Republic of the Philippines
HOUSE OF REPRESENTATIVES
Quezon City, Metro Manila

FIFTEENTH CONGRESS
First Regular Session

House Bill No. 1854

INTRODUCED BY HON. MARCELINO “MARCY” R. TEODORO.

EXPLANATORY NOTE

Article XIII, Section 11 of the Philippine Constitution says that “the State
shall adopt an integrated and comprehensive approach to health development
which shall endeavor to make essential goods, health and other social services
available to all the people at affordable cost. There shall be priority for the needs
of the under-privileged, sick, elderly, disabled, women, and children...” In this
light, this bill seeks the establishment of a children’s health insurance program by
introducing amendments to Republic Act 7875, also known as “The National
Health Insurance Act of 1995.”

The country’s future depends on the youth, and yet they seem to be part
of the marginal concerns of the government. They deserve ‘utmost care and
attention not only because of the aforementioned, but more importantly they are
the most vulnerable sector of society. Neglect or minimal attention to their needs
would only result in present and future concerns, such as delinquency or
criminality. It is the State's responsibility to ensure its tomorrow today by
providing quality health care insurance for its deserving future stewards.

In light of the foregoing, passage of this bill is earnestly sought.

MARCELINO “MARCY” R. TEODORO

Representative, 1* District
City of Marikina


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Republic of the Philippines
HOUSE OF REPRESENTATIVES
Quezon City, Metro Manila

FIFTEENTH CONGRESS
First Regular Session

House Bill No. 1854

INTRODUCED BY HON. MARCELINO “MARCY” R. TEODORO

AN ACT
INSTITUTING MECHANISMS FOR THE ESTABLISHMENT OF CHILDREN’S
HEALTH INSURANCE PROGRAM, AMENDING FOR THE PURPOSE
REPUBLIC ACT NO. 7875, OTHERWISE KNOWN AS “THE NATIONAL
HEALTH INSURANCE ACT OF 1995,” AS AMENDED BY R.A. 9241, AND.
FOR OTHER PURPOSES

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

SECTION 1. Section 4 of Republic Act No. 7875 is hereby amended to read as
follows:

“SEC. 4. Definition of Terms. — For the purposes of this Act, the following terms
shall be defined as follows:

Xxx

(d) CHILD HEALTH ASSISTANCE — A RANGE OF HEALTH CARE AND
SUPPORT SERVICES INCLUDING, BUT NOT LIMITED TO, PHYSICIAN
SERVICES AND ANY OTHER MEDICAL, DIAGNOSTIC, SCREENING,
PREVENTIVE, RESTORATIVE SERVICES;

Xxx

(s) Member - any person whose premiums have been regularly paid to the
National Health Insurance Program. He may be a paying member, an indigent
member, A QUALIFIED CHILD MEMBER, or a pensioner/ retiree member.

XXX

(dd) QUALIFIED CHILD MEMBER -ANY CHILD OF A LOW-INCOME FAMILY
UNDER 18 YEARS OF AGE OR OVER BUT WHO ARE UNABLE TO FULLY TAKE
CARE OF THEMSELVES OR PROTECT THEMSELVES FROM ABUSE,
NEGLECT, CRUELTY, EXPLOITATION OR DISCRIMINATION BECAUSE OF A
PHYSICAL, MENTAL DISABILITY OR CONDITION AND WHOSE FAMILY IS
BELOW POVERTY, AND DETERMINED AS SUCH BY THE PERTINENT
GOVERNMENT AGENCY;

SECTION 2. Section 5 of the same Act shall now read as follows:

“Sec. 5. Establishment and Purpose. — There is hereby crated the National
Health Insurance Program which — shall provide health insurance coverage and
ensure affordable, acceptable, available and accessible health care services for all
citizens of the Philippines, in accordance with the policies and specific provisions of


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H.B. No. 1854

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this Act. xxx. It shall initially consist of Programs | and II of Medicare and be expanded
progressively to constitute one universal health insurance program for the entire
population. IT SHALL INITIATE AND EXPAND THE PROVISION OF CHILD HEALTH
ASSITANCE TO INCLUDE A CHILD HEALTH INSURANCE PROGRAM FOR
UNINSURED, LOW-INCOME CHILDREN IN A EFFECTIVE AND EFFICIENT
MANNER THAT IS COORDINATED WITH OTHER SOURCES OF HEALTH
BENEFITS COVERAGE FOR CHILDREN. xxx.

SECTION 3. Section 6 of the same Act shall now read as follows:

“Sec. 6. Coverage. — All citizens of the Philippines, WHETHER CHILD OR
ADULT, shall be covered by the National Health Insurance program. In accordance
with the principles of universality and compulsory coverage enunciated in Section 2
(b) and 2 (1) hereof, implementation of the Program shall, furthermore, be gradual and
phased in over a period of not more than fifteen (15) years. Provided, That the
Program shall not be made compulsory in certain provinces and cities until the
Corporation shall be able to ensure that members in such localities shall have
reasonable access to adequate and acceptable health care services.”

SECTION 4. Section 7 of the same Act shall now read as follows:

“SEC. 7. Enrollment. — The Program shall enroll beneficiaries in order for them
to be placed under coverage that entitles them to avail of benefits with the assistance
of the financial arrangements provided by the Program. The process of enrollment
shall include the identification of beneficiaries, issuance of appropriate documentation
specifying eligibility to benefits, and indicating how membership was obtained or is
being maintained. The enrollment shall proceed in accordance with these specific
policies:

a) Xxx;
b) xxx;
¢) xxx; and
d) xxx.

All indigents AND QUALIFIED CHILD MEMBER not enrolled in the Program
shall have priority in the use and availment of the services and facilities of government
hospitals, health care personnel, and other health organization; Provided, however,
That such government health care providers shall ensure that said indigents AND
QUALIFIED MEMBER shall subsequently be enrolled in the Program.”

SECTION 5. Section 12 of the same Act shall now read as follows:

“SEC. 12. Entitlement to Benefits. — xxx

The following need not pay the monthly contributions to be entitled to the
Program's benefits. Retirees and pensioners of the SSS and GSIS prior to the
effectivity of this Act; Members who reach the age of retirement as provided for
by law and have paid at least one hundred twenty (120) monthly contributions;
fand] Enrolled indigents; AND (D) QUALIFIED CHILD OF LOW-INCOME
FAMILIES.”

SECTION 6. Section 28 of the same Act is hereby amended to read as follows:

“SEC. 28. Contributions. — All members of the Program shall contribute to the
Fund, in accordance with a reasonable, equitable and progressive contribution
schedule to be determined by the Corporation on the basis of applicable
actuarial studies and in accordance with the following guidelines:

XXX

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H.B. No. 1854 -2-

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CONTRIBUTIONS. MADE IN BEHALF OF A QUALIFIED CHILD
MEMBER SHALL NOT EXCEED THE MINIMUM CONTRIBUTIONS SET FOR
EMPLOYED MEMBERS.”

SECTION 7. Anew Section 30 is hereby added to read as follows:

F “SEC. 30. Payment for a Child Beneficiary’s Contributions. —
CONTRIBUTIONS FOR QUALIFIED CHILDREN BENEFICIARIES SHALL BE
SUBSIDIZED PARTIALLY BY THE LOCAL GOVERNMENT UNIT WHERE
THE MEMBER RESIDES. THE CORPORATION SHALL PROVIDE
COUNTERPART FINANCING EQUAL TO THE LGUS SHALL BE
PROGRESSIVELY INCREASED UNTIL SUCH TIME THAT IST SHARE
BECOMES EQUAL TO THAT OF THE NATIONAL GOVERNMENT.”

SECTION 8. Implementing Rules and Regulations. Within thirty (30) days
from the effectivity of this Act, the Board of Directors of the Philippine Health
Insurance Corporation (PHIC) shall convene to formulate the rules and regulations for
the implementation of this Act.

SECTION 9. Separability Clause. If any part or provision of this Act shall be
held unconstitutional or invalid, other provisions which are not affected thereby shall
continue to be in full force and effect.

SECTION 10. Repealing Clause. All laws, presidential decrees, executive
orders, rules and regulations or parts thereof which are deemed inconsistent with the
provisions of this Act are hereby repealed, amended, or modified accordingly.

SECTION 11. Effectivity Clause. This Act shall take effect fifteen (15) days

following its full and complete publication in at least two (2) newspapers of general
circulation.

Approved,