SEVENTEENTH CONGRESS OF THE 
REPUBLIC OF THE PHILIPPINES 
First Regular Session
)
SENATE
SENATE BILL NO. 1 4 5 8
'17 MAY 16. P5 57
RECElVtu D\.
INTRODUCED BY SENATOR JOSEPH VICTOR G. EJERCITO
AN ACT
PROVIDING UNIVERSAL HEALTH CARE FOR ALL FILIPINOS, 
AMENDING FOR THE PURPOSE REPUBLIC ACT NO. 7875, 
OTHERWISE KNOWN AS THE "NATIONAL HEALTH INSURANCE 
ACT OF 1995", AS AMENDED BY REPUBLIC ACT NO. 10606 AND 
APPROPRIATING FUNDS TLIEREFOR
EXPLANATORY NOTE
Life and health are most precious gifts that we must safely guard through 
our laws and consistently nurtured by our health care system.
Against a backdrop of a population now at 100.8 million, with 2 million 
Filipinos added every year1, an average GDP growth rate of 6.3% from 2010 to 
2014, and real per capita health expenditures growing from PhP 1,219 in 1991 to 
PhP 3,528 in 2014, the provision of adequate basic health services, family and 
reproductive health, nutrition activities and emergency care are stiU among our 
greatest challenges.
Studies show that our health spending per capita may be rising much faster 
(5.0 percent) than the growth of real GDP per capita (2.4 percent)2, yet our life 
expectancy and infant mortality rates continue to lag behind our ASEAN 
neighbors.
If almost 30% of the population are still deemed poor and marginalized, this 
translates to more than 30 million Filipinos who continue to live at risk with 
limited access to quality healthcare. On top of this number are millions more of
1 (P h ilip p in e  D e v e lo p m e n t Plan 2 0 1 7  -  20 2 2  /  S ource; P h ilip p in e  S ta tistics A u th o rity . C ensus o f  P o p u la tio n  2 0 1 5 )
2 U P Econ H e a lth  P olicy D e v e lo p m e n t P ro g ra m


low-income earners and middle class citizens who remain to have limited health 
coverage.
Children continue to die needlessly from malnutrition and other 
preventable diseases even before they reach their puberty. Poor senior citizens/ 
silently succumb to their deaths without proper diagnosis and care from 
competent doctors. Persons with Disability (PWDs) wither their dreams and 
potentials away due to lack of health care support. Patients suffering from 
debilitating illnesses such as cancer; chronic kidney disease; heart adments among 
others, lose all hope as they accept death as an option to spare their financially 
burdened loved ones from imdue suffering.
We remain a country where to be ill means losing aU your savings, dignity, 
sanity, and worse, life. This cycle of healthcare depravity must end. A Universal 
Health Care Law is our redeeming option to end needless deaths, human misery 
and sufferings due to the unavailabiHty and unaffordability of health care.
This bill will make it possible for every Filipino to enjoy the benefits of a 
Universal Health Care, where preventive, curative and rehabilitative healtli 
services are guaranteed to everyone. It will unburden poor families from financial 
difficulties when paying for these sei'vices. It will improve our people's health­
seeking behavior and guarantee affordable medical attention for everyone at 
home, at work, in school or anywhere in the country as government agencies. 
Local Government Units and the private sector create more cooperation and 
synergy to fund and improve basic health care service delivery in government and 
private hospitals down to the health centers at community level.
A Universal Health Care law banishes healthcare as an entitlement and as a 
privilege of the few because more health coverage is provided for those in the 
formal employed sector and informal economy. It will provide more health care 
services to children and young people and provide better coverage for senior 
citizens and persons with disability (PWDs).
This Universal Healthcare Bill preserves life and health as an inalienable 
right of every Filipino.
In view of thereof, immediate approval of this bill is urgently sought.
JOSEPH VICTOR G. EJERCITO


0
SEVENTEENTH CONGRESS OF THE 
REPUBLIC OF THE PHILIPPINES 
First Regular Session
)
SENATE
SENATE BILL NO. 
1 4 5 8
iBffirr p[ ll)r :v>i ftr.ri>
'17 MAY 16 \P5 57
RECfciVtOb*:
INTRODUCED BY SENATOR JOSEPH VICTOR G. EJERCITO
AN ACT
PROVIDING 
UNIVERSAL 
HEALTH 
CARE 
FOR 
ALL 
FILIPINOS, AMENDING FOR THE PURPOSE REPUBLIC ACT 
NO. 7875, OTHERWISE KNOWN AS THE "NATIONAL HEALTH 
INSURANCE ACT OF 1995", AS AMENDED BY REPUBLIC ACT 
NO. 10606 AND APPROPRIATING FUNDS THEREFOR
Be it enacted by the Senate and the House of Representatives of the 
Philippines in Congress assembled:
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CHAPTER I
GENERAL PROVISIONS
SECTION 1. Short Title. - This Act shall be known as the 
"Universal Health Care for All Filipinos Act."
SEC. 2. Declaration of Policy. - It is hereby declared a policy of 
the State to protect and promote the right to health of the Filipino 
people and to instill health consciousness among them. Towards this 
end, the State shall adopt an integrated and comprehensive 
approach to health development.
As such. The State shall endeavor to provide every Filipino a 
healthy and decent living and working conditions and provide 
accessible, cost-effective and quality health care without financial 
hardship for every Filipino.


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The State shall also adopt a whole-of system, whole-of- 
government, and whole-of-society approach, which considers and 
embraces all parts, sectors, and relevant stakeholders in the 
planning, implementation, monitoring, and evaluation of all health- 
related policies, programs, and actions for the universal health care 
of all Filipinos.
SEC. 3. Definition of Terms. - As used in this act, the term:
(a) 
Co-insurance 
refers 
to a 
payment made by 
a 
member/patient/beneficiary as a fixed proportion of the total cost of 
health services, with the remaining covered for by the insurer;
(b) Health intervention refers to public health and medical 
services aimed at promotional, preventive, and curative cares, 
diagnosis, rehabilitation and palliation; it can be population-based or 
individual based, depending on the recipient;
(c) Health facility refers to public and private health facilities 
as defined by the Department of Health;
(d) Health system refers to all organizations, people and 
actions whose primary intent is to promote, restore or maintain 
health;
(e) Individual-based interventions refer to those health care 
services that can be definitively traced back to a singular person (ex. 
vaccines, hospitalization, etc.);
(f) Population-based interventions refer to those health care 
services that cannot be specifically traced back to a singular person /  
beneficiary (ex. bed nets, water and sanitation, etc.);
(g) Service delivery networks refers to a group of health 
facilities encompassing primary care to higher level facilities within 
the geographic bounds of a province that render all levels of care 
and governed by a single board
(h) Universal Health Care refers to the right of every Filipino 
to healthy living, working, schooling conditions and to access 
needed promotive, preventive, curative and reliabilitative health 
services tlaat is of sufficient quality to be effective, and without 
financial hardship when paying for these services


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(i) Whole-of-government approach refers to the adoption of 
multi-sectoral approach in addressing health issues, affirming the 
inherently integrated and indivisible linkages between health and 
other sectors such as education, energy, agriculture, sports, 
transport, communication, urban planning, environment, labor, 
employment, industry and trade, finance, and social and economic 
development;
(j) Whole-of-society approach refers to the contribution and 
significant role played by all relevant stakeholders, including 
individuals, 
families 
and 
communities, 
non-governmental 
organizations, civil society, religious institutions, the academe, the 
media, and the private sector, in advancing health reforms; and 
strengthening the 
linkages 
and coordination among these 
stakeholders in order to improve the effectiveness of all efforts to 
improve the health system.
(k) Whole-of-system approach refers to the approach which 
looks at each of the component parts or functions of the health 
system, following tlie principle that all parts of a health system, or all 
its building blocks - leadership, human resources, information, 
medical products and technology, financing, and service delivery - 
are interrelated. Hence, all actions to be taken must be evaluated for 
their potential effects on the functioning of the entire system;
CHAPTER II
FRAMEWORK FOR UNIVERSAL HEALTH CARE (UHC)
SEC. 4. UHC Entitlement of Every Filipino. - Every Filipino 
citizen shall be entitled to healthy living, working and schooling 
conditions and access to comprehensive set of health services. Access 
to health services shall be through every Filipino's automatic 
inclusion into the National Health Insurance Program whereby 
services shall be made available at zero co-payment for non-formal 
sector and all who opt for basic accommodation and at fixed co- 
insurance for all who opt for higher types of accommodation.
SEC. 5. Primary Care as First and Continuing Point of Contact. - 
All Filipinos shall be required to register with a primary care facility, 
which shall be the initial point of contact prior to gaining access to 
higher level facilities, except in severe/emergency cases.


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SEC. 6. Department of Health as Steward of the Health of the 
People. - The DOH shall take all measures to fully discharge its 
mandate of ensuring the achievement of health system goals of 
better health outcomes, sustained health financing, and a responsive 
health system for the achievement of universal health care. As the 
overall technical authority on health, the DOH shall continue to 
provide national policy direction and continue to be tlie overall 
strategic implementer of the national health reform agenda. It shall 
explicitly define both population and individual-based services that 
Filipinos are entitled to. Tlie DOH regional offices shall be 
reorganized as teams supporting every province.
SEC. 7. Financing of Population-Based Health Services. - The 
DOH, in consultation with the National Economic and Development 
Authority, shall determine the annual per capita health allocation, 
which LGUs shall appropriate for health and shall be complemented 
by national government support primarily to finance capital 
investments and population based interventions.
SEC. 8. Financing of Individual-Based Health Services. - A 
national purchaser of health services shall be identified to achieve 
optimal economies of scale, significantly influence market, and drive 
down prices to tlie most affordable and cost-efficient levels. The 
Philippine Health Insurance Corporation (PhilHealth), the mandated 
implementer of the National Health Insurance Program (NHIP), 
shall transition towards this role in the next 5 years, through the 
enhancement of its roles, functions, scope, and powers.
SEC. 9. Renaming the Philippine Health Insurance Corporation. - 
The PhilHealth, as established under Republic Act No. 7875, as 
amended by Republic Act No. 10606, is hereby renamed as the 
Philippine Health Security Corporation, hereinafter referred to as the 
PHSC, wliich from hereon shall be referred to as the Corporation, in 
view of its expanded scope and role in financial protection. It shall 
admimster the National Health Security Program of the government.
SEC. 10. Delivery of Health Services. - Both public and private 
health facilities shall be engaged to render individual-based services, 
while the DOH and LGU shall provide botli population and 
individual-based services.
The Department of Interior and Local Government (DILG), as 
partner of tlie DOH, shall coordinate and 
promote the


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implementation of this Act nationwide, including the execution of 
local government unit (LGU)'s operation and investment plans 
related to health. LGUs shall be primarily responsible for delivering 
population and individual-based health care services in the 
communities within their respective jurisdictions.
LGUs shall retain the devolved functions relating to health 
pursuant to Republic Act No. 7160, otherwise known as the Local 
Government Code. They shall perform the functions enumerated in 
Title Five, Book 1 thereof. Specifically, LGUs shall:
a) Pass local resolutions and ordinances that enable creation of 
healthy living and working environments
b) Implement community empowerment, information and 
education campaigns
c) Implement public health programs in line with DOH 
standards
d) Harness 
existing 
community 
organizations, 
parent 
organizations, youth organizations, women's club, faith-based 
or religious organizations, and other existing groups within 
their jurisdiction, which are already engaged in health 
promotion and prevention, or in the absence of any, encourage 
the establishment of such groups
e) Establish, operate, and maintain functional barangay health 
stations, rural health units, or equivalent facilities, municipal 
and provincial hospitals
f) Grant financial autonomy/income retention for each health 
facility through a subsidiary ledger such that incomes such as 
PHSC reimbursement can be flexibly used to improve the 
services
g) Mandate participation of all healtli care providers within the 
jurisdiction to engage formally in province-wide service 
delivery networks
h) Ensure adequate and equitable distribution of health 
professionals based on the recommended ratios set by the 
DOH;
i) Purchase medicines in line with tlie Philippine National 
Formulary and Drug Price Reference Index
j) Allocate per capita health investment per DOH and NEDA 
recommendations
k) Regularly conduct profiling activities on tlie health status of 
the people in their locality; and
l) Develop relevant health programs according to the needs of


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their locality
SEC 11. Coverage for indirect costs. - The Social Security System 
or Government Service Insurance System shall cover indirect costs 
for members in the formal sector. The Department of Social Welfare 
and Development (DSWD), Philippine Amusement and Gaming 
Corporation (PAGCOR), Philippine Charity Sweepstakes Office 
(PCSO), Aurora Pacific Economic Zone and Freeport (APECO) and 
Authority of the Freeport Area of Bataan (AFAB) shall support those 
in the non-formal sector for all indirect costs borne out of accessing 
medical services. Tl-iis includes but not limited to transportation, 
accommodation or halfway house, compensation for missed work, 
meals.
SEC. 12. Supplementary Coverage. - Article VI, Sec. 25 5b of RA 
7875, as amended by Republic Act No. 10606, is hereby amended to 
read as follows:
The Corporation, Health Maintenance Organizations (HMOs), 
and private health insurance (PHIs) companies shall develop 
supplementary plans that complement PHSC's basic benefits 
package and co-insurance schedule. The DOH shall work with the 
Insurance Commission to develop and monitor implementation of 
standard plans for HMOs and PPHs. In addition, HMOs and PHIs 
are mandated to extend coverage of the insured beyond the current 
60-year old cut-off.
SEC. 13. Public Access to Price Information. - In order to promote 
informed choice, every health care facility is mandated to establish a 
desk where the public may obtain relevant and up to date 
information regarding prices of all goods and services being offered 
by such facility.
SEC. 14. Community Empowerment - The DOH shall develop 
health literacy programs/campaigns aimed at increasing awareness 
of the public on their rights and benefits, the available health 
services, the various health-related programs of the government, and 
health literacy.
CHAPTER III
HEALTH SYSTEM - GOVERNANCE
SEC. 15. Strengthening Whole of Society and Whole of Government.


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- The Department of Health (DOH) shall establish a Whole of 
Society and Government (WSG) unit which shall be in charge of 
coordinating with other line agencies in developing inter-sectoral 
policies beneficial to health, including but not limited occupational 
health and safety, urban planning, active design, transport safety, air 
and water pollution control and prevention, food desertification, 
inner city decay, crime prevention and control, etc.
SEC. 16. Implementation of National Health Programs in a Whole of 
System approach. - The DOH shall as much as possible minimize silos 
and integrate disease-based national health programs into other 
existing programs of government, including but not limited to the 
Pliilippine Health Security Program as benefit packages, and 
organize its disease-based technical program offices as life course- 
based teams.
SEC. 17. Health Technology Assessment Group. - The DOH and 
the PHSC shall jointly establish a Health Technology Assessment 
Group (HTAG), which shall ensure explicit and transparent 
prioritization of all health benefits that the PHSC shall cover by 
utilizing health technology assessment (HTA) which is a systematic 
evaluation of properties, effects, and/or impacts of health 
technology in order to arrive at an informed policy decision making.
The HTAG sliall be composed of experts from the National 
Institute of Health, Research Institute of Tropical Medicines, the 
Epidemiology Bureau of the DOH, Philippine Medical Association, 
Philippine Dental Association, the National Economic and 
Development Authority, public hospital association, private hospital 
association, pharmaceutical industry and the PHSC. The HTAG shall 
create a secretariat as the need arises to facilitate and ensure the 
achievement of its objectives. Such funds necessary to support its 
activities shall be allocated to the HTAG, specifically for research 
and administrative support to the HTAG secretariat.
The HTAG shall have the following functions:
(a) Define and establish the components of the benefit 
packages for primary, secondary and tertiary care;
(b) Update the benefit packages every three (3) years, based on 
the country's demography, epidemiology and burden of disease, the 
available tedmology, the financial position of the social health


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insurance fund, and the cost and affordability of new benefits to be 
included; and
(c) 
Review, update, and amend the benefit packages within 
the three-year period if the country faces a health situation or 
emergency and warrants immediate changes in the benefit packages.
The HTAG shall be directly accountable to the Secretary of the 
DOH. Further, it shall ensure tliat its decision-making processes 
shall be as transparent and the results of its deliberations shall be 
made public.
SEC. 18. Coverage of Health Benefits. - The coverage for the 
health benefits for both outpatient and in-hospital care shall include 
medicines, diagnostic studies, vaccinations and geriatric care. 
Particularly, it shall include the following benefits thereby amending 
Section 10 of Republic Act No. 7875, as amended by Republic Act 
10606:
(a) Inpatient care:
(1) room and board;
(2) services of health care professionals including dentists;
(3) diagnostic, laboratory, and other medical and dental 
services;
(4) use of surgical, medical or dental equipment and facilities;
(5) prescription drugs and biologicals;
(6) inpatient education packages; and
(7) post-inpatient hospital care rehabilitation services.
(b) Outpatient care:
(1) services of health care professionals including dentists;
(2) diagnostic, laboratory, and other medical and dental 
services;


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(3) use of surgical, medical or dental equipment and facilities;
(4) personal preventive services;
(5) prescription drugs and biologicals; and
(6) port-outpatient surgical home and rehabilitation services.
To minimize out-of-pocket expenses, emergency and transfer 
services and such otlier healthcare services that the DOH shall deem 
appropriate shall, as far as practicable, be covered. HTAG shall 
develop guidelines, in cooperation with appropriate government 
and private agencies, for the co-payment, which the patients may be 
asked to share when a health service incurred is beyond the PHSC 
coverage.
SEC. 19. 
Standards of Care. - The DOH shall establish a 
clearinghouse and work with various medical professional 
organizations in developing context-appropriate, evidence-based 
clinical practice guidelines to guide clinical decision support, 
reimbursement and payment incentives.
SEC. 20. Patient-friendly Procedures. - All health facilities are 
required to adopt a standard admission, billing and discharge 
procedures to be developed by the DOH, in coordination with 
private hospitals association, which will ensure that (1) patients are 
not treated differently based on their capacity to pay, (2) patients are 
accommodated and provided necessary health service at the most 
convenient, responsive and efficient way, and (3) medical social 
workers are seamlessly integrated into a single process.
SEC. 21. Research and Development. - The DOH and its attached 
agencies are hereby mandated to strengthen their capacity for 
producing and utilizing health policy and systems research to 
inform policymaking and as such shall earmark 2% of their MOOE 
for research. The DOH shall also establish the Health Policy and 
Systems Research Institute (HPSRl) as an office within the DOH 
funded primarily from the 2% 
MOOE, and support the 
establishment of research consortia in line with the vision of the 
Philippine National Health Research System.


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CHAPTER IV
HEALTH SYSTEM - HEALTH SERVICE DELIVERY
SEC. 22. Network of Health Service Providers. - All health 
facilities, encompassing primary to tertiary care within a provincial 
jurisdiction, are mandated to form a single network for purposes of 
effective referral system. The network shall be responsible for 
ensuring efficiency in using resources and establishing strategically 
located specialty centers to avoid redundant one-stop shops, and 
facilitate cross-subsidization of operational costs and the setting up 
of referral protocols including transport and accommodation 
services.
SEC. 23. Establishment of New Health Care Facilities. - All new 
health facilities shall be developed in line with the province-wide 
and nation-wide health facility development plan and shall require 
the issuance of a Certificate of Need from the DOH prior to 
establishment. Government hospitals, whether general or specialty, 
shall only be established in areas with documented demand.
SEC. 24. Income Retention. - To ensure that all government 
hospitals and health facilities have full authority to utilize their 
income to enhance their capacity to expand and to improve the 
quality of their services, all government hospitals are hereby 
authorized to retain and utilize one hundred percent (100%) of their 
income, which includes hospital fees from in-house services and 
facilities; income derived from non-patient-related services such as 
affiliation/ medical/professional fees, rental fees, parking fees, 
interview and tour fees; and income derived from interest on 
account deposits, without remitting the same to the Bureau of 
Treasury.
For this purpose, a trust fund constituting the retained income 
shall be established to be distributed among the following, in a ratio 
to be determined by tlie DOH: capital outlays for the purpose of 
equipment and infrastructure projects including construction, 
improvement, and/or renovation of hospital facility; other expenses 
for maintenance and operation of the facility; assistance to indigents; 
additional allowances of medical personnel and staff; and other 
purposes to be determined by the DOH.
This trust fund shall be deposited in an authorized 
government depositary bank/s recommended by the DOH, the
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Department of Finance (DOF), and the Department of Budget and 
Management (DBM).
Further, all public hospitals shall comply with DOH's 
standard cost accounting method and comprehensively account for 
facilities' finances and expenditures.
SEC. 25. Government Hospitals ns No Balance Billing (NBB) 
Hospitals. - Consistent with tlie objective of improving accessibility 
and availability of health care for all, especially the poor, all 
government hospitals are hereby required to operate with not less 
than ninety percent (90%) NBB beds, as mandated by RA 1939, 
Section 6. Specialty hospitals are required to operate with not less 
than sixty percent (60%), and private hospitals not less than ten 
percent (10%) of their capacity as NBB beds.
All government hospitals, specialty hospitals and private 
hospitals shall regularly submit a report on the allotment or 
percentage of their bed capacity to charity beds. Tlie DOH sliall issue 
the necessary guidelines for the immediate implementation of this 
Section.
CHAPTER V
HEALTH SYSTEM - HUMAN RESOURCES
SEC. 26. Appropriate Compensation Package. - In order to ensure 
that all health professionals, personnel, and staff in the public and 
private sector receive adequate compensation and benefits 
commensurate to their fundamental role in society and to the 
amount of work that they render as well as to inform the costing of 
PHSC reimbursements, the DOH shall set up a board which will 
determine the remuneration, and other benefits due to health 
professionals based on their qualification, with rates updated 
periodically.
SEC. 27. Underserved Areas. - In order to encourage service in 
underserved 
areas, 
government 
health 
workers 
shall 
be 
compensated based on 100% of Salary Standardization Rates.
SEC. 28. PHSC reimbursements to complement compensation in the 
public sector. - The DOH shall spearhead the setting up of guidelines 
on the use of reimbursements from PHSC to augment salaries and 
make overall compensation in the public sector competitive.
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SEC. 29. Available Plantilla Items. - The DOH shall work with 
the Department of Budget and Management (DBM) to regularly 
adjust plantilla items in government health facilities for both general 
practitioners and specialists, including residency positions, such that 
the ratio for health professionals will be met, consistent with the 
burden of disease and ensuring that distribution and allocation 
responsive to contextual geographic needs especially of underserved 
areas.
SEC. 30. Return of Service. - All healtli professional graduates 
from public schools shall be required to serve for at least two (2) full 
years, mider supervision, in an underserved area or in the public 
sector prior to obtaining their permanent/official license to practice.
SEC. 31. Publicly-funded Health Professional Education. Within 
the next 5 years, the DOH shall ensure that health professional 
education shall be publicly funded. The DOH, Commission on 
Higher Education (CHED), and the DBM shall develop and plan the 
expansion of health professional education degree programs as well 
as regulate the slots for each depending on market needs. In tlie 
interim, the government may contract out to private health 
professional institutions.
SEC. 32. Curriculum Shift. The DOH shall work with the 
Association of Philippine Medical Colleges and various academic 
institutions to shift the focus and learning outcomes of degree 
programs to that of primary care.
CHAPTER VI
HEALTH SYSTEM - HEALTH INFORMATION SYSTEM
SEC. 33. Administrative, Medical, Prescription, Reimbursement 
Data. - All health service providers and insurers sliall within four (4) 
years, create and maintain information systems including but not 
limited to enterprise resource planning, human resource information 
system, electronic medical records, and electronic prescription 
consistent with DOH standards which shall be electronically 
uploaded on a regular basis. The DOH, in consultation with 
appropriate government and private agencies, is hereby mandated 
to develop a single system to be used by all health service providers.
SEC. 34. Health Research Data Warehouse. - The DOH shall
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create a databank, which shall serve as a hub of all health 
transactions/data including but not limited to administrative, 
medical, prescription and reimbursement data. These shall be 
reviewed and archived and shall be used exclusively for the purpose 
of generating information to guide research and policy. Patient 
privacy and confidentiality shall at all times be upheld, in 
accordance with the Data Privacy Act of 2012.
SEC. 35. Access to Health Research Data Warehouse. - The PHSC 
shall be transparent with respect to data pertaining to the planning 
and implementation of the national health security fund. To the 
extent possible and unless restricted by the Data Privacy Act of 2012, 
these data shall be in the pubUc domain. The Corporation shall not 
unduly restrict tlie release of information required by its members, 
government officials, researchers, members of the academe, media, 
and other concerned parties, unless they require excessive costs to 
generate, in which case, arrangements should be made for those who 
are requesting the data to pay for the necessary costs of obtaining 
such data.
CHAPTER VII
HEALTH SYSTEM - REGULATION
SEC. 36. Regulation of private health facilities, drug outlets and 
diagnostics clinics outside public hospitals. - The Food and Drug 
Administration (FDA) and the DOH shall strictly regulate setting up 
private facilities within the vicinity of public hospitals as well as 
ownership of tliese facilities by health professionals engaged by the 
government hospital, as mandated by Article IV Sec. 38 of RA10918.
SEC. 37. Generics prescribing. Sec. 6 of RA 6675 is hereby 
amended to read as all medical, dental and veterinary practitioners, 
including private practitioners, shall write prescriptions using the 
international nonproprietary name (INN) or generic name ONLY. 
No brand names shall be allowed in any part of tlie prescription.
SEC. 38. Availability of Generics. All drug outlets shall be 
required at all times to carry the generic equivalent of all drugs in 
the Primary Care Formulary.
SEC. 39. Informed Choice. All health care providers are required 
to put up a desk within their health facilities where the public can 
readily access pertinent information regarding the costs of medical
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services.
Drug outlets shall be required to provide customers with a list 
of therapeutic equivalent and their corresponding prices when 
fulfilling prescriptions and/or in any transaction.
SEC. 40. Commodities of Public Health Significance. - The DOH 
shall determine a list of public health commodities that shall be 
taken out of the private market, especially if their unregulated use 
poses threats and risks to public health (e.g. drug resistance).
SEC. 41. Tariff Exemption for Raw Materials of Medicines. 
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Manufacturers of generic medicines may apply for exemption from 
tariffs through Philippine Economic Zone Autliority (PEZA) in the 
importation of raw materials for the sole use in the manufacturing of 
generic medicines part of the essential medicines list intended for 
domestic consumption.
SEC 42. Price Negotiation Committee. - The DOH shall be 
mandated to set-up a price negotiation committee which will ensure 
value-based pricing through a framework contract with suppliers of 
drugs which are either (1) on patent, (2) single-source (one supplier 
only), or (3) have no therapeutic equivalent in the Philippine 
National Formulary. The negotiated price in the framework contract 
shall be made available for all public sector institutions.
CHAPTER VIII
PHILIPPINE HEALTH SECURITY CORPORATION
SEC. 43. Membership Types. - For purposes of simplicity, all 
members previously enrolled under the NHIP, as provided under 
Section 7 of Republic Act No 7875, as amended by Republic Act No. 
10606, is hereby classified as follows:
a) Members in tlie formal group include government workers, 
private employees, all other workers rendering services, whether 
in government or private offices, such as job order contractors; 
project-based contractors and the like; owners of micro 
enterprises, owners of small, medium and large enterprises, 
household help, family drivers, migrant workers, self-earning 
individuals, professionals, Filipinos with dual citizenship, 
naturalized Filipino citizens, citizens of otlier countries working
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and/or residing in the Philippines; and lifetime members.
In view of the senior citizen's mandatory coverage, lifetime 
membership program shall no longer exist.
b) Members in the non-formal group include all others not included 
in the formal group.
SEC. 44. Membership Database. - The PHSC shall within (2) 
years of this Act shall use civil registration as the basis for cleaning 
up and regular updating its database. To this end, the Philippine 
Statistical Authority is hereby mandated to assist and align 
initiatives with the Corporation.
SEC. 45. Setting of Contribution or Premium Rates. - Section 28 
and 29 of Republic Act 7875, as amended by Republic Act No. 10606, 
is hereby amended to read as follows:
The PHSC shall review and adjust eveiy two (2) years or as 
often as necessary, the prevailing contribution in order to achieve 
desired support value.
Members in the formal group shall pay the monthly 
contribution rate, provided, that employers shall pay an equivalent 
contribution on behalf of each employee.
Members in the non-formal group shall have their 
contributions fully subsidized by the national government. Provided, 
that such contributions to the PHSC be included annually in the 
General Appropriations Act, among other sources. All LGUs whose 
premiums to the Corporation are shouldered by the national 
government are hereby mandated to utilize funds intended for 
premium payments of tlieir constituents for the improvement of 
their respective health facilities and the delivery of quality health 
care.
SEC 46. Collection of Contribution or Premimn. Collection 
functions, as stated in Article III, Section 5 of RA 7875, as amended 
by Republic Act No. 10606, is hereby amended to read as the 
Corporation shall unburden itself from the task of collecting 
premium and focus on benefits administration. As such, it shall 
enlist the assistance of Bureau of Internal Revenue in collecting 
contributions from the formal sector and directly collect from the
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SEC 47. Entitlement to Benefits. - Section 12 of RA 7875, as 
amended by Republic Act No. 10606, is hereby amended to read as 
folloows;
No minimum period after the contribution is paid will 
be required to activate entitlement to benefits. In the case of the 
formal sector, failure to pay will enable access to benefits but require 
retrospective payment of all missed contributions with at least 15% 
penalty for the individual (in the case of self-employed) and 15% 
penalty for the employer (in the case of employers), per annum.
SEC. 48. National Health Security Fund (NHSF). - The National 
Health Insurance Fund, as created and utilized under Articles VI and 
VII of Republic Act No. 7875 and amended by SecHons 15 to 21 of 
Republic Act No. 10606, is hereby referred to as National Health 
Security Fund, herein after referred to as the NHSF. All budgetary 
allocations for the Corporation and prepaid funds shall be 
consolidated and pooled as the NHSF. All other health assistance 
funds, such as, but not limited to, the DOH's Medical Assistance 
Fund, Philippine Charity Sweepstakes Office (PCSO) and Philippine 
Amusement and Gaming Corporation (PAGCOR), revenues from 
Sin Tax, shall be redirected into the NHSF. Furtliermore, budgetary 
allocations for inputs that can be included as part of the 
Corporation's benefit packages reimburses - such as drugs, devices - 
shall be pooled as part of NHSF.
SEC. 49. Breadth of Benefits Coverage. - The recommendations of 
the FTTAG shall be regarded as binding by default, with the PHSC 
negotiating solely on the basis of financial feasibility. Further, benefit 
packages shall be regularly reviewed by the Corporation for this 
purpose.
SEC. 50. Depth of Financial Coverage. - The PHSC shall ensure 
fair reimbursement rates that is informed by accurate disease 
groupings, periodic costing and consultation, and stronger 
surveillance and monitoring system to monitor compliance to co­
payment rates by all health care providers. In view of this, all health 
care providers are mandated to submit encoded cost, price, and 
clinical data provided that these are consistent with the Data Privacy 
Act of 2012. All healthcare providers are mandated to charge 
patients only according to PHSC's rules on co-payment.
DBM for all non-formal members.
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SEC. 51. Cost Containment. - In order to ensure that health 
expenditures remain manageable and the NHSF sustainable, the 
PHSC is hereby mandated to operationalize within five (5) years the 
Global Budget Payment Program as defined under Section 4 of 
Republic Act 7875, which shall be redefined hereon to mean as 
setting annual reimbursement thresholds for facilities based on 
facility type, facility level, geographic location, expected case mix, 
and other cost drivers, as may be determined by the PHSC and 
linked with key performance indicators.
SEC. 52. Administrative Cost. - For purposes of maximum 
utilization of existing funds, no more than five percent (5%) of the 
sum total of the various funds enumerated under Article VI, Section 
26 of Republic Act No. 7875, as amended by Republic Act No. 10606, 
shall be allocated for administering the Program.
SEC. 53. Accreditation and Advanced Participation - All licensed 
facilities shall be deemed accredited. In addition, the Corporation 
shall develop a scheme for advanced participation to incentivize 
high quality health networks.
SEC. 54. Claims. - Sec. 23 (j) of RA 7875, as amended by 
Republic Act No. 10606, is hereby amended to read as follows:
All claims should be reimbursed within thirty (30) days of 
filing of the health care provider. Provided, that all accompanying 
requirements including encoded cost, price, and clinical data are 
submitted completely.
The PHSC shall shift all claims review and processing to 
electronic within two (2) years of tlie enactment of tliis bill and 
engage third party administrators as may be necessitated. All health 
care facilities are expected to submit electronic or fully encoded 
claims, complete with all necessary documents and accompany data 
within fifteen days (15) upon discharge of the patient.
SEC. 55. Reorganization. - Section 18 (a) of Republic Act No. 
7875, as amended by Republic Act No. 10606, is hereby amended to 
read as follows:
The Board of the PHSC shall provide strategic oversight, 
planning, and alignment function towards the achievement of the
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institution's vision and mission, as well as the overall goals and 
targets of the sector. It shall primarily be concerned with macro- and 
top-level policy issues that directly concerns fulfillment of the NHSO 
role and mandate as a national single purchaser. On matters relating 
to the development and/or expansion of benefits, the Board shall be 
guided by the evidence results of a priority setting process as 
provided in the previous sections.
The Corporation shall be governed by a Board of Directors 
hereinafter referred to as the Board, composed of the following 
members:
Ex Officio Board Members
"The Secretary of Health;
"The Secretary of Labor and Employment or a permanent 
representative;
The Secretary of the Interior and Local Government or a 
permanent representative;
' The Secretary of Social Welfare and Development or a 
permanent representative;
"The Secretary of the Department of Finance (DOF) or a 
permanent representative;
"The Secretary of the Departnient of Budget and Management 
(DBM) or a permanent representative;
"The President and Chief Executive Officer (CEO) of the 
Corporation (ex officio Vice Chairperson);
The Vice Chairperson for the basic sector of the National Anti- 
Poverty Commission or a permanent representative;
"The Chairman of the Philippine Charity Sweepstakes Office 
(PCSO) or a permanent representative;
The Chairman and CEO of the Philippine Amusement and 
Gaming Corporation (PAGCOR) or a permanent representative;
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"A permanent representative of Filipino migrant workers;
"A permanent representative of the members in the formal 
economy;
"A permanent representative of the members in the informal 
economy;
"A representative of employers;
"A representative of health care providers to be endorsed by 
their national associations of "health care institutions and medical 
health professionals;
"A permanent representative of the elected local chief 
executives to be endorsed by the "League of Provinces, League of 
Cities and League of Municipalities; and
Appointive Board Members
Board.
'An independent director to be appointed by the Monetary
The Secretary of Health shall be the ex-officio Chairperson 
while the President and CEO of the Corporation shall be the Vice 
Chairperson of the Board.
SEC. 56. Selection Process of Nominees from the Sectors. - Section 
18 (b) of Republic Act No. 7875, as amended by Republic Act No. 
10606, is hereby amended to read as follows.
Within tliirty (30) days following the effectivity of this Act, the 
DOH shall promulgate tlie nomination process with a clear set of 
qualifications, credentials, and recommendation from the sector. The 
nominees shall be validated and shortlisted by the DOH, in 
consultation with relevant stakeholders particularly from the sector 
the nominee is expected to represent. The list of nominees shall be 
submitted to the Governance Commission for GCGs.
Prior to the start of their term, all members of the Board, 
including their respective alternates, shall be required to undergo 
training in health care financing, health systems, costing health 
services, and health technology assessment. Succeeding trainings
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shall be provided and required as necessary. Non-compliance 
and/or non-attendance to trainings can be grounds for dismissal.
SEC. 57. Conflict of Interest. - The members of the Board, the 
President of the PHSC, other officers and employees should not have 
any conflict of interest that may compromise his/her participation in 
the activities or decision of the Board. As such, prior to every board 
meeting, all members of the Board shall duly a sign a conflict of 
interest declaration.
A member of tlie Board who is in any way, whether directly or 
indirectly, interested in a contract or proposed contract with the 
Board must, as soon as practicable after the relevant facts have come 
to his or her knowledge, declare the fact and the nature and extent of 
the interest, in writing to the Chairperson, before the meeting of the 
Board and inhibit himself during the deliberations when such matter 
is taken up. The decision taken on the matter shall be made public 
and the minutes of the meeting shall reflect the disclosure made and 
the inhibition of the member concerned.
SEC. 58. Local Health Security Office. - Article V of RA 7875, as 
amended by Republic Act No. 10606, is hereby amended to read as 
follows:
The PHSC shall establish a Local Health Security Office, 
hereinafter referred to as the Office, in every congressional district 
Each Office shall have the following powers and functions:
a) to maintain and update the membership eligibility list at 
community levels;
b) to issue health insurance ID cards to persons whose premiums 
have been paid according to the requirements of the Office 
and the guidelines issued by the Board;
c) to grant or deny accreditation to health care providers in their 
area of jurisdiction, subject to the rules and regulations to be 
issued by the Board;
d) to monitor compliance of accredited health care providers 
specifically with regards to quality and financial protection;
e) to process, review and pay the claims of providers, within a 
period not exceeding thirty (30) days whenever applicable in 
accordance with the rules and guidelines of tlie PHSC;
f) to ensure quality of encoded claims data and recommend 
necessary sanctions and penalties in the form of financial
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g)
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demerits to succeeding claims of non-compliant health care 
providers;
to establish referral systems and network arrangements with 
other Offices as may be necessary following the guidelines set 
by the PHSC;
to serve as the first level for appeals and grievance cases; 
to tap community-based volunteer health workers and 
barangay officials, 
if necessary, 
for information and 
communication activities to grant such workers incentives 
according to the guidelines set by the PHSC and in accordance 
with applicable laws. However, the incentives for the 
barangay officials shall accrue to the barangay and not to the 
said officials;
to prepare an annual report according to guidelines set by the 
Board and to submit the same to the central office of the 
Corporation.
SEC. 59. Audit. - All funds intended for the universal health 
care shall be subject to an internal and external audit to be done as 
follows:
a) Internal Audit - There shall be an internal audit with respect 
to the finance, accounting and procurement of PHSC, with a 
corresponding audit report for the submission to the Board, at 
least once a year.
For purposes of internal audit, there shall be an official of the 
Board acting as an internal auditor with direct accountability 
to the Board, in accordance with the regulations prescribed by 
the Board. The Board shall prepare a financial statement, 
which must include at least a balance sheet and an operation 
account to be submitted to the auditor witliin one hundred 
and twenty (120) days from the end of each accounting year.
b) External Audit - At an interval of every year, the Commission 
on Audit shall appraise the utilization and disposition of the 
NHSF in accordance with existing laws and guidelines. The 
COA is also hereby directed to review its rules vis-a-vis the 
merits of the PHSC's provider payment mechanisms.
SEC. 60. Employees Covered by the Workmen's Compensation Act. 
- In cases where an employee is entitled to health care service under 
the Workmen's Compensation Act, also enjoys benefits of a health
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care provider pursuant to this Act, the health service provider shall 
notify such event to the Corporation. The Corporation shall be 
entitled to reimbursement for health services from the Workmen's 
Compensation Fund, not exceeding such amount as prescribed in the 
Workmen's Compensation Law, and shall submit such amount of 
reimbursement to the fund of the Corporation.
SEC. 61. Patients Covered by Motor Vehicle Accidents Insurance. - 
In cases where an insurance company is liable to pay the 
compensation to a motor vehicle accident victim who has enjoyed 
the right of health services pursuant to this Act, the Corporation 
shall be entitled to reimbursement from the insurance company, and 
shall submit such amount of reimbursement to the fund of the 
Corporation. The Corporation shall have powers to issue an order 
requesting the said insurance company to pay such health service 
expenses, not exceeding the amount in accordance with the 
conditions of the insurance policy.
SEC. 62. Appropriations. - Article XI of RA 7875, as amended by 
Republic Act No. 10606, is hereby amended to read as follows:
Tire amount necessary to implement the provisions of this Act 
shall be included in tlie General Appropriahons Act for the year 
following the approval of this Act. In addition, the Corporation may 
request Congress to appropriate supplemental funding to meet 
targeted milestones of the Program.
CHAPTER IX
MISCELLANEOUS PROVISIONS
SEC. 63. Implementing Rules and Regulations. - The DOH, the 
Corporation, and DILG, in consultation and coordination with 
appropriate government agencies, CSOs, NGOs, representatives 
from the private sector, and other stakeholders, shall promulgate a 
new set of implementing rules and regulations within sixty (60) days 
from the effectivity of this Act.
SEC. 64. Adoption of the Provisions of Republic Act No. 7875, 
Republic Act No. 10606, Republic Act No. 8980, and Act No. 10410. - 
The provisions of Republic Act No. 7875, otherwise known as the 
National Health Insurance Act of 1995, as amended by Republic Act 
No. 10606; Republic Act No. 8980, otherwise known as the ECCD 
Act of 2000; and Republic Act No. 10410, otherwise known as "Early
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Years Act of 2013" insofar as they are not inconsistent with the 
provisions of this Act, are hereby adopted and made an integral part 
of this Act.
SEC. 65. Interpretation. - Any doubt in the interpretation of any 
provision of this Act shall be liberally interpreted in a manner 
mindful of the rights and interests of every Filipino to quality, 
accessible and affordable health care.
SEC. 66. 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.
SEC. 67. Repealing Clause. - All other laws, decrees, executive 
orders and rules and regulations contrary to or inconsistent with the 
provisions of this Act are hereby repealed or modified accordingly.
SEC. 68. 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,
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