It has implications on policy, decision to adopt

and invest in these technologies, or in health benefit

coverage.

(pp) Informal Sector — Units engaged in the production

of goods and services with the primary objective of

generating employment and income for the persons

concerned.

It consists of households, unincorporated

enterprises that are market and nonmarket producers of

goods, as well as market producers of services.

These enterprises are operated by own-account workers,

which may employ unpaid family workers as well as

occasional, seasonally hired workers.

To this sector belong, among others, street hawkers,

market

vendors,

pedicab

and

tricycle

drivers,

small

construction workers and home-based industries and

services.

(qq) Other Self-earning Individuals — Individuals who

render services or sell goods as a means of livelihood

outside of an employer-employee relationship, or as a

career, but do not belong to the informal sector. These

include businessmen, entrepreneurs, actors, actresses

and other performers, news correspondents, professional

athletes,

coaches,

trainers,

and

other

individuals

as

recognized by the Department of Labor and Employment

(DOLE) and/or the Bureau of Internal Revenue (BIR).

(rr)

Out-patient

Services

—

Health services such as

diagnostic consultation, examination, treatment, surgery

and rehabilitation on an out-patient basis.

(ss) Professional Practitioners — Include doctors, lawyers,

certified

public

accountants,

and

other practitioners

required to pass government licensure examinations in

order to practice their professions.

(tt)

Traditional

and

Alternative

Health

Care — The

application of traditional knowledge, skills and practice of

alternative health care or healing methods which include

reflexology,

acupuncture,

massage,

accupressure,

chiropractics,

nutritional

therapy

and

other

similar

methods in accordance with the accreditation guidelines

set forth by the Corporation and the Food and Drug

Administration (FDA).

(uu) Lifetime Member — A former member who has

reached the age of retirement under the law and has

paid at least one hundred twenty (120) monthly premium

contributions.

(vv) Members in the Formal Economy — Workers with

formal

contracts

and

fixed

terms

of

employment

including workers in the government and private sector,

whose

premium

contribution

payments

are

equally

shared by the employee and the employer.

(ww) Members in the Informal Economy — Workers who

are not covered by formal contracts or agreements and

whose premium contributions are self-paid or subsidized

by another individual through a defined criteria set by the

Corporation.

(xx) Migrant Workers — Documented or undocumented

Filipinos who are engaged in a remunerated activity in

another country of which they are not citizens.

(yy) Sponsored Member — A member whose contribution

is being paid by another individual, government agency,

or private entity according to the rules as may be

prescribed by the Corporation.

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

10606, [June 19, 2013])

ARTICLE III The National Health Insurance

Program

SECTION 5. Establishment and Purposes . — There is

hereby created the National Health Insurance Program

which

shall

provide

health

insurance

coverage

and

ensure affordable, acceptable, available and accessible

health care services for all citizens of the Philippines, in

accordance with the policies and specific provisions of

this Act. This social insurance program shall serve as the

means for the healthy to help pay for the care of the sick

and for those who can afford medical care to subsidize

those who cannot. It shall initially consist of programs I

and II or Medicare and be expanded progressively to

constitute one universal health insurance program for the

entire

population.

The

Program

shall

include

a

sustainable

system

of

funds

constitution,

collection,

management

and

disbursement

for

financing

the

availment

of

a

basic

minimum

package

and other

supplementary packages of health insurance benefits by

a progressively expanding proportion of the population.

The Program shall be limited to paying for the utilization

of

health

services

by

covered

beneficiaries

or

to

purchasing health services in behalf of such beneficiaries.

It shall be prohibited from providing health care directly,

from buying and dispensing drugs and pharmaceuticals,

from employing physicians and other professionals for

the purpose of directly rendering care, and from owning

or investing in health care facilities.

SECTION 6. Mandatory Coverage . — All citizens of the

Philippines shall be covered by the National Health

Insurance Program. In accordance with the principles of

universality

and

compulsory

coverage

enunciated in

Section

2(b)

and

2(l) hereof, implementation of the

Program

shall

ensure sustainability of coverage and

continuous

enhancement

of

the

quality

of

service:

Provided, That the Program shall be compulsory in all

provinces,

cities

and

municipalities

nationwide,

notwithstanding

the

existence

of

LGU-based

health

insurance

programs:

Provided,

further ,

That

the

Corporation,

Department

of

Health

(DOH),

local

government units (LGUs), and other agencies including

nongovernmental

organizations

(NGOs)

and

other

national government agencies (NGAs) shall ensure that

members in such localities shall have access to quality

and cost-effective health care services. (National Health

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

2013])

SECTION 7. Enrollment . — The Corporation shall enroll

beneficiaries in order for them to avail of benefits under

this Act with the assistance of the financial arrangements

provided

by

the

Corporation

under

the

following

categories:

(a) Members in the formal economy;

(b) Members in the informal economy;

(c) Indigents;

(d) Sponsored members; and

(e) Lifetime members.

The process of enrollment shall include the identification

of beneficiaries, issuance of appropriate documentation

specifying

eligibility

to benefits, and indicating how

membership was obtained or is being maintained.

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

10606, [June 19, 2013])

SECTION 8. Health Insurance Identification (ID) Card and

ID

Number.

—

In

conjunction

with

the

enrollment

provided above, the Corporation through its local office

shall issue a health insurance ID with a corresponding ID

number

which

shall

be

used

for

purposes

of

identification,

eligibility

verification,

and

utilization

© Compiled By RGL

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