National Health Insurance Program

Question 1

1997

Answer 1

Medicare fxns for govt workers from GSIS

Question 2

1998

Answer 2

Private sectors from the SSS

Question 3

1998

Answer 3

Indigent program

Question 4

1999

Answer 4

Self employed

Question 5

2005

Answer 5

OWFs

Question 6

2014

Answer 6

14.7 M families are enrolled thru full Natl Govt subsidy by RA 10606
Kalusugan Pangkalahatan
“Bawat Pilipino, Miyembro, Bawat Miyembro, Protektado, Kalusugan Natin Sigurado”

Question 7

RA 10606

Answer 7

National Health Insurance Act of 2013

Question 8

Attainment of coverage for the entire population, with at least a basic minimum package of health insurance benefits

Answer 8

Universality

Question 9

Uniform acces to health care and benefits based on need, not on ability to pay

Answer 9

Equity

Question 10

Adequately meeting the needs for personal health services at various stages of a member’s life

Answer 10

Responsiveness

Question 11

Balance between economical use of resources and quality care

Answer 11

Effectiveness

Question 12

All citizens shall be required to enroll in the NHIP in order to avoid adverse selection & social inequality

Answer 12

Compulsory coverage

Question 13

Adaptation to changes in medical technology, health service organizations, payment system, professional practice and other trends, both in private and public sectors

Answer 13

Innovation

Question 14

Accountable in all their dealings wt the PhilHealth & its members

Answer 14

Professional resp of health care providers

Question 15

Promotes the quality & improvement of health services thru the instituionalization of quality assurance program at all levels of the health service delivey system.

Answer 15

Quality of services

Question 16

Satisfaction of the community & individual beneficiaries shall be a determinant of the quality for service delivery

Answer 16

Quality of service

Question 17

Govt shall provide basic package of needed personal health services thru premium subsidy, or thru direct service provision until such time that the program is fully implemented

Answer 17

Care for the indigent

Question 18

Any person entitled to health care benefits under this Act

Answer 18

Beneficiary

Question 19

Services that the NHIP offers to its members

Answer 19

Benefit Package

Question 20

Paid amt for coverage

Answer 20

Contribution

Question 21

Dependents

Answer 21

• The legitimate spouse who is not a member
• Unmarried and unemployed legitimate, legitimated, illegitimate, acknowledged children as appearing in the birth cert; legally adopted or stepchildren below 21
• children 21yo above suffefring from congenital disb, or any disab that renders them totally dependent
• parents 60yo above, mo income is below amt to be determined by Corporation
• parents wt permanent disabilities

Question 22

NHIP in 1995

Answer 22

RA 7875

Question 23

A person who has no visible means of income, or whose income is insufficient for the subsistence of his family

Answer 23

Indigent

Question 24

Childredn who have no known family willing & capable to twke care of them

Answer 24

Abandoned children

Question 25

Hospital payment method that reimburses to hospitals a predetermined fixed rate for each treated case or disease; Aka per case payment

Answer 25

Cash-based payment

Question 26

A former member who has reached the age of retirement under the law and has paid atleast 120 monthly premium contributions

Answer 26

Lifetime member

Question 27

Workers wt formal contracts & fixed terms of employment including workers in the govt & private sector; whose premium contribution payments are equally shared by the employee and employer

Answer 27

Members in the formal economy

Question 28

Workers who are not covered wt formal contracts or agreements & whose premium contributions are self-paid or subsidized by another individual thru a defined criteria set by the corporation

Answer 28

Members in the informal economy

Question 29

Documented or undocumented Filipinos who are engaged in remunerated activity in another country of whc they are not citizens

Answer 29

Migrant workers

Question 30

Member whose contribution os being paid by another individual, govt agency, or private entity accrdg to the rules as may be prescribed by the corporation

Answer 30

Sponsored member

Question 31

A member of the Program who has reached the afe of retirement as provided for by la or who was retird on acct of permanent disability as certified by the employer & the Corporation

Answer 31

Retiree

Question 32

Benefit package: | inpx hospital care

Answer 32

1. Room n board 2. Services of health care profs 3. Diagnostic, lab & pther medical examination services 4. Use of surgical/medical equipment & facilities 5. Prescription drugs & biologicals 6. Inpatient education packages

Question 33

Benefit package: | Outpx hospital care

Answer 33

1. Services of health care profs 2. Diagnostic, lab & other medical exam services 3. Personal preventive services 4. Pres drugs & biologicals

Question 34

Members confined abroad are eligible to avail benefit package provided:

Answer 34

1. Official receipt/ any proof of payment/ statement of acct 2. Cert of the attending physician as to final diagnosis, period of confinement & services rendered * submitted wtn 180 cal days from date of discharge

Question 35

Health care insts must give indigent members preferential access to their social welfare funds, whc may be used to augment the benefit package provided, in case of insufficiency to fully cover all confinement charges

Answer 35

No balance billing

Question 36

A field of science that investigates the value of health technology such as procedure, process, products or devices, specifically on their quailty,, relative cost effectiveness & safety

Answer 36

Health technology assessment