Philippines Covid Vaccine NFCS
The Philippines is triple covered - it has a national covid vaccine NFCS, see below, and is a member of the COVAX NFCS and the UNICEF NFCS.
Introduction
The Philippines created a no fault compensation for covid-19 vaccines on 3 March 2021, effective immediately.
This scheme was created under national legislation, Republic act No. 11525, An Act Establishing the Coronavirus Disease 2019 (COVID-19) Vaccination Program expediting the vaccine procurement and administration process, providing funds therefore, and for other purposes. The scheme rules are contained in Public Health Circular 2021/0007.
It is administered by the Philippine Health Insurance Corporation (PhilHealth) who are the state insurer.
The funding for the scheme comes from central Government funds.
Vaccines Covered
This NFCS covers Vaccines administered by the Government under the national inoculation programme. If a person reacts to a COVAX vaccine they are expected to claim against the COVAX NFCS not the national one.
It only includes vaccines approved for emergency use.
The scheme started on 3 March 2021 and will end on 2 March 2026 or when the National COVID vaccination programme ends, whichever is sooner.
Injuries Covered
This NFCS covers both temporary and permanent injuries.
Under this NFCS only eligible injuries are covered. These are defined at B of the Public Health Circular 2021/0007 as:
- Only serious cases identified by PhilHealth (Annex B: List of Conditions that may be claimed from COVID-19 Vaccine Injury Package) and assessed to be ‘vaccine product-related reaction’ or ‘vaccine quality-defect reaction’ due to COVID-19 vaccines by causality assessment shall be claimable. The cases eligible for compensation shall include the following:
- Hospitalisation due to Anaphylaxis, Guillain-Barre Syndrome (GBS), blood clots leading to Stroke and other diseases, and other such cases that may be determined by PhilHealth based on prevailing evidence;
- Permanent disability resulting from the loss of sight for both eyes; loss of any two limbs at or above the ankle or wrists; or permanent complete paralysis of any two limbs; brain injury resulting in incurable imbecility or insanity; and other such cases that may be determined by PhilHealth based on prevailing evidence;
- Death
Injuries can be added to Annex B and taken away.
Charges for making a claim
There is no charge for making a claim under this scheme.
Claimants
Under this scheme the following categories of individuals are permitted to make a claim.
- Principal - The vaccinated person is the 'principal' and they take precedence over all other claimants.
- Primary beneficiaries - If the principal is unable to make a claim the primary beneficiaries (legal spouse, legitimate, legitimated or acknowledged illegitimate children) may claim.
- Secondary beneficiaries - If there are no primary beneficiaries then secondary beneficiaries, such as legitimate parents, may claim.
There is no provision for legal representatives or other nominated individuals being able to claim.
Losses covered
This scheme pays the following
| Live Vaccine Recipient/their beneficiary | Dependants of Vaccine Recipient | Beneficiary of a Deceased Vaccine Recipient |
|
Hospital expenses only compensates eligible economic losses Permanent disability payments are for general categories and are not broken down into economic and non-economic losses |
No Compensation is provided specifically for dependants |
Hospital expenses only compensates eligible economic losses Death payments are for general categories and are not broken down into economic and non-economic losses |
Live Vaccine recipients
- Hospital Expenses - Hospitalisation costs only cover economic losses that are not met by PhilHealth or other private healthcare insurance - it is a top up payment scheme not a full costs scheme. Claims can be made for the cost of eligible admissions, which are generally for more than 24 hours, and must involve being admitted to hospital not just being seen in A&E. If there is a need for further treatment after a payment has been made by the scheme claimants may make multiple claims for hospitalisation up to the top cap limit of 100,000 Philippines Peso.
- Permanent disability - If a vaccine recipient is permanently disabled after hospitalisation they can claim both the hospitalisation payment and the one-off lump sum permanent disability payment of 100,000 Philippines Peso. The lump sum payment for permanent disability is not broken down into economic and non-economic loss.
Deceased Vaccine recipients
- Death - If a vaccine recipient dies after hospitalisation both the hospitalisation payment and the one-off lump sum death payment of 100,000 Philippines Peso can be claimed. The lump sum payment for death is not broken down into economic and non-economic loss.
Payments consist of a lump sum payment.
Funeral expenses are not available under this NFCS.
Compensation for medical expenses under this scheme is fully individualised.
Compensation for death or permanent disability under this scheme is a fixed sum amount of 100,000 Philippines Peso
Loss of earnings are not paid under this scheme.
Compensation under this scheme is not capped.
Compensation under this scheme is capped, with a top value of
- 100,000 Philippine Peso for inpatient treatment;
- 100,000 one-off lump sum payment for permanent disability/death.
Time limits for claims
The scheme does not set a time limit between vaccination and the adverse event occurring.
A claim under the scheme must be brought either before the scheme ends on 2 March 2026 or when the National COVID vaccination programme ends, whichever is sooner.
Evaluating claims – standard of proof required
Claimants are required to submit a Vaccine Injury Assessment Survey completed by the treating physician with their claim form. This is used as the primary document that PhilHealth will use when determining the injury, the extent of disability, the nature of the Serious Adverse Event, whether the injury is eligible for compensation and if so the quantum.
A causality assessment carried out by a PhilHealth recognized expert or pool of experts will be used to determine if there is a causal link between the vaccine and the injury. The standard of proof required by the scheme is that there is a preponderant probability that the vaccination caused the adverse event. Injuries listed in Annex B of circular 2021-0007 have a rebuttable presumption that they were caused by the vaccination. New injuries can be added to Annex B and injuries can be removed. Injuries will be added 'if it has been determined that the available literature, research, global data, and other resources collectively establish a preponderance of evidence in support of or against the notion that there is a causal link between the specific COVID vaccine in questions and the Serious Adverse Event(s) observed.'
Appeals and the right to litigate
Use of the scheme and litigation are mutually exclusive. Circular 2021-0007 states at para H2 'The beneficiary, in receiving any payments through the COVID-19 Vaccine Injury Compensation Package, shall forfeit any right to file suit against public officials and employees, contractors, manufacturers, volunteers, and representatives of duly authorized private entities involved in the administration of the COVID-19 vaccine.'
There is an internal review process, the first option is for the claimant to ask for a motion of reconsideration. If they are still not satisfied they can appeal the decision using the PhilHealth appeals process.
Useful information and links
It is not clear whether the scheme produces data on claims & financial performance (claim numbers, payments, claim processing timeframes, administrative costs, etc). PhilHealth publish annual statistics, there doesn't seem to be a mention of the NFCS in the 2022 statistics. PhilHealth also publishes an annual report, but the most recent Annual Report is from 2020.
Administrator
Philippine Health Insurance Corporation (philhealth.gov.ph)
Legislation
Scheme rules