Aquino EO: Insurance Commission to oversee health maintenance orgs

MANILA, Philippines – President Benigno Aquino III has signed an executive order transferring the regulation and supervision over health maintenance organizations (HMOs) to the Insurance Commission (IC) from the Department of Health (DOH).

Under Executive Order No. 192, signed on November 12 and released November 26, IC, in coordination with the Department of Budget and Management, will have authority to do the following:

• Issue rules and guidelines with respect to the establishment of HMO minimum capitalization, net worth, reserve funds, and security deposit requirements
• Issue criteria for qualification and disqualification of directors, officers, and marketing personnel, and the submission of reportorial and/or examination requirements, registration of contracts and plans, adjudication of claims, and other relevant matters, as necessary
• Approve, amend, renew, decline, suspend, or revoke any license, registration, or certificate of authority issued in favor of HMOs
• Fix, assess, collect, and utilize fees and/or changes as it may find reasonable in the exercise of regulatory powers
• Regulate, supervise, and monitor the operations and management of HMOs to ensure compliance with the order, existing laws, rules and regulations, and such other directives and circulars issued by the Insurance Commissioner

Fraud prevention
EO No. 192 also allows the IC to issue orders to prevent fraud and injury to the HMO plan holders and industry stakeholders; order examination of documents, papers, files, tax returns, books of accounts and other records.

Also, in whatever form, IC would be allowed to issue orders against any entity, person, or any HMO under investigation, including persons, entities and/or corporations with related interests; and impose sanctions and/or appropriate penalties pursuant to existing laws, rules, and regulations.

All HMOs, whether investor-based, community-based or cooperative, are required to comply with the regulatory requirements of procuring a license to operate from the IC.

The IC shall honor previously issued “clearance to operate” by the DOH subject to modifications, revisions, adjustments, and changes as may be provided in the implementing rules and regulations.

Transition

The DOH and IC may enter into inter-agency agreements to ensure the full and appropriate transfer of all functions related to HMOs including, but not limited to, temporary detail of DOH personnel concerned to the IC.

An oversight committee composed of the Secretary of Finance as chairman, with the Secretary of Health and the Insurance Commissioner as members, will be created to ensure the effective transfer of the jurisdiction and regulation of HMOs to the IC.

The committee shall exist until June 30, 2016.

In a statement from the Department of Finance released Wednesday, December 2, Insurance Commissioner Emmanuel Dooc said his agency is ready to take on the responsibility.

“We have championed good corporate governance among insurance companies for the benefit of everyday Filipinos availing of insurance products. We have promoted the solvency and stability of the insurance and pre-need industries to protect the interests of the consumers. We intend to apply the same principles in regulating HMOs,” Dooc said.

In the same statement, Finance Secretary Cesar Purisima welcomed the transfer and said, “It is important that government grows leaner and more agile, the better to efficiently deliver on regulatory functions for our people.” – Rappler.com

Doctor / health care provider concept image from Shutterstock