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State of Health of the Philippines, the Philippine Health System, The Department of Health The Municipal Health Unit, & Philippine Health Insurance System > Phil Health_UHC > Flashcards

Phil Health_UHC Flashcards

1
Q

Laws developed in response to the public’s clamor for more comprehensive health insurances were

A

→ House Bill 14225

→ Senate Bil 01738

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2
Q 
The Act that Established the National Health
Insurance Program (NHIP)
A

Republic Act 7875

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3
Q

When was NHIP signed

A

February 14, 1995

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4
Q

Established to be the agency that will administer the NHIP

A

Philippine Health Insurance Corporation

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5
Q

Programs that Philhealth took over its administration

A
  1. GSIS
  2. SSS
  3. OWWA
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6
Q

Laws that ensured coverage of the poor and the

marginalized

A
  1. RA 9241

2. RA 10606

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7
Q

Vision of Philhealth

A

All Filipinos are members and must have health protection and security

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8
Q

Mission of Philhealth

A

Quality Health Benefit for all

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9
Q

Core values of PhilHealth

A
  1. Agility
  2. Commitment
  3. Compassion
  4. Equity
  5. Innovation
  6. Integrity
  7. Social solidarity
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10
Q

Type of PHILHEALTH MEMBERS with formal contracts and fixed terms of employment including workers in the government and private sectors.

A

FORMAL ECONOMY

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11
Q

Non-PhilHealth members which include workers not covered by formal contracts and whose premium contributions are self-paid or subsidized.

A

INFORMAL ECONOMY

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12
Q

Under formal economy

A

Those rendering services, whether in
government or private offices, such as joborder
contractors and project-based
contractors.

Owners of micro, small, medium, and large
enterprises

Household help

Family drivers

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13
Q

Under Informal economy

A

Migrant workers

Street hawkers

Self-earning individuals

Filipinos with dual citizenship

Naturalized Filipino citizens

Citizens of other countries working and/or
residing in the Philippines

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14
Q

members whos premium contributions are paid for by another individual

A

SPONSORED MEMBERS

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15
Q

Members who have no visible means of income, or whose income is insufficient for family subsistence.

A

INDIGENT MEMBERS

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16
Q

Organization that compiles the definitive list of indigent members

A

National Household Targeting System (NHTS)

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17
Q

PhilHealth members who have reached the age of retirement (60 yrs. Old) have mad at least 120 monthly contributions, and have retired

A

LIFETIME MEMBERS

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18
Q

All elderly Filipinos who are 60 years

old and above and who are not covered under any of the other member categories of the NHIP

A

Senior citizens

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19
Q

6 Types of PhilHealth Members

A
  1. Formal economy
  2. Informal economy
  3. Sponsored members
  4. Indigent members
  5. Lifetime members
  6. Senior citizens
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20
Q

Where does funding for the senior citizen membership come from?

A

Sin tax

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21
Q

An Act providing for the mandatory PhilHealth coverage for all Senior Citizens

A

Republic Act No. 10645

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22
Q

PhilHealth Members going by the family-based membership coverage of PhilHealth.

A

LEGAL DEPENDENTS

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23
Q

A person intending to register as member should only submit a properly accomplished…..

A 
PhilHealth Member
Registration Form (PMRF)
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24
Q

What happens if you dont have a PhilHealth ID

A

The absence of the ID shall not prejudice the right of any member to avail of benefits or medical services under the Program.

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25
Q

Deadline of monthly Philhealth payment

A

Last working day of the month

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26
Q

What happens if a member has a gap of one or two months within the current quarter?

A

given a grace period of until the last day of the said quarter to settle the premium amount

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27
Q

How long can you go with advance payments to PhilHealth

A

up to 36 months

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28
Q

How to pay to PhilHealth

A

through ACAs (accredited collecting agents) and LHIO (Local Health Insurance Office)

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29
Q

Types of PhilHealth benefits are

A
  1. Inpatient benefits
  2. Outpatient benefit
  3. Primary Care Benefits (PCB) or “Tsekap”
  4. Catastrophic or Z-Benefits
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30
Q

How PhilHealth helps with illnessess requiring hospitalization

A

provides in-patient coverage for confinements of not less than 24 hours through any of the 1,064 accredited health care institutions nationwide

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31
Q

Method of payment for PhilHealth benefits

A

Case-based mechanism

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32
Q

Covered services by PhilHealth benefits

A
  1. Professional Fees

2. Health Care Institution charge

33
Q

Who is entitled to No Balance billing?

A
  1. Sponsored and indigent program members

2. legal dependents

34
Q

Purpose of No Balance Billing

A

Entitled benefactors need not pay any amount in

excess of what PhilHealth provides as coverage for these medical conditions.

35
Q

What are primary Care benefits

A

Primary preventive services,

diagnostic examinations, and drugs and medicines

36
Q

What are Expanded Primary Care Benefits

A

Primary preventive services for PhilHealth under the Formal Sector, Senior Citizens, and Lifetime Members and their qualified dependents.

37
Q

How are Primary Care benefits availed

A

Through Rural Health Units (RHU) and Outpatient Department (OPD) of government hospitals

38
Q

Components of the health care delivery system for Primary Care provider benefits

A
  1. Navigator
  2. Coordinator
  3. Initial and continuing point of contact
39
Q

benefit packages for selected catastrophic medical conditions that will require prolonged hospitalization and very expensive.

A

Catastrophic or Z-benefit packages

40
Q

Groups who can avail of the NBB policy for Z-benefit

packages include

A
  1. Indigents
  2. Sponsored
  3. Kasambahay
  4. Senior Citizens
  5. Lifetime members
  6. iGroup gold with existing group policy contract
41
Q

Eligibility of Patients who already availed of the Z-benefits

A

shall not be eligible for the same procedure in the same site for the next 5 years.

42
Q

Z-benefit offered in St. Pauls

A
  • Kidney Transplantation

- Peritoneal dialysis (PD) first

43
Q

Z-benefits offered in Western Visayas Medical Center

A
  • Acute Lymphocytic Leukemia
  • Breast CA
  • Coronary Artery Bypass Graft (CABG)
  • Prostate CA
  • Rheumatic Heart Fever (RHF)
  • Tetralogy of Fallot (TOF)
  • Ventricular Septal Defect (VSD)
44
Q

Z-benefits offered in Corazon Locsin Montelibano Memorial Regional Hospital

A
  • Acute Lymphocytic Leukemia
  • Breast CA
  • Orthopedic Implants (Selected)
  • Prostate CA
45
Q

Z-benefits offered in The Medical City Iloilo

A

-Coronary Artery Bypass (CABG)

46
Q

What are covered for Outpatient benefits

A
  • Cataract surgery (<24 hours)

* Herniography (<24 hours)

47
Q

Who provides for Outpatient benefits

A

All Accredited healthcare providers

48
Q

Services offered for Outpatient benefits

A

Facility Fees
• Room and board
• Drugs and medicines

49
Q

Payment mechanism for Outpatient benefits

A

Case-based mechanism with fixed rate across all member categories

50
Q

PHILHEALTH KONSULTA PACKAGE Goals

A

Expanding the Primary Care Benefit to Cover all Filipinos by integrating the existing PCB and EPCB Package

51
Q

PHILHEALTH KONSULTA PACKAGE targeted services

A
  1. Consultation
  2. Health screening and assessment
  3. Laboratories
  4. Drugs and medicines
52
Q

Who is entitled to Z-benefits

A

Covers primary diseases conditions perceived as

medically and economically “catastrophic”

53
Q

What are they types Packages for treatment of emerging disease as part of the 3 millennium development goals

A

Maternity Care Package, Outpatient HIV/AIDS Treatment, Ebola, MERS-CoV, Zika

54
Q

Stated to “…adopt an integrated and comprehensive
approach to ensure that all Filipinos are protected
from hazards and risks that could affect their health.”

A

PhilHealth Board Resolution No. 2497, s.2020

55
Q

Established the universal health care and was signed into law by president Rodrigo Roa Duterte on February 20, 2019.

A

Republic Act 11223

56
Q

Principles of RA 11223

A

→ Integrated and comprehensive approach to ensure health literacy, healthy living, and protection from hazards and risks.

→ Health care model that provides comprehensive
health services without causing financial hardship.

57
Q

UHC coverages

A
  1. Population coverage (SEC. 5)
  2. SERVICE COVERAGE AND ENTITLEMENT TO BENEFITS (SEC. 6 & 9)
  3. FINANCIAL COVERAGE (SEC. 7)
58
Q

Who are part of the Direct contributors for PROGRAM MEMBERSHIP

A

Those who have the capacity to pay premiums.

59
Q

Who are part of the Indirect contributors for PROGRAM MEMBERSHIP

A

All others NOT INCLUDED as direct contributors, as well as their qualified dependents.

60
Q

Section that allows every Filipino shall be granted immediate eligibility and access to all health care services

A

Section 6 (Service Coverage)

61
Q

Section that allows every member shall be granted immediate eligibility for health benefit package under the program.

A

Section 9 (Entitlement to Benefits)

62
Q

Is PhilHealth ID required for availing in Sect. 9 services?

A

No

63
Q

Co-payments and co-insurance for amenities in public hospitals under Section 9 shall be regulated by

A

DOH and PhilHealth

64
Q

What are the two (2) membership categories under Section 6

A

Direct and Indirect Contributors

65
Q

Are there any reduction in current PhilHealth package under Section 9?

A

No

66
Q

Under the event of Failure to pay premiums under Section 9

A

It shall not prevent the enjoyment of any program benefits.

67
Q

Who is responsible for financing the Population-based health services under Section 7?

A

The National Government through the DOH

68
Q

How will individual based health services be financed under Section 7?

A

Through prepayment mechanisms such as
social health insurance, private insurance, and HMO
plans

69
Q

What service and section wherein the DOH shall endeavor to contract province-wide and city-wide health systems for the delivery of population-based health services

A

Population-based Health Services under Section 7

70
Q

Minimum components of population based health services

A
  1. Primary care provider network with patient records accessible throughout the health system
  2. Accurate, sensitive and timely epidemiological
    surveillance systems
  3. Proactive and effective health promotion programs
    or campaigns
71
Q

Service wherein PhilHealth is to contract public, private or mixed health care provider networks that would agree on providing health data

A

Individual based Health Services.

72
Q

Role of Provincial/City Health board

A

Oversees and coordinate the integration and delivery of health services and Manages special health fund

73
Q

Section where The province-wide and city-wide health systems shall pool and manage all resources intended for health services through a Special Health Fund (SHF).

A

SPECIAL HEALTH FUND (SEC. 20)

74
Q

Income derived from PhilHealth payments shall accrue to the Special Health Fund and credited as…..

A

Annual Regular Income (ARI) of the LGU.

75
Q

Source of Special health fund

A
  1. Financial grants
  2. PhilHealth payments
  3. NGOs, churches and Official development assistance
76
Q

Fine for Offenses committed by the health care provider for the provisions of individual - based health services are classified as fraudulent acts, unethical acts, and abuse of authority

A

200,000 for each count, or

suspension of contract up to 3 months

77
Q

Fine for offenses Committed by a member wherein any violation of the Act or fails to pay all missed contributions with an interest,

A

P50,000 for each count or suspension from availment of the benefits of the Program for not less than 3 months but not more than 6 months

78
Q

Fine for offenses committed by an employer wherein Failure or Refusal to Register Employees, Failure or Refusal to Deduct Contributions, Failure or Refusal to Accurately and Timely Remit Contributions, Failure to Refusal to Submit Report

A

P50,000.00 for every violation per affected employee, or imprisonment of not less than six (6) months but not more than one (1) year

79
Q

Fine for offenses committed by a Director or employee wherein he/she Commits an unethical act, abuse of authority, or performs a fraudulent act

A

P200,000 or suspension for 3 months without pay. Or imprisonment for 6 months and 1 day up to 6 years.

State of Health of the Philippines, the Philippine Health System, The Department of Health The Municipal Health Unit, & Philippine Health Insurance System (2 decks)

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