Philhealthcare, In. “PhilCare” Affiliated Physician’s Terms and Conditions
This Terms and Conditions explains how the agreement is made up and sets out the terms and conditions of the agreement between PhilCare and the Affiliated Physician “PARTICIPATING PHYSICIAN”.
1.1. In order for the PARTICIPATING PHYSICIAN to provide medical services to PhilCare members, he must first agree to the terms and conditions and to the data privacy policy philcare.com.ph/md/privacypolicy.
1.2. He can accept the Terms and Conditions by:
1.2.1 Signing the PhilCare Physician Data Sheet and Conforme and providing a copy to PhilCare through [email protected] or
1.2.2 Expressing a written intent to be affiliated with PhilCare and abide by its terms and conditions set forth here through email to [email protected].
1.3. We encourage the PHYSICIAN to print or store a digital a copy of this terms and conditions for his records.
2.1. The PARTICIPATING PHYSICIAN agrees to:
2.1.1 Render professional medical care to Members when requested by PHILCARE through a Letter of Authorization (LOA) at duly designated hospitals or clinics, giving them always his best talent and skills, and exercising at all times the highest degree of care, attention, and diligence. The medical services and treatment provided shall be consistent with the standards set by the Professional Regulations Commission (PRC) or any regulatory agency that monitor the practice of the medical profession.
2.1.2 Attend to the consultation and treatment within the limits of his profession and specialization.
2.1.3 Thoroughly examine the Member to properly determine his/her health problem. This examination shall include any necessary diagnostic work-up consistent with the nature of the problem which shall be referred first to PHILCARE’s Coordinator for approval and / or issuance of a request form with a view to deliver the necessary health care attention in a cost-effective way.
2.1.4 In case the member demands that a certain procedure or surgery be done on him / her when in the assessment of the PARTICIPATING PHYSICIAN such procedure may NOT be necessary, the PARTICIPATING PHYSICIAN shall inform the member of his / her assessment and the said procedure or surgery shall be for the account of the member. In every case, the PARTICIPATING PHYSICIAN shall submit to PHILCARE’s Coordinator and/or Medical Director all records of services performed on every member for proper administration.
2.1.5 Refer to other PhilCare affiliated PARTICIPATING PHYSICIAN and or to AFFILIATED PHILCARE HOSPITAL.
2.1.6 Curtail any unnecessary confinement of the member and / or avoid inappropriate or unjustified procedures to be done on said member.
2.1.7 Prepare and accomplish the necessary documents for various purposes such as referral and request forms, medical record, billing and other report that may be required by PhilCare.
2.1.8 That any service provided without prior authorization as evidenced by an issued LOA will not be eligible for payment from PHILCARE.
2.1.9 Not to engage in Balance Billing. Any form of Balance Billing will be considered as a basis for automatic disaffiliation. Furthermore, the PARTICIPATING PHYSICIAN shall not enter into any private arrangements with the PhilCare Member, even with the latter’s consent. Should a Member or any of his dependent/s exceed his/their Maximum Benefit Limit, the PARTICIPATING PHYSICIAN is obligated to maintain PhilCare rates. Once the PARTICIPATING PHYSICIAN charges more than PhilCare rates, the excess will no longer be paid for by PhilCare and the PARTICIPATING PHYSICIAN is immediately disaffiliated.
2.1.10 The PARTICIPATING PHYSICIAN agrees to disclose to PhilCare, including its employees agents or representatives records/information, relative to a PhilCare Member’s availment or any other medical advice in connection with the application of benefit/claim under the service agreement and/or relevant LOA, as each may be amended or supplemented from time to time, upon PhilCare’s presentation of proof of Member’s consent.
3.1. The PARTICIPATING PHYSICIAN hereby warrants the following:
3.1.1 That he/she is a duly licensed physician of the Republic of the Philippines.
3.1.2 That he /she has sufficient medical knowledge, background, and experience to undertake this specialization.
3.1.3 That he/she shall email PhilCare through [email protected], within 15 days from submitting the signed Physician Data Sheet and Conforme, the latest documents enumerated below. PhilCare reserves the right to hold the processing of the affiliation of the PARTICIPATING PHYSICIAN if one of these documents is not provided. Furthermore, he/she shall immediately inform and submit to PhilCare in case of any change or update to these documents:
3.1.3.1 Bureau of Internal Revenue Certificate of Registration or Form 2303;
3.1.3.2 Professional Regulations Commissions Professional Physician ID;
3.1.3.3 Diplomate or Fellow Certificate from his/her respective specialty society; and
3.1.3.4 Curriculum Vitae.
4.1 The PARTICIPATING PHYSICIAN agrees to forward to PhilCare all valid bills incurred by its Members not later than thirty (30) days from availment date when conducted in the National Capital Region, and not later than sixty (60) days from availment date when conducted in the provinces.
4.2 Bills submitted shall include the following:
4.2.1 Statement of account (SOA) listing the names of PhilCare members seen along with their date of availment;
4.2.2 Letter of Authorization (LOA) Form;
4.2.3 Operative Technique (if applicable); and
4.2.4 Other documents which may be required by PhilCare to process the payment.
4.3 Billing Documents sent by post or courier are considered received by PhilCare upon receipt by PhilCare’s authorized representative. Failure to submit the Billing Documents within the agreed term shall no longer be subject for payment.
4.4 PhilCare shall compensate the PARTICIPATING PHYSICIAN based on the following fee-for-service schedule as provided in Table 1, Schedule of Fees.
5.1 The Philhealth benefits shall, when applicable be deducted from the professional fee. The application forms, papers and/or reports in support thereof or pertinent thereto shall be duly accomplished and filed on/or before the date of discharge of the Member. In the event that the Member fails to file the Philhealth documents on time, the Member will pay the cost equivalent of the Philhealth portion of the professional fee of the doctor and PhilCare will not be held liable for these charges after the discharge of the member. The PARTICIPATING PHYSICIAN shall not hold PhilCare liable for these charges.
6.1 The PARTICIPATING PHYSICIAN is an independent contractor and is not in any way, or for any purpose, be considered as an employee, partner, or co-venturer of, or in any other relationship with PhilCare.
6.2 In this regard, PhilCare shall not assume any statutory employer obligations such as but not limited to, social Security, Medicare and Employees compensation premiums. Neither is PhilCare responsible in any manner for any claim for personal injury or damage, including death which may be suffered by the PARTICIPATING PHYSICIAN.
6.3 The Participating Physician, in accordance with law, shall issue an Official Receipt to cover every payment made by PhilCare.
6.4 The manner in which the PARTICIPATING PHYSICIAN conducts the physical examination, immunization, diagnosis or treatment of the Members shall be within the PARTICIPATING PHYSICIAN’s sole control and discretion, subject to high professional standards of work and business ethics including, but not limited to, the PARTICIPATING PHYSICIAN’s covenants as provided under Article 3 hereof.
7.1 The PHYSICIAN agrees to hold PHILCARE, its officers, agents, successors-in-interest, assigns and all parties-at-interest therein or thereon, whether named or not named, free and harmless from any and all claims, demands, debts, dues, liens, actions or causes of action, at law or in equity, now held, owned or possessed by PHYSICIAN his / her heirs, successors-in-interest and assigns arising from, or related to, or concerning, either directly or indirectly, proximately or remotely, without being limited to but including his / her affiliation / accreditation with PHILCARE, for any claim or liability to third person whether in contract, tort, or otherwise arising out of or related to any of his / her omission.
8.1 The Parties agree that neither Party shall offer or provide gifts to any employee or representative of the other Party, excepting small gifts of negligible value during the holiday season, and at all times only after obtaining the consent of the other Party. The Parties agree likewise that neither Party shall give preferential treatment to any employee or representative of the other Party, or supply said persons with any gift, remuneration or other benefit as a consequence of any of the official functions or responsibilities of said persons for either Party.
9.1 In case of breach of any of the provisions of this Agreement or failure on the part of the Physician to strictly adhere to the policies of PHILCARE, or in case of fraud, bad faith, gross or willful negligence on the part of the Participating Physician, and for any other cases specifically permitted by law, PHILCARE reserves the right to impose the appropriate sanctions which may include immediate termination of this Agreement, suspension of the issuance of LOA to the physician, with notice to the Participating Physician, without prejudice to all other legal rights and remedies provided by law and reimbursement and/or payment of all claims, losses, costs, damages, liabilities, or expenses due to PHILCARE.
9.2 This Agreement may be terminated by either Party prior to its expiration with or without cause as such Party may see fit, upon written notice to the other at least fifteen (15) days prior to the intended date of termination of the Agreement, and without any obligation by the terminating party to explain in case termination is without cause.
9.3 This Agreement may be terminated by PHILCARE immediately, by written notification to the Physician at least one (1) day prior to the intended date of termination, if Participating Physician breaches or fails in any material respects to perform or comply with any of his material covenants and agreements.
10.1 The Physician shall cease to be affiliated with PHILCARE and shall refrain from representing himself or herself as having any affiliation with PHILCARE based on this Agreement.
10.2 Any equipment provided by PHILCARE to the Physician in connection with or in furtherance of Physician’s services under this Agreement including, but not limited to, medical equipment and tools shall immediately be returned to PHILCARE upon termination of this Agreement.
10.3 Physician further agrees to return to PHILCARE all records, memoranda, manuscripts, sketches, calculations, correspondence, documents and properties in his custody and control belonging or pertaining to PHILCARE upon demand or termination of this Agreement.
10.4 The provisions on Confidentiality and Non-Solicitation herein shall survive the termination of this Agreement and shall remain in full force and effect.
10.5 The termination of this Agreement shall be without prejudice to any rights or claims of either Party, which may have accrued prior to the effectivity of such termination.
11.1 PhilCare may make changes to the Terms and Conditions from time to time. When these changes are made, PhilCare will make a copy of the Terms and Conditions available at https://philcare.com.ph/md/terms.
11.2 The PARTICIPATING PHYSICIAN understands and agrees that if he/she didn’t express any objection after thirty (30) calendar days on the effectivity of the new Terms and Conditions, PhilCare will treat the no objection as acceptance to the new terms and conditions.
12.1 PhilCare shall compensate the PARTICIPATING PHYSICIAN based on the following schedule of professional fees:
| Members of PCP (effective 1 July 2021), and PPS (effective 1 March 2022) | ||
| Members of PCP | Members of PPS | |
| Outpatient Consultation | 500.00 | 500.00 |
| Inpatient: (Medical Cases) | Per Day | Per Day |
| ICU / CCU | 1,600.00 | 1,600.00 |
| Suite Room | 1,400.00 | 1,400.00 |
| Private Room | 1,050.00 | 1,050.00 |
| Semi-Private Room | 950.00 | 950.00 |
| Ward | 750.00 | 750.00 |
| Cardio-Pulmonary Clearance |
Routine Outpatient and Inpatient Pre-procedure Medical Evaluation: 1,000.00 |
Pre-Procedure Outpatient and Inpatient Medical Evaluation with Medical Indication: 1,200.00 |
| Intra-Operative Monitoring | 1,600.00 | |
| Members of PCS (effective 1 March 2022), and POGS (effective 1 August 2022) | ||||
| Members of PCS | Members of POGS | |||
| Consultation | Surgical Procedure | Consultation | Surgical Procedure | |
| Outpatient | 600.00 | 140.00 x RVU | 550.00 | 140.00 x RVU |
| For Surgical Cases: Below amount multiplied by the Relative Value Unit (RVU) based on the Revised Value Scale (RVS) by PHIC https://www.philhealth.gov.ph/circulars/2009/circ10_2009.pdf inclusive of two (2) days pre-operative and five (5) days post-operative visits | ||||
| Inpatient | Per Day | Surgical Procedure | Per Day | Surgical Procedure |
| ICU Initial Visit / Follow up | 1,500.00 | n/a | 1,500.00 | n/a |
| Suite Room | 1,300.00 | 155.00 | 1,300.00 | 155.00 |
| Private Room | 1,000.00 | 150.00 | 1,300.00 | 150.00 |
| Semi-Private Room | 850.00 | 145.00 | 850.00 | 145.00 |
| Ward | 700.00 | 140.00 | 700.00 | 140.00 |
| Other Fees | ||||
| Surgical Clearance whether in the Emergency Room or inpatient | 1,200.00 | n/a | n/a | n/a |
| Obstetric Gynecologic Clearance personally seen in emergency room | n/a | n/a | 1,400.00 | n/a |
| Obstetric Gynecologic Clearance not personally seen in emergency room | n/a | n/a | 1,200.00 | n/a |
| For examinations done for procedures; and collection of Specimens done for cytology (pap’s smear, grams stain, wet smear) additional for consumables such as gloves, under pads, lubricating jelly, cytology brush and utilities expense | n/a | n/a | 350.00 | n/a |
| Wound Care | n/a | n/a | 350.00 | n/a |
| First Assistant Surgeon’s Fee - for surgeries with RVS of at least 250 units based on PHIC RVS | ||||
| Fellow / Diplomate | 25% of the main surgeon’s fee | |||
| Non-Fellow / Non-Diplomate, Non-Specialist Physician (excluding residents-in-training) | 10% of the main surgeon’s fee | |||
| Non-Members of PCP, PCS, POGS, and PPS | Members of PAFP (Effective 1 May 2022) | |
| Outpatient Consultation | 250.00 | 500.00 |
| Inpatient: (Medical Cases) | ||
| CU Initial Visit / Follow up | 1,200.00/day | |
| Suite Room | 1,000.00/day | |
| Private Room | 650.00/day | |
| Semi-Private Room | 550.00/day | |
| Ward | 450.00/day | |
| PSA Members | ||
| Anesthesiologist’s Fee | 50% of the Professional Fee of the Surgeon but not less than Php 2,000.00 | |
12.2 All rates are in Philippine Peso (PHP)
12.3 All Professional Fees are subject to withholding tax or VAT rates whichever is applicable
12.4 PCP – Philippine College of Physicians
12.5 PCS – Philippine College of Surgeons
12.6 POGS – Philippine Obstetrical and Gynecological Society
12.7 PPS – Philippine Pediatric Society
12.8 PAFP - Philippine Academy of Family Physicians
12.9 PSA - Philippine Society of Anesthesiologists
13.1 The PARTICIPATING PHYSICIAN, including their employees, agents and any other person representing them ("staff"), shall conduct themselves with utmost professionalism in their dealings, especially towards Members and with PhilCare. In light of this, the PARTICIPATING PHYSICIAN and their staff shall refrain from any and all forms of:
13.1.1. discrimination;
13.1.2. abuse;
13.1.3. lambasting;
13.1.4. bad-mouthing; or
13.1.5. any other act which may constitute a crime.
13.2 The PARTICIPATING PHYSICIAN shall be liable for the acts of their staff as if done by them. Breach of this clause shall be met with the appropriate penalty according to the severity of the act, which shall range from a reprimand to disaffiliation.
13.3 Further, any claim, complaint or suggestion the PARTICIPATING PHYISICIAN may have with PhilCare shall be coursed through the proper channels and not to third parties. Failure to do so may constitute a breach of this provision. The imposition of a penalty by PhilCare shall not prevent or bar PhilCare from seeking other available remedies under law, including but not limited to, the institution of civil, criminal or administrative proceedings against the PARTICIPATING PHYSICIAN."
14.1 The PHYSICIAN authorizes PHILCARE to publish his or her business contact details provided.
14.2 Should there be any changes in the affiliated hospitals and clinics, contact details, personal information, the PHYSICIAN shall inform PHILCARE by accomplishing and submitting the PHYSICIAN AFFILIATION DATA SHEET AND CONFORME.
14.3 The PARTICIPATING PHYSICIAN agrees to have his/her name, clinic hours, business contact details, specialty, and other pertinent data posted in the PHILCARE’s website and other forms, published documents of PHILCARE, including communication materials routinely provided to its Members.
14.4 AMENDMENTS AND WAIVERS. This Agreement may be amended by PHILCARE in its sole discretion subject to Section 11 above. Changes to the terms shall be published through its website.