Republic of the Philippines
HOUSE OF REPRESENTATIVES
Quezon City

FIFTEENTH CONGRESS
Second Regular Session

HOUSE BILL NO. 5038
Introduced by REP. ANTHONY G. DEL ROSARIO

EXPLANATORY NOTE

This bill seeks to expand the benefit package of the National Health Insurance
Program, amending for the purpose Republic Act (RA) No. 7875 otherwise known as
the "National Health Insurance Act of 1995.”

Section 11 of Article XIII of the Constitution provides that the “State shall adopt
an integrated and comprehensive approach to health development which shall
endeavour to make essential goods, health and other social service available to all the
people at affordable cost.”

Under this mandate, the government provides several health care programs to
the people. Among these is the National Health Insurance Program created by RA
7875, as amended by RA 9241, designed to help the people pay for their health care
services. Membership to this program has been quite useful to many Filipinos so it
makes health care services more accessible and affordable. It somehow lessens the
cost of hospitalization and other medical bill.

A review of the program would reveal, however, the need to strengthen the
delivery of health care services to the people because the Philhealth care benefits
under the program are limited. Philhealth does not cover the basic needs of health care
services such as annual physical check-up. Also, it has little preventive health care
function. The focus is a curative healthcare when a patient is too sick to rest at home
and needs hospital confinement. Also, it does not cover outpatient consultation such as
psychiatric cases, basic dental and optometric services. Finally, because of the limited
cost of coverage, the health care benefits are not enough to cover expenses for serious
diseases. Thus, being a Philhealth member alone is not sufficient. A member still
needs private health maintenance organization (HMO) membership cards for a wider
coverage but HMOs have many limitations, including the cost of premiums.

In this light, this measure seeks to address the program coverage limitations by
expanding the Philhealth benefit package to include health services such as annual
physical check-up, outpatient consultation, dental and optometric service and bigger
health care coverage. Hopefully, this measure will answer the growing imperative to
make more available, and accessible, appropriate and adequate health care service at
affordable and reasonable cost to every Filipino.

In view of the foregoing, immediate approval of this bill is highly recommended.

G. DEL ROSARIO


Republic of the Philippines
HOUSE OF REPRESENTATIVES
Quezon City

FIFTEENTH CONGRESS
‘Second Regular Session

5038

HOUSE BILL NO.
Introduced by REP. ANTHONY G. DEL ROSARIO

AN ACT
EXPANDING THE BENEFIT PACKAGE OF THE NATIONAL HEALTH INSURANCE

PROGRAM, AMENDING FOR THE PURPOSE REPUBLIC ACT NO. 7875,
OTHERWISE KNOWN AS THE “NATIONAL INSURANCE ACT OF 1995,”AS
AMENDED

Be it enacted by the Senate and House of Representatives of the Philippines in
Congress assembled:

SECTION 1. Section 10 of Republic Act No. 7875 is hereby amended to read as

follows:

SEC. 10. Benefit Package. — Subject to the limitations specified in
this Act and as may be determined by the Corporation, the following
categories of personal health services granted to the member or his

dependents as medically necessary or appropriate shalll include:
a) xx
OK XK Xxx
b) Outpatient Care:
20K XK 70K
3. personal preventive services; [and]

4. prescription drugs and biologicals, subject to the limitations

described in Section 37 of this Act;

5. ANNUAL PHYSICAL EXAMINATION;


6. DENTAL SERVICES;

Bs OPTOMETRIC SERVICES; AND

8. PSYCHIATRIC CONSULTATION.
c) XXX

d) Such other health care services that the Corporation shall
determine to be appropriate and cost-effective: Provided, That the Program,
during the initial phase of implementation, which shall not be more than five (5)
years, shall provide a basic minimum package of benefits which shall be defined

according to the following guidelines:
1: XXX
OK xx 1x

4. THE PRESENT COST OF COVERAGE FOR INPATIENT
HOSPITAL CARE, OUTPATIENT CARE, EMERGENCY AND
TRANSFER SERVICES AND SUCH OTHER HEALTH CARE SERVICES
SHALL BE INCREASED TO TWENTY-FIVE PERCENT (25%) OF THE
TOTAL CHARGES BILLED BY THE HEALTH CARE PROVIDER.”

SEC. 2. Section 11 of the same Act, as amended, is hereby further amended by

deleting item (d) to read as follows:

“SEC. 11. Excluded Personal Health Services. - The benefits
granted under this Act shall not cover expenses for the services
enumerated hereunder except when the Corporation, after actuarial

studies, recommends their inclusion subject to the approval of the Board.

a) xxx


[(¢) _optometric services:]
{()] (0) _ Fifth subsequent normal obstetrical deliveries; and

((] (E) Cost-ineffective procedure, which shall be defined by

the Corporation.

SEC. 3. The amount necessary to carry out the provisions of this Act upon its
effectivity shall be charged to the appropriations of the Philippine Health Insurance
Corporation. Thereafter, any such sum as shall be needed for the regular
implementation of this Act shall be included in the General Appropriations Act following

its enactment into law.

SEC. 4. This Act shall take effect fifteen days (15) days after publication in the

Official Gazette or in two (2) national newspapers of general circulation.

Approved,