Article 82Labor and Agrarian Laws and Social Legislation, p. 82

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

the social welfare officer and community-based health

care organizations to determine the economic status of

all households and individuals, including those who are

indigent;

f) to issue health insurance ID cards to persons whose

premiums have been paid according to the requirements

of the Office and the guidelines issued by the Board;

g) to recommend to the Board premium schedules that

provide for lower rates to be paid by members whose

dependents include those with reduced probability of

utilization, as in fully immunized children;

h) to recommend to the Board a contribution schedule

which specifies contribution levels by individuals and

households, and a corresponding uniform package of

personal health service benefits which is at least equal to

the minimum package of such benefits prescribed by the

Board as applying to the nation;

i) to grant or deny accreditation to health care providers

in their area of jurisdiction, subject to the rules and

regulations to be issued by the Board;

j) to process, review and pay the claims of providers,

within a period not exceeding sixty (60) days whenever

applicable in accordance with the rules and guidelines of

the Corporation;

k)

to pay fees, as necessary, for claims review and

processing when such are conducted by the central

office of the Corporation or by any of its contractors;

l) to establish referral systems and network arrangements

with other Offices, as may be necessary and following the

guidelines set by the Corporation;

m) to establish mechanisms by which private and public

sector health facilities and human resources may be

shared in the interest of optimizing the use of health

resources;

n)

to

support

the management information system

requirements of the Corporation;

o) to serve as the first level for appeals and grievance

cases;

p) to tap community-based volunteer health workers and

barangay officials, if necessary, for member recruitment,

premium collection and similar activities, and to grant

such workers incentives according to the guidelines set

by the Corporation and in accordance with applicable

laws. However, the incentives for the barangay officials

shall accrue to the barangay and not to the said officials.

q) to participate in information and education activities

that

are

consistent

with

the

government's

priority

programs on disease prevention and health promotion;

and

r) to prepare an annual report according to guidelines set

by the Board and to submit the same to the central office

of the Corporation.

ARTICLE VI The National Health Insurance Fund

SECTION 24. Creation of the National Health Insurance

Fund . — There is hereby created a National Health

Insurance Fund, hereinafter referred to as the Fund, that

shall consist of:

(a) Contribution from Program members;

(b) Other appropriations earmarked by the national and

local governments purposely for the implementation of

the Program;

(c)

Subsequent

appropriations

provided

for

under

Sections 46 and 47 of this Act;

(d) Donations and grants-in-aid; and

(e) All accruals thereof.

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

10606, [June 19, 2013])

SECTION

25.

Components

of

the

National

Health

Insurance Fund . — The National Health Insurance Fund

shall have the following components:

a) The Basic Benefit Fund . — This Fund shall finance the

availment of the basic minimum benefit package by

eligible beneficiaries. All liabilities associated with the

extension of entitlement to the basic minimum benefit

package to the enrolled population shall be borne by the

basic benefit fund. It shall be constituted and maintained

through the following process:

1) upon the determination of the amount of government

subsidies and donations available for paying fully or

partially the premium of indigent beneficiaries, a basic

minimum benefit package affordable for enrolling as

many of the indigent beneficiaries as possible shall be

defined.

The

government

subsidies

will

then

be

constituted as premium payments for enrolled indigents

and contributed into the basic benefit fund.

2) for extending coverage of this same minimum benefit

package to non-indigents who are not members of

Medicare, premium prices for specific population shall be

actuarially

determined

based

on

variations

in

risk,

capacity to pay, and projected costs of services utilized.

The amounts corresponding to the premium required,

including costs of direct benefit payments, all costs of

administration, and provision of adequate reserves, for

extending the coverage of the basic minimum benefit

package for such population groups shall be contributed

into the basic benefit fund.

3) for the population enrolled through Medicare Program

I under SSS, the corresponding premium for the basic

minimum benefit package, including costs of direct

benefit

payments,

all

costs

of

administration,

and

provision of adequate reserves, shall be charged to the

health insurance fund of the SSS and paid into the basic

benefit fund;

4) for the population enrolled through Medicare Program

I under GSIS, the corresponding premium for the basic

minimum benefit package, including costs of direct

benefit

payments,

all

costs

of

administration,

and

provision of adequate reserves, shall be charged to the

health insurance fund of the GSIS and paid into the basic

benefit fund; and,

5) for groups enrolled through any of the existing or

future health insurance schemes and plans, including

those created under Medicare Programs II and those

organized by local government units, national agencies,

cooperatives,

and

other

similar

organizations,

the

corresponding premium, including costs of direct benefit

payments, all costs of administration, and provision of

adequate reserves, for extending the basic minimum

benefit package to their respective enrollees will be

charged to their respective funds and paid into the basic

benefit fund.

b) Supplementary Benefit Funds . — These are separate

and distinct supplementary benefit funds created by the

Corporation as eligible for use to provide supplementary

coverage to various groups of the population enjoying the

basic

benefit

coverage

as

are

affordable

by

their

respective funding sources. Each supplementary benefit

fund

shall

finance

the

extension

and

availment

of

additional benefits not included in the basic minimum

benefit

package

but

approved

by

the

Board. Such

supplementary benefits shall be financed by whatever

amounts

are

available

after

deducting the costs of

providing the basic minimum benefit package, including

costs

of

direct

benefit

payments,

all

costs

of

administration, and provision of adequate reserves. All

liabilities associated with the extension of supplementary

benefits to the defined group of enrollees shall be borne

exclusively by the respective supplementary benefit fund.

Upon the implementation of this Act, the following

supplementary benefit funds shall be established:

1)

supplementary

benefit

fund

for

SSS-Medicare

members and beneficiaries. After deducting the amount

corresponding to the premium of the basic minimum

© Compiled By RGL

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