Philippine Health Care Providers, Inc. vs. Commission On Internal Revenue (Case Digest)

1. Philippine Health Care Providers, Inc. vs.
Commission on Internal Revenue, 600 SCRA 413, September 18, 2009 *MRC
PHILIPPINE HEALTH CARE PROVIDERS, INC.

vs.
COMMISSIONER OF INTERNAL REVENUE
G.R. No. 167330 | September 18, 2009 | Corona, J.
One test to determine whether one is engaged in insurance business is whether the assumption of risk and indemnification of
loss (which are elements of an insurance business) are the principal object and purpose of the organization or whether they are merely
incidental to its business. If these are the principal objectives, the business is that of insurance. But if they are merely incidental and
service is the principal purpose, then the business is not insurance. In this case, Health Maintenance Organizations (HMOs) are not
insurance business.
FACTS:
Philippine Health Care Providers, Inc. (PHCP) is a domestic corporation engaged in the business of providing medical services
to individuals who enter into health agreements with it. Individuals enrolled in its health care programs pay an annual membership fee
and are entitled to various medical services provided by its duly licensed physicians, specialists and other professional technical staff
participating in the group practice health delivery system at a hospital or clinic owned, operated or accredited by it.
Subsequently, the CIR sent PHCP a formal demand letter and the corresponding assessment notices demanding the payment
of deficiency documentary stamp tax for the taxable years 1996 and 1997. The deficiency assessment was imposed on PHCPs health
care agreement with the members of its health care program pursuant to Section 185 of the 1997 Tax Code.
PHCP protested the assessment alleging that being a health maintenance organization (HMO) and not an insurance company,
it is not liable to pay DST. It contended that under the NIRC of 1997 only companies engaged in the business of fidelity bonds and other
insurance policies are liable to pay DST.
The SC in its decision dated June 12, 2008 ruled that the health care agreement offered by PHCP is in the nature of a non-life
insurance which is a contract of indemnity. Moreover, the fact that PHCP is an HMO and not an insurance company is irrelevant because
the contracts between an HMO and its beneficiaries are treated as insurance contracts. Hence the present motion for reconsideration.
ISSUE: Whether or not PHCP, as an HMO, is engaged in the business of insurance
RULING:
No, PHCP is not engaged in the business of insurance.
Section 2 (2) of P.D. 1460, otherwise known as the Insurance Code enumerates what constitutes doing insurance business or
transacting an insurance business.
One test to determine whether one is engaged in insurance business is whether the assumption of risk and indemnification of
loss (which are elements of an insurance business) are the principal object and purpose of the organization or whether they are merely
incidental to its business. If these are the principal objectives, the business is that of insurance. But if they are merely incidental and
service is the principal purpose, then the business is not insurance. In this case, Health Maintenance Organizations (HMOs) are not
insurance business.
Applying the principal object and purpose test, there is significant American case law supporting the argument that a
corporation (such as an HMO, whether or not organized for profit), whose main object is to provide the members of a group with health
services, is not engaged in the insurance business.
Although Group Healths activities may be considered in one aspect as creating security against loss from illness or accident
more truly they constitute the quantity purchase of well-rounded, continuous medical service by its members. The functions of such an
organization are not identical with those of insurance or indemnity companies. The latter are concerned primarily, if not exclusively, with
risk and the consequences of its descent, not with service, or its extension in kind, quantity or distribution; with the unusual occurrence,
not the daily routine of living. Hazard is predominant. On the other hand, the cooperative is concerned principally with getting service
rendered to its members and doing so at lower prices made possible by quantity purchasing and economies in operation. Its primary
purpose is to reduce the cost rather than the risk of medical care; to broaden the service to the individual in kind and quantity; to enlarge
the number receiving it; to regularize it as an everyday incident of living, like purchasing food and clothing or oil and gas, rather than
merely protecting against the financial loss caused by extraordinary and unusual occurrences, such as death, disaster at sea, fire and
tornado. It is, in this instance, to take care of colds, ordinary aches and pains, minor ills and all the temporary bodily discomforts as well
as the more serious and unusual illness. To summarize, the distinctive features of the cooperative are the rendering of service, its
extension, the bringing of physician and patient together, the preventive features, the regularization of service as well as payment, the
substantial reduction in cost by quantity purchasing in short, getting the medical job done and paid for; not, except incidentally to these
features, the indemnification for cost after the services is rendered. Except the last, these are not distinctive or generally characteristic
of the insurance arrangement. There is, therefore, a substantial difference between contracting in this way for the rendering of service,
even on the contingency that it be needed, and contracting merely to stand its cost when or after it is rendered.
Lastly, it is significant that PHCP, as an HMO, is not part of the insurance industry. This is evident from the fact that it is not
supervised by the Insurance Commission but by the Department of Health.

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1. Philippine Health Care Providers, Inc. vs.

PHILIPPINE HEALTH CARE PROVIDERS, INC.

G.R. No. 167330 | September 18, 2009 | Corona, J.

ISSUE: Whether or not PHCP, as an HMO, is engaged in the business of insurance

No, PHCP is not engaged in the business of insurance.

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