Article 84Labor and Agrarian Laws and Social Legislation, p. 84

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

(1) A fund to secure benefit payouts to members prior to

their becoming lifetime members;

(2) A fund to secure payouts to lifetime members; and

(3) A fund for any optional supplemental benefits that are

subject to additional contributions.

A portion of each of the above funds shall be identified as

current and kept in liquid instruments. In no case shall

said portion be considered part of invested assets.

Another portion of the said funds shall be allocated for

lifetime

members

within

six

(6)

months

after

the

effectivity of this Act. Said amount shall be determined by

an actuary or pre-calculated based on the most recent

valuation of liabilities.

The

Corporation

shall

allocate

a

portion

of

all

contributions to the fund for lifetime members based on

an allocation to be determined by the PHIC actuary

based on a pre-determined percentage using the current

average age of members and the current life expectancy

and morbidity curve of Filipinos.

The Corporation shall manage the supplemental benefits

and the lifetime members' fund in an actuarially sound

manner.

The Corporation shall manage the supplemental benefits

fund

to

the

minimum required to ensure that the

supplemental benefit payments are secure.

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

10606, [June 19, 2013])

ARTICLE VII Financing

SECTION 28. Contributions . — All members who can

afford to pay shall contribute to the Fund, in accordance

with a reasonable, equitable and progressive contribution

schedule to be determined by the Corporation on the

basis of applicable actuarial studies and in accordance

with the following guidelines:

(a) Members in the formal economy and their employers

shall continue paying the same monthly contributions as

provided for by law until such time that the Corporation

shall have determined a new contribution schedule:

Provided,

That their monthly contributions shall not

exceed five percent (5%) of their respective monthly

salaries. AcEIHC

It shall be mandatory for all government agencies to

include the payment of premium contribution in their

respective annual appropriations: Provided, further , That

any increase in the premium contribution of the national

government as employer shall only become effective

upon inclusion of said amount in the annual General

Appropriations Act.

(b)Contributions from members in the informal economy

shall be based primarily on household earnings and

assets. Those from the lowest income segment who do

not qualify for full subsidy under the means test rule of

the DSWD shall be entirely subsidized by the LGUs or

through cost sharing mechanisms between/among LGUs

and/or legislative sponsors and/or other sponsors and/or

the

member,

including

the

national

government:

Provided, That the identification of beneficiaries who

shall receive subsidy from LGUs shall be based on a list to

be provided by the DSWD through the same means test

rule or any other appropriate statistical method that may

be adopted for said purpose.

(c) Contributions made in behalf of indigent members

shall

not

exceed

the

minimum

contributions

for

employed members.

(d)

The

required

number

of

monthly

premium

contributions to qualify as a lifetime member may be

increased by the Corporation to sustain the financial

viability of the Program: Provided, That the increase shall

be based on actuarial estimate and study

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

10606, [June 19, 2013])

SECTION

29. Payment for Indigent Contributions . —

Premium

contributions

for

indigent

members

as

identified by the DSWD through a means test or any

other

appropriate

statistical

method

shall

be

fully

subsidized by the national government. The amount

necessary shall be included in the appropriations for the

DOH

under

the

annual

General

Appropriations Act.

(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

29-A.

Payment

for

Sponsored

Members'

Contributions. —

(a) The premium contributions of orphans, abandoned

and abused minors, out-of-school youths, street children,

PWDs, senior citizens and battered women under the

care of the DSWD, or any of its accredited institutions run

by NGOs or any nonprofit private organizations, shall be

paid by the DSWD and the funds necessary for their

inclusion in the Program shall be included in the annual

budget of the DSWD.

(b) The needed premium contributions of all barangay

health workers, nutrition scholars and other barangay

workers and volunteers shall be fully borne by the LGUs

concerned.

(c) The annual premium contributions of househelpers

shall be fully paid by their employers, in accordance with

the

provisions

of

Republic

Act

No.

10361

or

the

' Kasambahay Law '.

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

10606, [June 19, 2013])

SECTION 29-B. Coverage of Women About to Give Birth.

— The annual required premium for the coverage of

unenrolled women who are about to give birth shall be

fully borne by the national government and/or LGUs

and/or legislative sponsor which shall be determined

through the means testing protocol recognized by the

DSWD. (National Health Insurance Act of 2013, Republic

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

ARTICLE VIII Health Care Providers

SECTION 30. Free Choice of Health Facility, Medical or

Dental Practitioner . — Beneficiaries requiring treatment

or confinement shall be free to choose from accredited

health care providers. Such choice shall, however, be

subject to limitations based on the area of jurisdiction of

the concerned Office and on the appropriateness of

treatment in the facility chosen or by the desired provider.

SECTION 31. Authority to Grant Accreditation . — The

Corporation shall have the authority to grant to health

care providers accreditation which confers the privilege of

participating in the Program.

SECTION 32. Accreditation Eligibility . — All health care

providers, as enumerated in Section 4(o) hereof and

operating for at least three (3) years may apply for

accreditation: Provided, That a health care provider which

has not operated for at least three (3) years may likewise

apply and qualify for accreditation if it complies with all

the

other accreditation requirements of and further

meets any of the following conditions:

(a) Its managing health care professional has had a

working experience in another accredited health care

institution for at least three (3) years;

(b) It operates as a tertiary facility or its equivalent;

(c) It operates in a LGU where the accredited health care

provider cannot adequately or fully service its population;

and

(d) Other conditions as may be determined by the

Corporation.

A health care provider found guilty of any violation of this

Act shall not be eligible to apply for the renewal of

accreditation.

© Compiled By RGL

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