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Highlights of the Mandates and Objectives of GSIS, SSS, Philhealth, and other Leading Private Insurance Companies in the Philippines Prepared by Engr. MARLON D. MATA, RMP, MEngg.ME. PhD.TM. Student
GSIS MANDATES Created by Commonwealth Act No. 186 and Republic Act No. 8291 (GSIS Act of 1997), GSIS is a social insurance institution that provides a defined benefit scheme under the law. It insures its members against the occurrence of certain contingencies in exchange for their monthly premium contributions. GSIS members are entitled to an array of social security benefits, such as life insurance benefits, separation or retirement benefits, and disability benefits.
GSIS is also the administrator of the General Insurance Fund by virtue of RA 656 (Property Insurance Law). It provides insurance coverage to government assets and properties that have government insurable interests.
GSIS VISION By 2022, GSIS will have a longer actuarial life with sustained member benefits and responsive service to its stakeholders.
GSIS MISSION GSIS commits to – • Provide social security/insurance and financial benefits to all government employees and their dependents; • Satisfy the non-life insurance needs of government; • Maintain and strengthen the viability of the fund; and • Build an enduring partnership with its stakeholders.
GSIS COVERAGE • The GSIS covers all government workers except:– Members of the Judiciary and Constitutional Commissions who are covered by separate retirement laws;– Contractual employees who have no employee-employer relationship with their agencies;– Uniformed members of the Armed Forces of the Philippines and the Philippine National Police, including the Bureau of Jail Management and Penology and the Bureau of Fire Protection.
GSIS COVERAGE • Does not include: Barangay and Sanggunian officials who are not receiving fixed monthly compensation (Source RIRR) • Does not include: Employees who do not have monthly regular hours of work and are not receiving fixed monthly compensation (RIRR)
GSIS BENEFITS AND SERVICES • The principal benefit package of the GSIS consists of compulsory and optional life insurance, retirement, separation, and employee’s compensation benefits.
GSIS SERVICE PRIVILEGES • GSIS offers the following loan products to assist you with your financial needs: Enhanced Consolidated Salary Loan (ConsoLoan) Plus, Policy Loan, Enhanced Emergency Loan, Pension Loan, and Pensioners Emergency Loan.
GSIS ORGANIZATION • The governing and policy-making body of the GSIS is the Board of Trustees, the members of which are appointed by the President of the Philippines.
GSIS ORGANIZATION • The GSIS workforce consists of 3,104 employees, 52% of whom are in the Head Office while the remaining 48% are in the Branches. To date, the GSIS has 42 Branch Offices, 14 Extension Offices nationwide and 58 service desks.
SSS MANDATES "It is the policy of the State to establish, develop, promote and perfect a sound and viable tax-exempt social security system suitable to the needs of the people throughout the Philippines which shall promote social justice through savings, and ensure meaningful social security protection to members
and their beneficiaries against the hazards of disability, sickness, maternity, old age, death, and other contingencies resulting in loss of income or financial burden. Towards this end, the State shall endeavor to extend social security protection to Filipino workers, local or overseas, and their beneficiaries.
In the pursuit of this policy, a social security program shall be developed emphasizing the value of “work, save, invest and prosper”. The maximum profitability of investible funds and resources of the program shall be ensured through a culture of excellence in management grounded upon sound and efficient policies employing internationally recognized best practices." (Section 2, RA 11199)
SSS VISION A viable social security institution providing universal and equitable social protection through world-class service.
SSS MISSION To manage a financially stable social security system which shall promote social justice through savings, and provide meaningful protection and exemplary service to members and their families.
SSS CORPORATE VALUES The SSS aims to institutionalize a corporate culture that instills the core values of trust, empowerment and teamwork.
Philhealth MANDATES The National Health Insurance Program was established to provide health insurance coverage and ensure affordable, acceptable, available and accessible health care services for all citizens of the Philippines. It shall serve as the means for the healthy to help pay for the care of the sick and for those who can afford medical care to subsidize those who cannot.
It shall initially consist of Programs I and II or Medicare and be expanded progressively to constitute one universal health insurance program for the entire population. The program shall include a sustainable system of funds constitution, collection, management and disbursement for financing the availment of a basic minimum package and other supplementary packages of health insurance benefits by a progressively expanding proportion of the population.
The program shall be limited to paying for the utilization of health services by covered beneficiaries. It shall be prohibited from providing health care directly, from buying and dispensing drugs and pharmaceuticals, from employing physicians and other professionals for the purpose of directly rendering care, and from owning or investing in health care facilities. (Article III, Section 5 of RA 7875 as amended)
Philhealth Powers and Functions PhilHealth is a tax-exempt Government Corporation attached to the Department of Health for policy coordination and guidance. (Article IV, Section 15 of RA 7875 as amended). It shall have the following powers and functions (Article IV, Section 16 of RA 7875 as amended by RA 10606):
a) To administer the National Health Insurance Program; • b) To formulate and promulgate policies for the sound administration of the Program; • c) To supervise the provision of health benefits and to set standards, rules and regulations necessary to ensure quality of care, appropriate utilization of services, fund viability, member satisfaction, and overall accomplishment of Program objectives;
d) To formulate and implement guidelines on contributions and benefits; portability of benefits, cost containment and quality assurance; and health care provider arrangements, payment, methods, and referral systems; • e) To establish branch offices as mandated in Article V of this Act; • f) To receive and manage grants, donations, and other forms of assistance;
g) To sue and be sued in court; • h) To acquire property, real and personal, which may be necessary or expedient for the attainment of the purposes of this Act; • i) To collect, deposit, invest, administer, and disburse the National Health Insurance Fund in accordance with the provisions of this Act;
j) To negotiate and enter into contracts with health care institutions, professionals, and other persons, juridical or natural, regarding the pricing, payment mechanisms, design and implementation of administrative and operating systems and procedures, financing, and delivery of health services in behalf of its members;
k) To authorize Local Health Insurance Offices to negotiate and enter into contracts in the name and on behalf of the Corporation with any accredited government or private sector health provider organization, including but not limited to health maintenance organizations, cooperatives and medical foundations, for the provision of at least the minimum package of personal health services prescribed by the Corporation;
l) To determine requirements and issue guidelines for the accreditation of health care providers for the Program in accordance with this Act;
m) To visit, enter and inspect facilities of health care providers and employers during office hours, unless there is reason to believe that inspection has to be done beyond office hours, and where applicable, secure copies of their medical, financial, and other records and data pertinent to the claims, accreditation, premium contribution, and that of their patients or employees, who are members of the Program;
n) To organize its office, fix the compensation of and appoint personnel as may be deemed necessary and upon the recommendation of the president of the Corporation;
o) To submit to the President of the Philippines and to both Houses of Congress its Annual Report which shall contain the status of the National Health Insurance Fund, its total disbursements, reserves, average costing to beneficiaries, any request for additional appropriation, and other data pertinent to the implementation of the Program and publish a synopsis of such report in two (2) newspapers of general circulation;
p) To keep records of the operations of the Corporation and investments of the National Health Insurance Fund; • q) To establish and maintain an electronic database of all its members and ensure its security to facilitate efficient and effective services;
r) To invest in the acceleration of the Corporation’s information technology systems;
s) To conduct information campaign on the principles of the NHIP to the public and to accredited health care providers. This campaign must include the current benefit packages provided by the Corporation, the mechanisms to avail of the current benefit packages, the list of accredited and disaccredited health care providers, and the list of offices/branches where members can pay or check the status of paid health premiums;
t) To conduct post audit on the quality of services rendered by health care providers; • u) To establish an office, or where it is not feasible, designate a focal person in every Philippine Consular Office in all countries where there are Filipino citizens. The office or the focal person shall, among others, process, review and pay the claims of the overseas Filipino workers (OFWs);
v) Notwithstanding the provisions of any law to the contrary, to impose interest and/or surcharges of not exceeding three percent (3%) per month, as may be fixed by the Corporation, in case of any delay in the remittance of contributions which are due within the prescribed period by an employer, whether public or private. Notwithstanding the provisions of any law to the contrary, the Corporation may also compromise, waive or release, in whole or in part, such interest or surcharges imposed upon employers regardless of the amount involved under such valid terms and conditions it may prescribe;
w) To endeavour to support the use of technology in the delivery of health care services especially in farflung areas such as, but not limited to, telemedicine, electronic health record, and the establishment of a comprehensive health database; • x) To monitor compliance by the regulatory agencies with the requirements of this Act and to carry out necessary actions to enforce compliance;
y) To mandate the national agencies and LGUs to require proof of PhilHealth membership before doing business with a private individual or group; • z) To accredit independent pharmacies and retail drug outlets; and • aa) To perform such other acts as it may deem appropriate for the attainment of the objectives of the Corporation and for the proper enforcement of the provisions of this Act.
1.4 Private Insurance Companies (Manulife, Pru Life UK, Sunlife)
With headquarters in Canada, Manulife is proud to take care of the financial and protection needs of more than 28 million customers worldwide, providing a wide range of insurance, investment, wealth management and financial planning services.
Their principal operations are in Asia, Canada and the United States where they have served customers for more than 100 years. They trade as 'MFC' on the Toronto, New York, and the Philippine stock exchanges and under '945' in Hong Kong.
MANULIFE MISSION • Their mission is to make the complex world of financial and insurance services easier to understand, so it’s easier for customers to make better decisions about their lives. • They’ve summarised this simply as Decisions made easier. Lives made better. It’s a simple statement, yet a bold mission to achieve.
They are committed to: • dealing honestly and fairly with their public; • exceeding customer expectation in services and products; • caring for the well-being and development of their people; • giving a fair return to our stakeholders; and • contributing to the development of the Filipino community.
Their guiding principles: • They maintain and develop the Company’s reputation for integrity, fair dealing and security. • They work as a team, as a family, unified in purpose, treating each other with respect and care in an atmosphere of mutual trust and in a happy working environment. • They promote the art of listening as it is only in listening to the needs of our customers that they can know and understand their specific needs.
They communicate openly and constantly with our customers and their own people. • They develop themselves continually to their fullest potential to keep improving the quality of everything they do. • They maintain a strong financial position to meet their promise of financial stability to all their customers.
They are accurate and timely. • They have a strong sense of responsibility and will work toward the achievement of the Philippines’ economic goal.
