Republic of the Philippines
HOUSE OF REPRESENTATIVES
Quezon City

FIFTEENTH CONGRESS
First Regular Session

Introduced by HONORABLE JUAN EDGARDO “SONNY” M. ANGARA

EXPLANATORY NOTE

The National Health Insurance Act or PHILHEALTH Act envisioned the establishment of
a system that would provide all citizens, especially the poor, financial access to health services
through a National Health Insurance Program (NHIP). | believe PhilHealth has indeed
revolutionized our health insurance in ways never before imagined. If before, the poor stayed at
home when they are ill because healthcare is unaffordable and inaccessible, this time, their
PhilHealth membership has made it possible for them to enter a hospital (some for the first time)
to be properly attended to by doctors and nurses.

While this has resulted in marked gains in the delivery of basic health care services in
the country, there still remain major challenges facing the country's health, sector. This
government has yet to increase its health budget. This dismal level of financing in the health
sector simply shows the insufficient efforts to make substantial improvements in the health of
the population, especially our poor.

‘So problems persist.

For instance, World Bank reports that infant and mortality rates for babies below 5 years
old are 2.3 - 2.7 times higher for households in the poorest groups in the country. Among pre-
school age children, the national estimates for the prevalence of malnutrition reveal that 31 out
of every 100 children (30.6%) are underweight. Among school-age children, 33 out of every 100
children (32.9%) are underweight for their age. Full vaccination rate has likewise decreased. A
national government survey indicates that 3 out of 10 children age 12-23 months have not
received the recommended vaccinations.

These statistics highlight the difference in living standards and access to health care.
Poor families would usually forego health care and put more of their resources on food
consumption.

This measure aims to do its share in addressing this lamentable experience. It proposes
to increase and expand the scope and coverage of our NHIP to cover one of the most unirisured
population to benefit from public health insurance programs — the children, Let us make our
children not only dependents but beneficiaries as well. The Children's Health Insurance
Program (CHIP), as proposed, is designed for low-income families who cannot afford to insure
the health needs of their children. With the implementation of a Children's Health Insurance
Program (CHIP) under the NHIP, eligible low-income children shall be entitled to a full range of
health services including regular checkups, immunizations, prescription drugs, lab tests, X-rays,
hospital and clinic visits, durable medical equipments, hospital visits, dental and eye care.

These innovations will do wonders to our young population and will be consistent with
the Millenium Development Goals (MDGs) of galvanizing unprecedented and concerted efforts
to meet the needs of the underprivileged sector. Let us take pride in our achievements while we


continue to explore ways in making PhilHealth even more responsive to changing times and the
needs of our people especially the uninsured children of our poor.

Approval of this measure, therefore, is urgently and earnestly sought

JUAN EDGARDO “SONNY” Mi. ANGARA
Representative
Lone District, Province of Aurora


FIFTEENTH CONGRESS OF THE)
REPUBLIC OF THE PHILIPPINES )
First Regular Session )

H.B.No.G3?

Introduced by Honorable JUAN EDGARDO “SONNY” M. ANGARA

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

Be jit enacted by the Senate and House of Representatives of the Philippines in
Congress 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, REMEDIAL, THERAPEUTIC OR
REHABILITATIVE 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 SIX (6) 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 LINE, AND DETERMINED AS SUCH
BY THE PERTINENT GOVERNMENT AGENCY;

SEC. 2. Section 5 of the same Act shall now read as follows:
“SEC. 5. Establishment and Purpose. - There is hereby created 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 this Act. x x x. It shall initially consist of Programs | and
I1 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 ASSISTANCE TO INCLUDE A CHILD
HEALTH INSURANCE PROGRAM FOR UNINSURED, LOW-INCOME
CHILDREN IN AN EFFECTIVE AND EFFICIENT MANNER THAT IS
COORDINATED WITH OTHER SOURCES OF HEALTH BENEFITS
COVERAGE FOR CHILDREN.

Xxx"

SEC. 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.”

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

“SEC. 7, Enrolment. - 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) xx;
b) 200%;
) x00; and
4) xx,

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 organizations:
Provided, however, That such government health care providers shall ensure
that said indigents AND QUALIFIED CHILD MEMBER shall subsequently be
enrolled in the Program.”


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

“SEC. 12. Entitlement to Benefits. — x x x 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; [and] Enrolled indigents; AND (D)
QUALIFIED CHILD OF LOW-INCOME FAMILIES. .

SEC. 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
Xxx
XXX

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

SEC. 7. A new Section 30 is hereby added to read as follows:

“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
SUBSIDY FOR CHILDREN. THE SHARE OF THE LGUS SHALL BE
PROGRESSIVELY INCREASED UNTIL SUCH TIME THAT ITS SHARE
BECOMES EQUAL TO THAT OF THE NATIONAL GOVERNMENT.

SEC. 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.

SEC. 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.

SEC. 10. Repealing Clause. All laws, presidential decrees, executive orders, rules and

regulations or parts thereof which are deemed inconsistent wit the provisions of this Act are

hereby repealed, amended, or modified accordingly.

3


SEC. 11. Effectivity Clause. This Act shall take effect fifteen (15) days following its full
and complete publication in an Official Gazette or in at least two (2) newspapers of general
circulation, whichever comes first.

Approved,