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  • Circ2020 0005

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    Adrian De Vera
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    Premium Contribution Schedule In The National Health Insurance Program (NHIP) Pursuant To R.A. 11223 Known As The Universal Health Care Act” (Revision 1)

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    circ2020-0005

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    Premium Contribution Schedule In The National Health Insurance Program (NHIP) Pursuant To R.A. 11223 Known As The Universal Health Care Act” (Revision 1)

    Copyright:

    © All Rights Reserved
    Als PDF herunterladen oder online auf Scribd lesen
    Markieren Sie unangemessene Inhalte
    5 Ansichten5 Seiten

    Circ2020 0005

    Hochgeladen von

    Adrian De Vera
    Premium Contribution Schedule In The National Health Insurance Program (NHIP) Pursuant To R.A. 11223 Known As The Universal Health Care Act” (Revision 1)

    Copyright:

    © All Rights Reserved
    Als PDF herunterladen oder online auf Scribd lesen
    Markieren Sie unangemessene Inhalte
    von 5
    ® Republic of the Philippines PHILIPPINE HEALTH INSURANCE CORPORATION CCitystate Cente, 709 Shaw Boulevard, Pesig.Clty (Call Center: (02) 41-7442 | Trunkline: (02) 441-7444 ‘www philealth gov. ph PHILHEALTH CIRCULAR No. _2020- 060 TO ALL DIRECT CONTRIBUTOR MEMBERS OF THE NATIONAL HEALTH INSURANCE PROGRAM AND ALL OTHERS CONCERNED SUBJECT : jum Contribution Sch in the National Health Program (NHI to RA. No, 1 m_as the “Universal Care Act” (Revision 1 I, RATIONALE 00: ye Date. 24/208 Itis the policy of the State “to adopt an integrated and comprehensive approach to health development which shall endeavor to make essential goods, health and other social services available to all the people at affordable cost and to provide free medical care to paupers. ‘Towards this end, the State shall provide, among others, (b) A health care model that provides all Filipinos access to a comprehensive set of quality and cost-effective, promotive, preventive, curative, rehabilitative and palliative health services without causing financial hardship, and prioritizes the needs of the population who cannot afford such services [Section 11, Article XVII on Social Justice and Human Rights of the Constitution and typified in Anticle 1 of Republic Act (R.A) No. 7875, as amended by R.A. No. 10606, and RA. No! 11223 otherwise known as the Universal Health Care (UHC) Act of 2019). Among the genetal objectives of the UHC Act is to progressively realize universal health care in the country through 2 systemic approach and clear delineation of roles of key agencies and stakeholders towards better performance in the health system; and to ensure that all Filipinos are guaranteed equitable access to quality and affordable health care goods and services, and protected against financial risk. ‘To accomplish these objectives, Section 7 of the UHC Act provides for an “Individual-based health services” that shall be financed primarily through prepayment mechanisms such as social health insurance, private health insurance, and HMO plans to ensure predictability of health expenditures.” Under Section 8 of the UHC Act, the program membership in the NHIP is simplified into two (2) types, namely Direct and Indisect Contributors, As such, the National Health Insurance Program (NHIP) under R.A. No. 7875 was engaged with the same purpose of providing health insurance coverage and ensuting affordable, acceptable, available and accessible health cate services for all citizens of the Philippines, in accordance with the policies and specific provisions of the Act. This social health insurance program serves as the means for the healthy to help pay for the care of the sick and for those who can afford medical care to subsidize those who cannot (Section 5, Asticle II of R.A. No. 7875, as amended), Qerireroict QO eorpnineatn actoncentorgntineskh gov 0. mI. OBJECTIVE To opesationalize the “Individual-based health services” for all Direct Contributors of the NHIP by providing set of rules and guidelines on the payment mechanism pursuant to R.A. No. 7875, as amended by the UHC Act. SCOPE, ‘This Citcular covers all Direct Contributors as defined under the UHC Act, including their qualified dependents. DEFINITION OF TERMS A. Dependent— the qualified dependents of a member, namely: 1. Legal spouse/s who is/are not an actine member; 2. Unmarried and unemployed bgitimate, ilegitimate children, and kgally adopted or stepchildren below twenty-one (24) years of age: 3. Foster children as defined in RA 10165 (Foster Care Act of 2012); and 4, Parents who are sixty (60) years old and above, not otherwise an enrolled member. B. Direct Conteibutors — including their qualified dependents shall be eamposed of, but not limited to, fifo /. Employees with formal employment characterized by the existence of an employeramployee relationship, which include workers in the government and private seclor, whether regular, casnal or contractual are occupying either an ebetve or appointive position, regardless of the status of appointment, whose premiam coutribation payments are equally shared by the employee and the employer 2. Kasanbahays, as defined in RA 10361 (Domestic Workers Ad); 3. All otber workers who are not covered by formal contrasts or agreements or who bave no empleyee- employer relationship and whose preminnu contributions are selfpaid, and with capacity to pay prominnss, such as the following: a Selfearning individuals; and b,Profesionals practitioners; 4. Overseas Filipino Workers, as defined in RA 10022 (Migrant Workers Act) and RA 10801 (OWWA Act) such as, bat not limited to: a. Sea-based Filipino workers or seafarers; and 6, Land-based overseas Filipino workers; Filipino lining abroad; Filipinos with dnalctzenship; Liine members as defined in RA10606 (National Heal Insurance Act); and ‘AI Pilipinos aged 21 years and above who have the capacity to pay premiums. SN AM . Indirect contributors — refer to all others not included as direct contributors, as well as their qualified dependents, whose premium are subsidized by the national government including those who are subsidized as a result of special laws. ). Member — all Filipino citizens as defined under the 1987 Philippine Constitution. E, Professional Practitioners - refer to all practitioners required to pass government Page 2of5 GQ rnivieavortca GO woronineath @actoncerteeephuhestnaoveh > O. 2 o 4 a 3 a g 3 i BE a

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