Republic of the Philippines
HOUSE OF REPRESENTATIVES
Quezon City

SIXTEENTH CONGRESS
Third Regular Session

House Bit No.__ 6477

Introduced by Congressman Alfredo D. Vargas III

EXPLANATORY NOTE

Breast cancer is the most common type of cancer in the country and is the primary
cause of death among Filipino women?. With one out of every 13 Filipinas expected to
develop breast cancer in her lifetime, the Philippines ranks first in breast cancer incidences
in Asia?

It is important to note, however, that breast cancer is preventable and curable.
Through early screening and detection, coupled with proper treatment, the physical,
emotional, and economic consequences of being afflicted by breast cancer can be
prevented. Thus, it is critical that breast cancer patients are given the maximum benefits
and opportunities.

This bill seeks to require health insurance companies to provide coverage in their
plans for a minimum hospital stay for mastectomies, lumpectomies, and lymph node
dissection for the treatment of breast cancer. Furthermore, it also requires coverage for
secondary consultations.

Through this initiative, not only do we give breast cancer patients better chances of
healing and survival but we are also sparing their families from dealing with the physical,
emotional and financial burdens that cancer brings to the family.

In view of the foregoing, the passage of this bill is earnestly sought

VARGAS IIL

* Philip C. Tubeza. Breast cancer is the most prevalent in PH. Philippine Daily Inquirer. Available at:
hnttp://newsinfo, nquirer.net/291078/breast-cancer-is-the-most-prevalent-in-ph [21 October 2015]

* Inquirer.net. PH highest breast cancer incidence rate in Asia, health experts say. Available at:
htto://lfestvle,inquirer.net/128663/ph-highest-breast-cancer-incidence-rate-in-asia-health-experts-sav [21 October
2015)



Republic of the Philippines
HOUSE OF REPRESENTATIVES
Quezon City

SIXTEENTH CONGRESS
‘Third Regular Session

HouSE BILL No.__6477

Introduced by Congressman Alfredo D. Vargas III

AN ACT
REQUIRING HEALTH INSURANCE COMPANIES TO PROVIDE COVERAGE IN THEIR
MEDICAL INSURANCE PLAN FOR A MINIMUM HOSPITAL STAY FOR MASTECTOMIES,
LUMPECTOMIES, AND LYMPH NODE DISSECTION FOR THE TREATMENT OF BREAST
CANCER AND COVERAGE FOR SECONDARY CONSULTATIONS

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

Section 1. Short Title. - This Act shall be known as the “Breast Cancer Patient Protection
Act.”

Section 2. Declaration of Policy. -It is the policy of the State to protect and promote the
right to health of the people and instill health consciousness among them.

Section 3. Definition of Terms. - As used in this Act, the term;

1. “Breast cancer” means a type of malignant growth in the breast tissue;

2. “DOH” means the Department of Health;

3. “Health plan” means a medical insurance plan provided by a health
insurance company to certain groups in order to provide them with
medical and surgical benefits;

4. “Lumpectomy” means a medical operation that removes a lump from
the breast;

5. “Lymph node” means rounded mass of lymphatic issue that is
surrounded by a capsule of connective tissue;

6. “Mastectomy” means medical operation that removes a woman's breast;
and

7. “Secretary” means the DOH Secretary.


Section 4, Required Coverage for Minimum Hospital Stay for Mastectomies,
Lumpectomies, and Lymph Node Dissections for the Treatment of Breast Cancer and
Coverage for Secondary Consultations. -

1. In-patient Care, -
A. In General. - A group health plan and a health insurance issuer
providing health insurance coverage in connection with a group
health plan that provides medical and surgical benefits shall ensure

that the in-patient, and in the case of a lumpectomy, the out-patient
coverage and radiation therapy is provided for breast cancer
treatment. Such plan or coverage may not, except as provided for in

paragraph (B) ~

a. Restrict benefits for any hospital length of stay in
connection with a mastectomy or breast conserving
surgery, such as a lumpectomy, for the treatment of breast
cancer to less than 48 hours;

b. Restrict benefits for any hospital length of stay in
connection with a lymph node dissection for the treatment
of breast cancer to less than 24 hours; or

c. Require that a provider obtain authorization from the plan
or the issuer for prescribing any length of stay required
under Subparagraph (1) without regard to paragraph (B)

B. Exception. - Nothing in this Section shall be construed as requiring
the provision of in-patient coverage if the attending physician and
patient determine that either a shorter period of hospital stay, or
out-patient treatment, is medically appropriate.

2. Prohibition on Certain Modifications. - In implementing the
requirements of this Section, a group health plan, and a health insurance
issuer providing health insurance coverage in connection with a group
health plan, may not modify the terms and conditions of coverage based
on the determination by a participant or beneficiary to request less than
the minimum coverage required under paragraph (A).

3. Notice. ~ A group health plan and a health insurance issuer providing
health insurance coverage in connection with a group health plan shall
provide notice to each participant and beneficiary under such plan
regarding the coverage required by this section in accordance with
regulations promulgated by the Secretary. Such notice shall be in
writing prominently positioned in any literature or correspondence
made available or distributed by the plan or issuer and shall be
transmitted in the next mailing made by the plan or issuer to the
participant or beneficiary; whichever is earlier.


Section 5. Secondary Consultations. -

1. In General, - A group health plan, and a health insurance issuer
providing health insurance coverage in connection with a group health
plan, that provides coverage with respect to medical and surgical
services provided in relation to the diagnosis and treatment of cancer
shall ensure that full coverage is provided for secondary consultations
by specialists in the appropriate medical fields, including pathology,
radiology, and oncology, whether such consultation is based on a
positive or negative initial diagnosis. In any case in which the attending
physician certifies in writing that services necessary for such a
secondary consultation is not sufficiently available from specialists
operating under the plan with respect to whose services coverage is
otherwise provided under such plan or by such issuer, such plan or
issuer shall ensure that coverage is provided with respect to the
services necessary for the secondary consultation with any other
specialist selected by the attending physician for such purpose at no
additional cost to the individual beyond that which the individual would
have paid if the specialist was participating in the network of the plan.

2. Exception. - Nothing in paragraph (A) shall be construed as requiring
the provision of secondary consultations where the patient determines
not to seek such a consultation,

Section 6. Prohibition on Penalties or Incentives. - A group health plan, and a health
insurance issuer providing health insurance coverage in connection with a group health
plan, may not -

1. Penalize or otherwise reduce or limit the reimbursement of a provider
or specialist because the provider or specialist provided care to a
participant or beneficiary in accordance with this Section;

2. Provide financial or other incentives to a physician or specialist to
induce the physician or specialist to keep the length of inpatient stays of
patients following a mastectomy, lumpectomy, or a lymph node
dissection for the treatment of breast cancer below certain limits or to
limit referrals for secondary consultations;

3. Provide financial or other incentives to a physician or specialist to
induce the physician or specialist to refrain from referring a participant
or beneficiary for a secondary consultation that would otherwise be
covered by the plan or coverage involved under Section 5; or

4. Deny to a woman eligibility, or continued eligibility, to enroll or to
renew coverage under the terms of the plan or coverage solely for the
purpose of avoiding the requirements of this Section.

Section 7. Effective Dates. ~


1. In General. ~ The amendments made by this section shall apply to group
health plans for plan years beginning on or after 90 days after the date
of enactment of this Act.

2. Special Rule for Collective Bargaining Agreements. - In the case of a
group health plan maintained pursuant to one or more collective
bargaining agreements between employee representatives and one or
more employers ratified before the date of enactment of this Act, the
amendments made by this section shall not apply to plan years
beginning before the date on which the last collective bargaining
agreements relating to the plan terminates, determined without regard
to any extension thereof agreed to after the date of enactment of this
Act. For purposes of this paragraph, any plan amendment made
pursuant to a collective bargaining agreement relating to the plan which
amends the plan solely to conform to any requirement added by this
section shall not be treated as a termination of such collective
bargaining agreement.

Section 8. Separability Clause. -If any provision of this Act is held invalid or
unconstitutional, the same shall not affect the validity and effectivity of the other
provisions hereof.

Section 9. Repealing Clause. - All laws, decrees, orders, and issuances, or portions thereof,
which are inconsistent with the provisions of this Act, are hereby repealed, amended or
modified accordingly.

Section 10. Effectivity Clause. - This Act shall take effect fifteen (15) days after its
publication in the Official Gazette or in two (2) newspapers of general circulation.

Approved,