Article 79Labor and Agrarian Laws and Social Legislation, p. 79

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

recording.

The

issuance

of

this

ID

card

shall

be

accompanied by a clear explanation to the enrollee of his

rights, privileges and obligations as a member. A list of

health care providers accredited by the Local Health

Insurance

Office

shall

likewise

be

provided

to

the

member together with the ID card.

The absence of the ID card shall not prejudice the right of

any member to avail of benefits or medical services under

the National Health Insurance Program (NHIP).

This health insurance ID card with a corresponding ID

number

shall be recognized as a valid government

identification and shall be presented and honored in

transactions

requiring

the

verification

of

a

person's

identity.

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

10606, [June 19, 2013])

SECTION 9. Change of Residence . — A citizen can be

under only one Local Health Insurance Office which shall

be located in the province or city of his place of residence.

A person who changes residence, becomes temporarily

employed, or for other justifiable reasons, is transferred to

another locality should inform said Office of such transfer

and subsequently transfer his Program membership.

SECTION 10. Benefit Package . — Members and their

dependents

are

entitled

to

the

following minimum

services, subject to the limitations specified in this Act

and as may be determined by the Corporation:

(a) Inpatient hospital care:

(1) room and board;

(2) services of health care professionals;

(3) diagnostic, laboratory, and other medical examination

services;

(4) use of surgical or medical equipment and facilities;

(5) prescription drugs and biologicals, subject to the

limitations stated in Section 37 of this Act; and

(6) inpatient education packages;

(b) Outpatient care:

(1) services of health care professionals;

(2) diagnostic, laboratory, and other medical examination

services;

(3) personal preventive services; and

(4) prescription drugs and biologicals, subject to the

limitations described in Section 37 of this Act;

(c) Emergency and transfer services; and

(d) Such other health care services that the Corporation

and the DOH shall determine to be appropriate and

cost-effective.

These services and packages shall be reviewed annually

to determine their financial sustainability and relevance

to health innovations, with the end in view of quality

assurance, increased benefits and reduced out-of-pocket

expenditure.

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

10606, [June 19, 2013])

SECTION 11. Excluded Personal Health Services . — The

Corporation shall not cover expenses for health services

which

the

Corporation

and

the

DOH

consider

cost-ineffective through health technology assessment.

The Corporation may institute additional exclusions and

limitations as it may deem reasonable in keeping with its

protection

objectives

and

financial

sustainability.

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

[February 10, 2004], as further amended by National

Health Insurance Act of 2013, Republic Act No. 10606,

[June 19, 2013])

SECTION 12. Entitlement to Benefits . — A member whose

premium contributions for at least three (3) months have

been paid within six (6) months prior to the first day of

availment, including those of the dependents, shall be

entitled to the benefits of the Program: Provided, That

such member can show that contributions have been

made with sufficient regularity: Provided, further , That

the member is not currently subject to legal penalties as

provided for in Section 44 of this Act.

The following need not pay the monthly contributions to

be entitled to the Program's benefits:

(a) Retirees and pensioners of the SSS and GSIS prior to

the effectivity of this Act; and

(b) Lifetime members.

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

10606, [June 19, 2013])

SECTION 13. Portability of Benefits . — The corporation

shall develop and enforce mechanisms and procedures to

assure that benefits are portable across Offices.

ARTICLE IV The Philippine Health Insurance

Corporation

SECTION 14. Creation and Nature of the Corporation . —

There is hereby created a Philippine Health Insurance

Corporation, which shall have the status of a tax-exempt

government corporation attached to the Department of

Health for Policy coordination and guidance.

SECTION 15. Exemption from Taxes and Duties . — The

Corporation shall be exempt from the payment of taxes

on all contributions thereto and all accruals on its income

or investment earnings.

Any donation, contribution, bequest, subsidy or financial

aid

which

may

be

made

to

the

Corporation

shall

constitute as allowable deduction from the income of the

donor for income tax purposes and shall be exempt from

donor's tax, subject to such conditions as provided in the

National Internal Revenue Code, as amended.

SECTION 16. Powers and Functions . — The Corporation

shall have the following powers and functions:

a) to administer the National Health Insurance Program;

b) to formulate and promulgate policies for the sound

administration of the Program;

c) To supervise the provision of health benefits and to set

standards, rules, and regulations necessary to ensure

quality of care, appropriate utilization of services, fund

viability,

member

satisfaction,

and

overall

accomplishment of Program objectives; (National Health

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

2013])

d)

to

formulate

and

implement

guidelines

on

contributions and benefits; portability of benefits, cost

containment and quality assurance; and health care

provider arrangements, payment methods; and referral

systems;

e) to establish branch offices as mandated in Article V of

this Act;

f) to receive and manage grants, donations, and other

forms of assistance;

g) to sue and be sued in court;

h) to acquire property, real and personal, which may be

necessary

or

expedient

for

the

attainment

of

the

purposes of this Act;

i) to collect, deposit, invest, administer, and disburse the

National Health Insurance Fund in accordance with the

provisions of this Act;

j) To negotiate and enter into contracts with health care

institutions, professionals, and other persons, juridical or

natural, regarding the pricing, payment mechanisms,

design

and

implementation

of

administrative

and

operating

systems

and

procedures,

financing,

and

delivery of health services in behalf of its members;

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

10606, [June 19, 2013])

k)

to

authorize

Local

Health

Insurance

Offices

to

negotiate and enter into contracts in the name and on

© Compiled By RGL

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