HOUSEOF REPRESENTATIVES
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Republic of the Philippines nae 2S Ae 28
HOUSE OF REPRESENTATIVES = T™__ 2-700
Quezon City, Metro Manila ey: bey

SEVENTEENTH CONGRESS REOISTR ATION UIT
First Regular Session BILLS #0 (ROLX SERVICE

: 2
HOUSE BILL NO. 3337

Introduced by Honorable Estrellita B. Suansing
and Honorable Horacio P. Suansing, Jr.

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EXPLANATORY NOTE

The bill seeks to require health maintenance organizations to include
hypertension, diabetes mellitus as well as pregnancy related illnesses in its medical
care coverage.

Health maintenance organizations provide customers with access to a full
range of medical facilities at their time of need, in exchange for membership fees up
front. Health maintenance organizations formally started in the United States in the
early 70s and penetrated the Philippine market thereafter becoming a reliable
partner to the Philippine government in providing health care to our people.

Getting sick in the Philippines is very expensive especially if one does not
have money and health insurance. Many Filipinos are forced to borrow money from
the bank, friends and relatives just to pay medical bills. Health emergencies eat up
savings and even investments. While Philhealth is there to alleviate the situation, it
will not pay everything especially when one is confined in private hospitals
Philhealth can only pay a percentage of the total bill. This is where the health
maintenance organizations come in as a reliable partner in providing health care
services. Health maintenance organizations cover basic medical expenses for
preventive and outpatient care, medical treatment and hospitalization. Unfortunately,
they do not include in its coverage for individual plans, chronic diseases like
hypertension, diabetes mellitus and pregnancy related illnesses to include ante and
postnatal care. For corporate plans however, chronic diseases as above mentioned
are included subject to pre-existing conditions rule where usually, on the first year,
the condition is not covered. Hence, this bill.

By making it mandatory for health maintenance organizations to cover the
mentioned chronic diseases, at a premium acceptable by both covered client and the


health maintenance organization, the healthcare needed to cover the enrolled clients
will be assured. The premium is determined by the Insurance Commission in
consultation with the Secretary of Health and the stakeholders taking into
consideration the constitutional right of the health maintenance organization to
reasonable return of their investment.

In view of the foregoing, early approval of this bill is earnestly sought.

ES’ LLITA B. SUANSII

HORACIO PYSUANSING, JR.
1* District, Nueva Ecija’

24 District, Sultan Kudarat


eCaorvraunnewn

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

SEVENTEENTH CONGRESS
First Regular Session

°
HOUSE BILL NO. 3237

Introduced by Honorable Estrellita B. Suansing
and Honorable Horacio P. Suansing, Jr.

AN ACT
REQUIRING HEALTH MAINTENANCE ORGANIZATIONS TO INCLUDE
HYPERTENSION, DIABETES MELLITUS AS WELL AS PREGNANCY RELATED
ILLNESSES IN THEIR MEDICAL CARE COVERAGE

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

SECTION 1. All health maintenance organizations are mandated to include in
their medical care coverage pregnancy, hypertension and diabetes mellitus, whether
the condition is pre-existing or manifested only during the period covered. Provided,
That the corresponding premium equitably acceptable to both client and the health
maintenance organization is considered and agreed upon subject to allowable limit
of coverage as provided in the contract. The Insurance Commissioner shall, in
consultation with the health maintenance providers, devise proper graduated scale of
payment appropriate for the corresponding diseases. The Secretary of Health shall
closely collaborate with the Insurance Commission and the stakeholders in arriving
with the appropriate amount of premium that considers both the healthcare needs of
the clients and the right of the health maintenance providers as corporate citizens to
reasonable return of their investment.

SECTION 2. The Insurance Commission shall, in coordination with the
Department of Health, promulgate the implementing rules and regulations within
ninety (90) days after the enactment of this Act.


1 SECTION 3. This Act shall take effect fifteen (15) days after its publication in
2 the Official Gazette or in a newspaper of general circulation.
3 Approved,