National Health Insurance Act of 2013

Section 14

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

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

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 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

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; The Vice Chairperson for the basic sector of the National Anti-Poverty Commission or a permanent representative; The Chairperson of the Civil Service Commission (CSC) or a permanent representative; A permanent representative of Filipino migrant workers; A permanent representative of the members in the informal economy; A permanent representative of the members in the formal economy; A representative of employers; A representative of health care providers to be endorsed by their national associations of health care institutions and medical health professionals; A permanent representative of the elected local chief executives to be endorsed by the League of Provinces, League of Cities and League of Municipalities; and An independent director to be appointed by the Monetary Board. The Secretary of Health shall be the ex officio Chairperson while the President and CEO of the Corporation shall be the Vice Chairperson of the Board. (b) Appointment and Tenure. — Except for ex officio members, the other members of the Board shall be appointed by the President of the Philippines in accordance with the provisions of Republic Act No. 10149, otherwise known as the 'GOCC Governance Act of 2011': Provided, That sectoral board members shall be appointed by the President of the Philippines upon the recommendation of the Chairperson and after due consultations with the sectors concerned. The term of office of the appointive members of the Board shall be in accordance with Republic Act No. 10149. (National Health Insurance Act of 2013, Republic Act No. 10606, [June 19, 2013]) c) Meetings and Quorum. — The Board shall hold regular meetings at least once a month. Special meetings may be convened at the call of the Chairperson or by a majority of the members of the Board. The presence of a majority of all the members shall constitute a quorum. In the absence of the Chairperson and Vice Chairperson, a temporary presiding officer shall be designated by the majority of the quorum. d) Allowances and Per Diems — The members of the Board shall receive a per diem for every meeting actually attended subject to the pertinent budgetary laws, rules and regulations on compensation, honoraria and allowances. (Amendment to R.A. No. 7875, Republic Act No. 9241, [February 10, 2004])

Section 19

The President of the Corporation. — a) Appointment and Tenure — The President of the Philippines shall appoint the President and CEO of the Corporation, hereinafter referred to as the President, upon the recommendation of the Board. The President shall have a tenure of one (1) year in accordance with the provisions of Republic Act No. 10149. (National Health Insurance Act of 2013, Republic Act No. 10606, [June 19, 2013]) b) Duties and Functions — The President shall have the duty of advising the Board and carrying into effect its policies and decisions. His functions are as follows: 1) to act as the chief executive officer of the Corporation; and 2) to be responsible for the general conduct of the operations and management functions of the Corporation and for other duties assigned to him by the Board. c) Qualifications — The President must a Filipino citizen and must possess adequate and appropriate training and at least five (5) years experience in the field of health care financing and corporate management. d) Salary — The President shall receive a salary to be fixed by the Board, with the approval of the President of the Philippines, payable from the funds of the Corporation. e) Prohibition — To avoid conflict of interest, the President must not be involved in any health care institution as owner or member of its board.

Section 20

Among the staff departments that will be established by the Corporation shall be the Health Finance Policy Research Department, which shall have the following duties and functions: a) development of broad conceptual framework for implementation of the Program through a national health finance master plan to ensure sustained investments in health care, and to provide guidance for additional appropriations from the National Government; b) conduct of researches and studies toward the development of policies necessary to ensure the viability, adequacy and responsiveness of the Program; c) review, evaluation, and assessment of the Program's impact on the access to as well as the quality and cost of health care in the country; d) periodic review of fees, charges, compensation rates, capitation rates, medical standards, health outcomes and satisfaction of members, benefits, and other matters pertinent to the operations of the Program; e) comparison in the delivery, quality, use, and cost of health care services of the different Offices; f) submission for consideration of program of quality assurance, utilization review, and technology assessment; (g) submission of recommendations on policy and operational issues that will help the Corporation meet the objectives of this Act; and (h) conduct of client-satisfaction surveys and research in order to assess outcomes of service rendered by health care providers. (National Health Insurance Act of 2013, Republic Act No. 10606, [June 19, 2013])

Section 21

An Office of Actuary shall be created within the Corporation to conduct the necessary actuarial studies and present recommendations on insurance premium, investments and other related matters.