Wednesday, April 29, 2015

PhilHealth to pursue negligent employers

The Philippine Health Insurance Corporation (PhilHealth) recently announced that it will run after employers who have failed to fulfill their obligations to their employees and to the state-run health insurer.

“We do not want any employee or their dependents to experience non-availment of PhilHealth benefits because of the employers’ negligence,” said PhilHealth President and CEO Alexander A. Padilla, “that is why we are issuing this reminder for the benefit of over 13 million employees, both in the public and private sectors.”

Reports have reached PhilHealth about erring employers who either do not remit the premium contributions deducted from a member’s monthly salary; do not remit the correct amount promptly; or do not submit the required remittance reports on schedule, thereby causing anxiety among employees who expect to avail themselves of the benefits at point-of-service.

According to Padilla, failure of employers to remit the required contributions and submit remittance reports shall make them liable for reimbursement of payment of a properly filed claim of their employees, as prescribed under Section 18(d) of the Revised Implementing Rules and Regulations of the National Health Insurance Act of 2013.

Through Circular No. 003, s-2015, PhilHealth stressed its authority to recover the full amount of claim payments from employers for properly filed claims by employed members and their dependents who were later found out to have no qualifying contributions.
These erring employers shall also be penalized with a fine of not less than P5,000 multiplied by the total number of employees for failure or refusal to register or deduct PhilHealth premium contributions. In the same manner, a fine of not less than P5,000 but not more than P10,000 multiplied by the total number of employees shall be applied for employers who refused or failed to remit and report contributions.

Delinquent employers are those who have missed monthly premium contributions in behalf of its employees for at least one month within a six-month period. Under-remitting employers, on the other hand, are those who remitted and reported contributions that are less than the prescribed amount or those who remitted accurate contributions but did not include all its employees.

The circular also defines non-remitting employers as those who have not remitted any premium contributions to PhilHealth from the start of its operations or for six months or more, while non-reporting employers are those that may or may not have remitted premium contributions and have not submitted any report for at least one month within a period of six month. (PhilHealth)

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