AN ACT AMENDING REPUBLIC ACT NO. 7875, OTHERWISE KNOWN AS "AN ACT INSTITUTING A NATIONAL HEALTH INSURANCE PROGRAM FOR ALL FILIPINOS

Case Overview and Summary

Summary of Republic Act No. 9241 Amending the National Health Insurance Program

Definitions (Section 1)
- Defines key terms used in the law, including:
• Beneficiary, benefit package, capitation, contribution, coverage, dependent, diagnostic procedure, emergency, employee, employer, enrollment, fee for service, global budget, health care provider, health insurance ID card, indigent, inpatient education package, member, means test, pensioner, personal health services, prescription drug, public health services, quality assurance, residence, retiree, self-employed, treatment procedure, utilization review, rehabilitation center, home care and medical rehabilitation services.

Excluded Personal Health Services (Section 2)
• The benefits shall not cover expenses for the following services, unless recommended for inclusion by the Corporation after actuarial studies and approved by the Board: non-prescription drugs and devices, alcohol abuse or dependency treatment, cosmetic surgery, optometric services, fifth and subsequent normal obstetrical deliveries, and cost-ineffective procedures. (Section 11)

Board of Directors (Section 3)
• Composition: Secretaries of Health (Chairperson), Labor and Employment, Interior and Local Government, Social Welfare and Development, President of the Corporation (Vice Chairperson), representatives of labor, employers, SSS, GSIS, basic sector, overseas workers, self-employed, and health care providers. (Section 18)
• Appointment and tenure: Appointed by the President for 4 years, renewable for 2 years, except for government representatives whose terms are co-terminous with their positions.
• Meetings and quorum: Regular meetings at least once a month, special meetings as needed, majority constitutes quorum.
• Allowances and per diems for members.

Payment of Indigent Contributions (Section 4)
• Contributions for indigent members shall be subsidized partially by the local government unit where the member resides, with the Corporation providing counterpart financing equal to the LGU's subsidy. (Section 29)
• For fourth, fifth and sixth class municipalities, the National Government shall provide up to 90% of the subsidy for indigents until upgraded to first, second or third class.

Accreditation Eligibility (Section 5)
• All health care providers operating for at least 3 years may apply for accreditation. (Section 32)
• Providers operating for less than 3 years may also apply if certain conditions are met, such as managing professional's experience, tertiary facility, serving underserved areas, or other conditions determined by the Corporation.

Penalties (Section 6)
• Failure or refusal to deduct contributions from employee's compensation or remit to the Corporation shall be fined P500 to P1,000 multiplied by the total number of employees, and imprisonment of 6 months to 1 year. (Section 44)

Oversight Provision (Section 7)
• Congress shall conduct regular review of the Program's performance, impact and accomplishments through the Senate and House committees with legislative jurisdiction. (Section 54)
• NEDA, NSO and UP National Institutes of Health shall undertake validation studies, funded by PhilHealth's income.