All there is to know about PhilHealth’s No Balance Billing Policy

In the Philippines, did you know that it is actually possible to avail of healthcare services without spending a single peso?

The Philippine Health Insurance Corporation (PhilHealth) strongly advocates for the advancement of Universal Health Care in the country to ensure that all Filipinos can access affordable and equitable healthcare services they need without experiencing financial hardship.

The implementation of the “No Balance Billing Policy” (NBB) is one of the direct translations of this advocacy.

Under the Republic Act 10606, otherwise known as the National Health Insurance Act of 2013, the qualified members of PhilHealth are given the privilege to seek medical care for free provided that it is under the services of the accredited health facilities of the corporation.

Who are covered by the NBB Policy?

While all members are equally cared for by PhilHealth as the state health insurer, not everyone is eligible to claim the benefits of the NBB Policy.

In line with the corporation guidelines, there are specific members to which the policy applies. These are the following:

  • Indigent – Filipinos with no visible and classified means of income to sufficiently provide for the needs of their families as identified by the Department of Social Welfare and Development (DSWD).
  • Sponsored – Members of the corporation whose contributions are being paid for by other individual or public and private entities including the national and local government, non-government organizations, and other sponsors.
  • Household Helpers – Filipinos engaged in domestic work or general househelp within an employment relationship as stipulated in Republic Act No. 10361 or the “Batas Kasambahay.”
  • Senior Citizens – Filipinos aged 60 years old and above who are automatically registered as PhilHealth members regardless if they are paying the contribution or not.
  • Lifetime – Members aged 60 years and above who have paid at least 120 monthly contributions to PhilHealth and other former medicare programs of the Social Security System (SSS) and the Government Service Insurance System (GSIS).
    Meanwhile, PhilHealth members who are employees of the national government, private sector, and other organized groups including self-earning individuals, migrant workers, and overseas Filipino workers (OFW) do not fall under the eligible beneficiaries of the policy.

The health facilities with accreditation from PhilHealth have the responsibility to create their own effective mechanism to identify the patients who are covered by the NBB Policy.

This is to ensure the strict application of the mandatory or statutory discounts to the medical expenses incurred by PhilHealth members during hospitalization.

The provision of the benefits as mandated by the NBB Policy should be automatic and no qualified patients should be categorized as indigent, partially paid, or fully paid using the guidelines from the Department of Health (DOH) once the mandatory discounts are applied.

What health benefits or services are covered by the NBB Policy?

Through the NBB Policy, member-patients are given quality access to the range of preventive, promotive, curative, and rehabilitative healthcare services without worrying about out-of-pocket expenses.

Be it hospital room, food, medicines, medical supplies, laboratory facilities, and doctor’s professional fee–the PhilHealth benefits covered by the NBB Policy should suffice the hospitalization charges.

Among the benefits which are also covered by the policy include those that are paid through Case Rates, Case Type Z, Primary Care Benefit (PCB), and other packages such as the MERS-CoV and Ebola Virus Disease.

In this regard, patients are no longer required to pay any services and are not obliged to give monetary donations aside from the coverage provided by PhilHealth membership.

However, in the event that the patient has more than one (1) membership benefit from PhilHealth, the membership with the privilege of NBB policy shall be honored by the health facility.

What health facilities implement the NBB Policy?

Only PhilHealth-accredited government health facilities are obliged to implement the NBB Policy.

These include public hospitals, ambulatory surgical clinics, dialysis centers, infirmaries, dispensaries, TB-DOTS centers, maternity clinics, PCB, as well as Animal Bite and OHAT (Outpatient HIV/AIDS Treatment) providers.

On the other hand, the NBB Policy only applies to private health facilities with contracted facilities for Z Benefit Packages, Ambulatory Surgical Clinics, Freestanding and Peritoneal Dialysis Centers, TB-DOTS Centers, Birthing Homes, PCB Providers, and Infirmaries and Dispensaries but limited to normal spontaneous delivery as well as maternity, ante-natal, and newborn care package.

Other than these services, private hospitals can voluntarily apply the NBB Policy as they see fit.

In retrospect, having access to the highest attainable standard of healthcare is as important as any other realization of universal rights.

Any violation to this right should be considered as a direct attempt to hamper our fundamental freedom to have a sense of well-being.

In an effort to protect the rights of Filipinos to healthcare, PhilHealth provides for a Performance Commitment Agreement to guarantee the compliance of accredited health facilities with the quality delivery of sought services. (PIA-NCR)

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