Article 80Labor and Agrarian Laws and Social Legislation, p. 80

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

behalf

of

the

Corporation

with

any

accredited

government

or

private

sector

health

provider

organization,

including

but

not

limited

to

health

maintenance organizations, cooperatives and medical

foundations, for the provision of at least the minimum

package of personal health services prescribed by the

Corporation;

l) to determine requirements and issue guidelines for the

accreditation of health care providers for the Program in

accordance with this Act;

m) To visit, enter and inspect facilities of health care

providers and employers during office hours, unless there

is reason to believe that inspection has to be done

beyond office hours, and where applicable, secure copies

of their medical, financial, and other records and data

pertinent

to

the

claims,

accreditation,

premium

contribution, and that of their patients or employees, who

are

members

of

the

Program;

(National

Health

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

2013])

n) to organize its office, fix the compensation of and

appoint personnel as may be deemed necessary and

upon

the

recommendation

of

the president of the

Corporation;

o) to submit to the President of the Philippines and to

both Houses of Congress its Annual Report which shall

contain the status of the National Health Insurance Fund,

its total disbursements, reserves, average costings to

beneficiaries, any request for additional appropriation,

and other data pertinent to the implementation of the

Program and publish a synopsis of such report in two (2)

newspapers of general circulation;

p) To keep records of the operations of the Corporation

and investments of the National Health Insurance Fund;

(q) To establish and maintain an electronic database of all

its members and ensure its security to facilitate efficient

and effective services;

(r) To invest in the acceleration of the Corporation's

information technology systems;

(s) To conduct an information campaign on the principles

of the NHIP to the public and to accredited health care

providers.

This

campaign

must

include

the

current

benefit

packages

provided

by

the

Corporation,

the

mechanisms to avail of the current benefit packages, the

list of accredited and disaccredited health care providers,

and the list of offices/branches where members can pay

or check the status of paid health premiums;

(t) To conduct post-audit on the quality of services

rendered by health care providers;

(u) To establish an office, or where it is not feasible,

designate a focal person in every Philippine Consular

Office in all countries where there are Filipino citizens.

The

office or the focal person shall, among others,

process, review and pay the claims of the overseas Filipino

workers (OFWs);

(v) Notwithstanding the provisions of any law to the

contrary, to impose interest and/or surcharges of not

exceeding three percent (3%) per month, as may be fixed

by the Corporation, in case of any delay in the remittance

of contributions which are due within the prescribed

period

by

an

employer,

whether

public

or

private.

Notwithstanding the provisions of any law to the contrary,

the Corporation may also compromise, waive or release,

in whole or in part, such interest or surcharges imposed

upon employers regardless of the amount involved under

such valid terms and conditions it may prescribe;

(w) To endeavor to support the use of technology in the

delivery of health care services especially in farflung areas

such as, but not limited to, telemedicine, electronic health

record, and the establishment of a comprehensive health

database;

(x) To monitor compliance by the regulatory agencies

with the requirements of this Act and to carry out

necessary actions to enforce compliance;

(y) To mandate the national agencies and LGUs to require

proof of PhilHealth membership before doing business

with a private individual or group;

(z) To accredit independent pharmacies and retail drug

outlets; and

(aa)

To

perform

such

other

acts

as

it

may

deem

appropriate for the attainment of the objectives of the

Corporation

and for the proper enforcement of the

provisions of this Act.

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

10606, [June 19, 2013])

SECTION 17. Quasi-Judicial Powers . — The Corporation, to

carry out its tasks more effectively, shall be vested with

the following powers:

a) Subject to the respondent's right to due process, to

conduct

investigations

for

the

determination

of

a

question, controversy, complaint, or unresolved grievance

brought to its attention, and render decisions, orders, or

resolutions

thereon.

It

shall

proceed

to

hear

and

determine the case even in the absence of any party who

has been properly served with notice to appear. It shall

conduct its proceedings or any part thereof in public or in

executive session; adjourn its hearings to any time and

place; refer technical matters or accounts to an expert

and to accept his reports as evidence; direct parties to be

joined in or excluded from the proceedings; and give all

such directions as it may deem necessary or expedient in

the determination of the dispute before it;

(National

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

[June 19, 2013])

b)

to

summon

the

parties

to

a

controversy,

issue

subpoenas requiring the attendance and testimony of

witnesses or the production of documents and other

materials necessary to a just determination of the case

under investigation;

c) Subject to the respondent's right to due process, to

suspend temporarily, revoke permanently, or restore the

accreditation of a health care provider or the right to

benefits of a member and/or impose fines. The decision

shall immediately be executory, even pending appeal,

when the public interest so requires and as may be

provided for in the implementing rules and regulations.

Suspension

of

accreditation shall not exceed six (6)

months. Suspension of the rights of members shall not

exceed six (6) months.

The revocation of a health care provider's accreditation

shall operate to disqualify him from obtaining another

accreditation in his own name, under a different name, or

through another person, whether natural or juridical.

The Corporation shall not be bound by the technical rules

of evidence.

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

10606, [June 19, 2013])

SECTION 18. The Board of Directors . —

a) Composition — The Corporation shall be governed by a

Board of Directors hereinafter referred to as the Board,

composed of the following members:

The Secretary of Health;

The Secretary of Labor and Employment or a permanent

representative;

The Secretary of the Interior and Local Government or a

permanent representative;

The Secretary of Social Welfare and Development or a

permanent representative;

The Secretary of the Department of Finance (DOF) or a

permanent representative;

The President and Chief Executive Officer (CEO) of the

Corporation;

The SSS Administrator or a permanent representative;

The

GSIS

General

Manager

or

a

permanent

representative;

© Compiled By RGL

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