THIRTEENTH CONGRJISS OF THE 
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Third Regular Session 
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REPUBLIC OF THE PI4ILTpPINES 
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S.B. No. 
Introdnced by SENATOR EDGARDO J. 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 
WHIP). I 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 delively of basic health care 
services in the country, there sal 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 uninsured 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. To 
date, the estimated number of children in the Philippines is at 33,134,812 wherein 
14,093,102 are considered poor. With the implementation of a Children's Health 
Insurance Program (CHIP) under the NYIP, 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 popufation 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. 
&fi 
EDGARDO J. ANGARA 
Senator 


THIRTEENTH CONGRESS OF THE 
1 
REPUBLIC OF THE PHlLIPPlNES 
) 
Tkid Regulav Session 
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7 T 
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Introduced by SENATOR EDGARDO J. ANGARA 
AN ACT INSTITUTING MECHANlSMS FOR THE ESTABLISHMENT OF A 
CHD,DREN’S HEALTH INSURANCE PROGRAM, AMENDING FOR THE 
PURPOSE REPUBLIC ACT NO. 7875, OTHERWISE KNOWN AS “THE 
NATIONAL HEfiTH INSURANCE ACT OF 1995,” 
As AMENDED BY R.A. 9241, AND FOR OTHER PURPOSES 
Be it enacted By the Senate and the House of Repesentatives in Congress duly 
assembled: 
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as follows: 
SECTION 1. Section 4 of Republic Act No. 7875 is hereby amended to read 
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“SEC. 4. Definition of Terms. - For the purposes of this Act, the 
following terms shall be defined as follows: 
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(d) CffILD HEALTH ASSISTmCE - A RANGE OF HEALTH 
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CARE AND SUPPORT SERVICES INCLUDING, BUT NOT LIMITED 
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TO, PHYSICIAN SERVICES AND ANY OTHER MEDICAL, 
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DIAGNOSTIC, 
SCREENING, 
PREVENTIVE, 
RESTORATIVE, 
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REMEDIAL, THERAPEUTIC OR REHABILITATIVE SERVICES; 
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xxx 
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(s) 
Member - Any person whose premiums have been regularly 
paid to the National Health Insurance Program. He may be a paying member, 
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retiree member. 
an indigent member, A QUALIFIED CHILD MEMBER, or a pensioner / 
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(dd) 
QUALIFIED CHILD MEMBER - ANY CHILD OF A 
LOW-INCOME PAMEY 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 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 PuTose. - There is hereby created the 
National HeaIth 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. Xxx. It shall initially consist of Programs I 
and 11 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 W AN EFFECTIVE AND 
EFFICIENT MANNER THAT IS COORDINATED WITH OTHER 
SOURCES OF HEALTH BENEFITS COVERAGE FOR CHILDREN. 
xxx. 
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SEC. 3. Section 6 of the same Act shall now read as follows: 
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“SEC. 6. Coverag, - 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 
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coverage enunciated 
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in Section 2 @) and 2 (1) hereof, implementation of the 
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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 reasonabre access to 
adequate and acceptable health care services.” 
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SEC. 4. Section 7 of the same Act shall now read as follows: 
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“SEC. 7. Enrollment. - The Program shall enroll beneficiaries in order 
for them to be placed under coverage that entitles them to avail of benefits 
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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: 
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c) xxx; and 
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d) xxx. 
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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: Pvovided 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. - xxx 
The following need not pay the monthly contributions to be entitled to 
the Program’s benefits: 
(a) 
Retirees and pensioners of the SSS and GSIS prior to the 
effectivity of this Ad; 
(b) 
Members who reach the age of retirement as provided for by 
law and have paid at least one hundred twenty (120) monthfy contributions; 
[andl 
(c) 
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 
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basis of applicable actuarial studies and in accordance with the following 
guidelines: 
( 4  XM 
@I = 
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(d) 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 
BENEFICMY’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 LGU’S 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. ImpIementing Rules and Regdatiom. Within thirty (30) days from the 
effectivity of this Act, the Board of Directors of the Philippine Health Insurance 
Corporation @“IC) shall convene to formulate the rules and reguIations for the 
implementation of this Act. 
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SEC. 9. SeparabiliYy Clause If any part or provision of this Act shall be heId 
unconstitutional or invalid, other provisions which are not affected thereby shall 
continue to be in fun force and effect.. 
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SEC. 10. Repealing Clause. AU 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. 
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SEC. 11. Effectivity Clause. This Act shall take effect fifteen (15) days 
fozlowing its full and complete publication in an Oflicial Gazette or in at least two (2) 
newspapers of general circulation, whichever comes first. 
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Approved 
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