TWENTIETH CONGRESS OF THE 
REPUBLIC OF THE PHILIPPINES 
First Regular Session
)
SENATE 
S. No.
s&euatc
of ti)t' ;gbeifp!3r^
25 AUG-4 PI :29
RECElVtO BY:
Introduced by Senator Loren Legarda
AN ACT
FURTHER AMENDING REPUBLIC ACT NO. 7875, OTHERWISE KNOWN AS 
THE "NATIONAL HEALTH INSURANCE ACT OF 1995", AS AMENDED, TO 
INSTITUTIONALIZE THE PHILHEALTH MEMBER RECOGNITION PROGRAM 
(PMRP)
EXPLANATORY NOTE
The government's promise of Zero Balance Billing (ZBB) represents a 
meaningful step toward improving access to affordable healthcare. It aims to ensure 
that eligible patients, particularly those admitted to public hospitals, will no longer 
incur out-of-pocket expenses for essential services. This policy direction aligns with 
the objectives of the Universal Health Care (UHC) Act and reflects a broader 
commitment to health equity.
However, for many PhilHealth members, ZBB remains largely aspirational. 
While pilot implementations have begun in select government facilities, the policy has 
yet to deliver consistent results across the healthcare system. Many contributors, 
especially those seeking treatment in private hospitals or for conditions not fully 
covered by existing benefit packages, continue to face substantial personal expenses.
In these cases, the gap between expectation and reality persists.
This reality is familiar to millions of Filipinos who make mandatory contributions 
to PhilHealth as part of their employment or livelihood obligations. Formal workers, 
small business owners, and self-employed individuals contribute with the belief that 
the system will support them when medical needs arise. Yet many find themselves


absorbing most of the cost of care, leading to frustration and the recurring question: 
What have my years of contributions amounted to?
At its foundation, the National Health Insurance Program (NHIP) is a shared 
commitment to distribute the burden of healthcare costs fairly. But for such a system 
to endure, it must recognize and retain the trust of its contributors. PhilHealth must 
evolve beyond minimum guarantees by introducing reforms that affirm the value of 
long-term participation and encourage continued engagement.
This bill proposes the creation of the PhilHealth Member Recognition Program 
(PMRP). Consistent with Article I, Section 2(g) of Republic Act No. 7875, which 
identifies innovation as a guiding principle of the NHIP, the PMRP introduces a points- 
based rewards system for long-term and consistent contributors. Earned points may 
be used to access enhanced health services, reduce out-of-pocket expenses, and 
support preventive care. Members will also have the option to transfer points to their 
family, allowing benefits to be shared where they are most needed.
The PMRP complements ongoing reforms such as ZBB. It addresses a different 
but equally important concern: the need to reward long-term payors and strengthen 
the perceived value of participation in PhilHealth. For many who fall outside the reach 
of full subsidy or ZBB coverage, the PMRP provides a mechanism to improve 
satisfaction, extend health protection, and reinforce their role in sustaining the system. 
This measure promotes fairness, strengthens member trust, and encourages the long­
term viability of the NHIP.
In view of the foregoing, the urgent passage of this bill is earnestly sought.
LOREN LEGARDA


TWENTIETH CONGRESS OF THE 
REPUBLIC OF THE PHILIPPINES 
First Regular Session
)
SENATE 
S. No. 808
10
of flji' .-Sii tirtarp
25 AUG-4 PI :29
RECtiVED W-
Introduced by Senator Loren Legarda
AN ACT
FURTHER AMENDING REPUBLIC ACT NO. 7875, OTHERWISE KNOWN AS 
THE "NATIONAL HEALTH INSURANCE ACT OF 1995", AS AMENDED, TO 
INSTITUTIONALIZE THE PHILHEALTH MEMBER RECOGNITION PROGRAM 
(PMRP)
Be it enacted by the Senate and the House of Representatives of the Philippines in 
Congress assembled:
1 
Section 1. Section 2 of Republic Act No. 7875, as amended, is hereby further
2 
amended to read as follows:
3 
SEC. 2 Declaration of Principles and Policies. — It is hereby
4 
declared the policy of the State to adopt an integrated and
5 
comprehensive approach to health development which shall
6 
endeavor to make essential goods, health, and other social
7 
services available to all the people at affordable cost and to
8 
provide free medical care to paupers. Towards this end, the
9 
State shall provide comprehensive health care services to all
10 
Filipinos through a socialized health insurance program that will
11 
prioritize the health care needs of the underprivileged, sick,
12 
elderly, persons with disabilities (PWDs), women, and children,
13 
and provide free health care services to indigents.
14 
THE STATE ALSO RECOGNIZES THE SUSTAINED CONTRIBUTIONS OF
15 
ITS MEMBERS AS ESSENTIAL TO THE STABILITY OF THE HEALTH
16 
INSURANCE PROGRAM AND SHALL ENSURE EQUITABLE RECOGNITION
1


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AND ADDITIONAL BENEFITS TO LONG-TERM CONTRIBUTORS, FOSTERING
2 
TRUST, LOYALTY, AND GREATER PARTICIPATION.
3 
Pursuant to this policy, the State shall adopt the following principles:
4 
XXX XXX XXX
5 
s) 
EQUITABLE RECOGNITION OF SUSTAINED
6 
CONTRIBUTIONS — THE PROGRAM SHALL RECOGNIZE
7 
AND REWARD THE SUSTAINED CONTRIBUTIONS OF
8 
LONG-TERM MEMBERS BY PROVIDING ADDITIONAL
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BENEFITS THAT ENHANCE EQUITY AND FOSTER TRUST,
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LOYALTY, AND ENGAGEMENT AMONG CONTRIBUTORS.
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THE PROGRAM SHALL GIVE DUE EMPHASIS TO THE
12 
VALUE OF CONSISTENT PARTICIPATION AND ENSURE
13 
THAT MEMBERS PERCEIVE TANGIBLE RETURNS FOR
14 
THEIR SUPPORT.
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Sec. 2. Section 4 of Republic Act No. 7875, as amended, is hereby amended to
16 
read as follows:
17 
SECTION 4. Definitions of Terms. — For the purpose of this Act,
18 
the following terms shall be defined as follows:
19 
(a) Abandoned Children - Children who have no known
20 
family willing and capable to take care of them and are
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under the care of the Department of Social Welfare and
22 
Development (DSWD), orphanages, churches, and other
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institutions.
24 
(b) Beneficiary - Any person entitled to health care benefits
25 
under this Act.
26 
(c) Benefit Package - Services that the Program offers to its
27 
members.
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(d) Capitation - A payment mechanism where a fixed rate,
29 
whether per person, family, household, or group, is
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negotiated with a health care provider who shall be
31 
responsible for delivering or arranging for the delivery of
32 
health services required by the covered person under the


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conditions of a healthcare provider contract.
(e) Case-based Payment - Hospital payment method that 
reimburses hospitals a predetermined fixed rate for each 
treated case or disease; also called per-case payment.
(f) CONTRIBUTION - The amount paid by or in behalf of a 
member to the Program for coverage, based on salaries 
or wages in the case of formal sector employees, and on 
household earnings and assets, in the case of the self- 
employed, or on other criteria as may be defined by the 
Corporation in accordance with the guiding principles set 
forth in Article I of this Act. CONTRIBUTIONS SHALL 
RECOGNIZE SUSTAINED AND LONG-TERM 
PAYMENTS, WHICH MAY QUALIFY MEMBERS FOR 
ADDITIONAL BENEFITS AND REWARDS UNDER 
PROGRAMS ESTABLISHED BY THE CORPORATION.
(g) COVERAGE - The entitlement of an individual, as a 
member or as a dependent, to the benefits of the 
Program. COVERAGE SHALL INCLUDE ACCESS TO 
ADDITIONAL BENEFITS AND SERVICES PROVIDED 
UNDER SPECIAL RECOGNITION PROGRAMS FOR 
LONG-TERM AND SUSTAINED CONTRIBUTORS, AS 
DETERMINED BY THE CORPORATION.
(h) Dependent - The legal dependents of a member are:
1. the legitimate spouse who is not a member;
2. the unmarried and unemployed legitimate, 
legitimated, illegitimate, acknowledged children as 
appearing in the birth certificate; legally adopted 
or stepchildren below twenty-one (21) years of 
age;
3. children who are twenty-one (21) years old or 
above but suffering from congenital disability, 
either physical or mental, or any disability


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acquired that renders them totally dependent on
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the member for support;
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4. the parents who are sixty (60) years old or above
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whose monthly income is below an amount to be
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determined by the Corporation in accordance with
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the guiding principles set forth in Article I of this
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Act; and
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5. parents with permanent disability that render
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them totally dependent on the member for
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subsistence;
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(i)
Diagnostic Procedure - Any procedure to identify a
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disease or condition through analysis and examination.
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a)
DIGITAL INTEGRATION PLATFORM - A WEB-
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BASED AND MOBILE PLATFORM DEVELOPED FOR
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THE PMRP PARTICIPANTS TO TRACK POINTS,
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REDEEM BENEFITS, NOMINATE BENEFICIARIES,
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AND ACCESS PROGRAM UPDATES.
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(k)
Emergency - An unforeseen combination of
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circumstances which calls for immediate action to
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preserve the life of a person or to preserve the sight of
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one or both eyes; the hearing of one or both ears; or one
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or two limbs at or above the ankle or wrist.
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(1)
Employee - Any person who performs services for an
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employer in which either or both mental and physical
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efforts are used and who receives compensation for such
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services, where there is an employer-employee
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relationship.
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(m)
Employer - A natural or juridical person who employs the
29
services of an employee.
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(n)
Enrollment - The process to be determined by the
31
Corporation in order to enlist individuals as members or
32
dependents covered by the Program.


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(o) Fee-for-Service - A fee pre-determined by the 
Corporation for each service delivered by a health care 
provider based on the bill. The payment system shall be 
based on a pre-negotiated schedule promulgated by the 
Corporation.
(p) Global Budget - An approach to the purchase of medical 
services by which health care provider negotiations 
concerning the costs of providing a specific package of 
medical benefits is based solely on a predetermined and 
fixed budget.
(q) Health Care Provider - Refers to:
1. a health care institution, which is duly licensed and 
accredited devoted primarily to the maintenance 
and operation of facilities for health promotion, 
prevention, diagnosis, treatment, and care of 
individuals suffering from illness, disease, injury, 
disability or deformity, or in need of obstetrical or 
other medical and nursing care. It shall also be 
construed as any institution, building, or place 
where there are installed beds, cribs, or bassinets 
for twenty-four hour use or longer by patients in 
the treatment of diseases, injuries, deformities, or 
abnormal physical and mental states, maternity 
cases or sanitarial care; or infirmaries, nurseries, 
dispensaries, and such other similar names by 
which they may be designated; or
2. a health care professional, who is any doctor of 
medicine, nurse, midwife, dentist, or other health 
care professional or practitioner duly licensed to 
practice in the Philippines and accredited by the 
Corporation; or
3. a health maintenance organization, which is an


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entity that provides, offers, or arranges for 
coverage of designated health services needed by 
plan members for a fixed prepaid premium; or 
4. a community-based health care organization, which 
is an association of indigenous members of the 
community organized for the purpose of improving 
the health status of that community through 
preventive, promotive and curative health services.
(r) 
Health Insurance Identification (ID) Card - The document 
issued by the Corporation to members and dependents 
upon their enrollment to serve as the instrument for 
proper identification, eligibility verification, and utilization 
recording.
(s) Health Technology Assessment - A field of science that 
investigates the value of a health technology such as 
procedure, process, products, or devices, specifically on 
their quality, relative cost-effectiveness, and safety. It 
usually involves the science of epidemiology and 
economics.
(t) Indigent - A person who has no visible means of income, 
or whose income is insufficient for the subsistence of their 
family, as identified by the Department of Social Welfare 
and Development (DSWD) based on specific criteria set 
for this purpose in accordance with the guiding principles 
set forth in Article I of this Act.
(u) Informal Sector - Units engaged in the production of 
goods and services with the primary objective of 
generating employment and income for the persons 
concerned. It consists of households, unincorporated 
enterprises that are market and nonmarket producers of 
goods, as well as market producers of services. These 
enterprises are operated by own-account workers, which


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may employ unpaid family workers as well as occasional, 
seasonally hired workers. To this sector belong, among 
others, street hawkers, market vendors, pedicab and 
tricycle drivers, small construction workers, and home- 
based industries and services.
(v) Inpatient Education Package - A set of informational 
services made available to an individual who is confined 
in a hospital to afford them knowledge about their illness 
and its treatment, and of the means available, particularly 
lifestyle changes, to prevent the recurrence or 
aggravation of such illness and to promote their health in 
general.
(w) Lifetime Member - A former member who has reached 
the age of retirement under the law and has paid at least 
one hundred twenty (120) monthly premium 
contributions.
(X) LOYALTY TIERS - A CLASSIFICATION SYSTEM 
WITHIN THE PMRP THAT CATEGORIZES MEMBERS 
BASED ON THE DURATION AND CONSISTENCY OF 
THEIR CONTRIBUTIONS TO THE PROGRAM.
(y) Member - Any person whose premiums have been 
regularly paid to the National Health Insurance Program 
who may be a paying member, a sponsored member, or 
a lifetime member.
(z) Members in the Formal Economy - Workers with formal 
contracts and fixed terms of employment, including 
workers in the government and private sector, whose 
premium contribution payments are equally shared by the 
employee and the employer.
(aa) Members in the Informal Economy - Workers who are not 
covered by formal contracts or agreements and whose 
premium contributions are self-paid or subsidized by


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another individual through a defined criterion set by the 
Corporation.
(bb) Migrant Workers - Documented or undocumented 
Filipinos who are engaged in a remunerated activity in 
another country of which they are not citizens.
(cc) NOMINEE - REFERS TO THE IMMEDIATE NEXT OF 
KIN OF A PMRP MEMBER, LIMITED TO THE 
MEMBER'S SPOUSE, BIOLOGICAL OR LEGALLY 
ADOPTED CHILDREN OR LIVING PARENT(S), WHO 
MAY BE DESIGNATED TO RECEIVE UNREDEEMED 
PMRP BENEFITS IN THE EVENT OF THE MEMBER'S 
DEATH, SUBJECT TO APPLICABLE GUIDELINES, 
(dd) Other Self-earning Individuals - Individuals who render 
services or sell goods as a means of livelihood outside of 
an employer-employee relationship, or as a career, but do 
not belong to the informal sector. These include 
businessmen, entrepreneurs, actors, actresses, and other 
performers, news correspondents, professional athletes, 
coaches, trainers, and other individuals as recognized by 
the Department of Labor and Employment (DOLE) and/or 
the Bureau of Internal Revenue (BIR).
(ee) Out-patient Services - Health services such as diagnostic 
consultation, examination, treatment, surgery, and 
rehabilitation on an outpatient basis.
(ff) PHILHEALTH MEMBER RECOGNITION PROGRAM 
(PMRP) - A COMPLEMENTARY PROGRAM 
ESTABLISHED TO RECOGNIZE AND REWARD 
LONG-TERM MEMBERS FOR THEIR CONSISTENT 
CONTRIBUTIONS TO THE NATIONAL HEALTH 
INSURANCE PROGRAM.
(gg) POINTS ACCUMULATION SYSTEM - A MECHANISM 
UNDER THE PMRP WHERE MEMBERS EARN
8


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POINTS BASED ON THEIR PREMIUM 
CONTRIBUTIONS, LONGEVITY OF MEMBERSHIP, 
AND LOYALTY TIERS.
(hh) Portability - The enablement of a member to avail of 
Program benefits in an area outside the jurisdiction of 
their Local Health Insurance Office.
(ii) Professional Practitioners - Include doctors, lawyers, 
certified public accountants, and other practitioners 
required to pass government licensure examinations in 
order to practice their professions.
(jj) Quality Assurance - A formal set of activities to review 
and ensure the quality of services provided. Quality 
assurance includes quality assessment and corrective 
actions to remedy any deficiencies identified in the quality 
of direct patient, administrative, and support services.
(kk) Retiree - A member of the Program who has reached the 
age of retirement as provided for by law or who was 
retired on account of permanent disability as certified by 
the employer and the Corporation.
(II) Sponsored Member - A member whose contribution is 
being paid by another individual, government agency, or 
private entity according to the rules as may be prescribed 
by the Corporation.
(mm) Traditional and Alternative Health Care - The application 
of traditional knowledge, skills, and practice of alternative 
health care or healing methods which include reflexology, 
acupuncture, massage, acupressure, chiropractics, 
nutritional therapy, and other similar methods in 
accordance with the accreditation guidelines set forth by 
the Corporation and the Food and Drug Administration 
(FDA).
(nn) TRANSFERABLE POINTS - POINTS ACCUMULATED


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UNDER THE PMRP THAT MAY BE TRANSFERRED TO
2 
NOMINATED FAMILY MEMBERS OF THE MEMBER.
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(oo) Treatment Procedure - Any method used to remove the
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symptoms and cause of a disease.
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(pp) Utilization Review - A formal review of patient utilization
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or of the appropriateness of health care services, on a
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prospective, concurrent, or retrospective basis.
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Sec. 3. Section 5 of Republic Act No. 7875, as amended, is hereby amended to
9 
read as follows:
10 
Section 5. Establishment and Purposes. — There is hereby
11 
created the National Health Insurance Program which shall
12 
provide health insurance coverage and ensure affordable,
13 
acceptable, available and accessible health care services for all
14 
citizens of the Philippines, in accordance with the policies and
15 
specific provisions of this Act. This social insurance program shall
16 
serve as the means for the healthy to help pay for the care of
17 
the sick and for those who can afford medical care to subsidize
18 
those who cannot. It shall initially consist of programs I and II
19 
or Medicare and be expanded progressively to constitute one
20 
universal health insurance program for the entire population.
21 
The Program shall include a sustainable system of funds
22 
constitution, collection, management and disbursement for
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financing the availment of a basic minimum package and other
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additional packages of health insurance benefits by a
25 
progressively expanding proportion of the population.
26 
FURTHER, THE PROGRAM SHALL ALSO INCLUDE A
27 
RECOGNITION AND INCENTIVIZATION FRAMEWORK TO
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REWARD LONG-TERM AND SUSTAINED CONTRIBUTORS
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THROUGH ADDITIONAL BENEFITS, LOYALTY
30 
PROGRAMS, AND TRANSFERABLE BENEFITS. The Program
31 
shall be limited to paying for the utilization of health services by
32 
covered beneficiaries or to purchasing health services in behalf
10


1 
of such beneficiaries. It shall be prohibited from providing health
2 
care directly, from buying and dispensing drugs and
3 
pharmaceuticals, from employing physicians and other
4 
professionals for the purpose of directly rendering care, and from
5 
owning or investing in health care facilities.
6 
Sec. 4. Section 7 of Republic Act No. 7875, as amended, is hereby amended to
7 
read as follows:
8 
Sec. 7. Enrollment. — The Corporation shall enroll beneficiaries
9 
to avail of benefits under this Act with the assistance of the
10 
financial arrangements provided by the Corporation under the
11 
following categories:
12 
(a) Members in the formal economy;
13 
(b) Members in the informal economy;
14 
(c) Indigents;
15 
(d) Sponsored members; and
16 
(e) Lifetime members.
17 
The process of enrollment shall include the identification of
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beneficiaries, issuance of appropriate documentation specifying
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eligibility to benefits INCLUDING THOSE UNDER SPECIAL
20 
PROGRAMS SUCH AS THE PMRP and indicating how
21 
membership was obtained or is being maintained.
22 
Sec. 5. Section 11 of Republic Act No. 7875, as amended, is hereby amended
23 
to read as follows:
24 
Sec 11. Excluded Personal Health Services. — The Corporation
25 
shall not cover expenses for health services which the
26 
Corporation and the DOH consider cost-ineffective through
27 
health technology assessment.
28 
The Corporation may institute additional exclusions and
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limitations as it deems reasonable to maintain protection
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objectives and financial sustainability. SPECIFIC GUIDELINES
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FOR REDEEMABLE EXCLUDED SERVICES UNDER PMRP
32 
SHALL BE ISSUED BY THE CORPORATION IN
11


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CONSULTATION WITH THE DOH
2 
Sec. 6. Section 16 of Republic Act No. 7875, as amended, is hereby amended
3 
to read as follows:
4 
Sec. 16. Powers and Functions. — The Corporation shall have
5 
the following powers and functions
6 
XXX XXX XXX
7 
(bb) TO ESTABLISH, MANAGE, AND OVERSEE THE PMRP,
8 
INCLUDING FORMULATING POLICIES, RULES, AND
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GUIDELINES FOR ITS OPERATION, ELIGIBILITY
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CRITERIA, BENEFIT STRUCTURES, AND ADDITIONAL
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BENEFITS, ENSURING ALIGNMENT WITH PRINCIPLES
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OF CONTRIBUTION RECOGNITION, HEALTHCARE
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QUALITY IMPROVEMENT, AND FINANCIAL
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SUSTAINABILITY.
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(cc) TO INTEGRATE THE PMRP INTO THE
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CORPORATION'S INFORMATION SYSTEMS FOR
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EFFICIENT TRACKING OF MEMBER CONTRIBUTIONS,
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POINTS, AND BENEFITS REDEMPTION; CONDUCT
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REGULAR MONITORING AND EVALUATION TO ENSURE
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ITS SUSTAINABILITY AND ALIGNMENT WITH THE
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CORPORATION'S OBJECTIVES AND MEMBER NEEDS.
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(dd) TO CONDUCT TARGETED INFORMATION
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CAMPAIGNS ABOUT THE PMRP, INCLUDING ITS
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BENEFITS AND MECHANISMS, AND COLLABORATE WITH
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GOVERNMENT AGENCIES, LOCAL UNITS, AND
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STAKEHOLDERS FOR ITS EFFECTIVE IMPLEMENTATION.
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Sec. 7. Section 20 of Republic Act No. 7875, as amended, is hereby amended
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to read as follows:
29 
Sec. 20. Health Finance Policy Research. — Among the staff
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departments that will be established by the Corporation shall be
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the Health Finance Policy Research Department, which shall
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have the following duties and functions:
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to
XXX XXX XXX
c) Review, evaluation, and assessment of the Program's 
impact on the access to as well as the quality and cost of health 
care in the country, INCLUDING THE ADDITIONAL 
BENEFITS AND MECHANISMS INTRODUCED UNDER THE 
PMRP TO ENSURE EQUITY, FINANCIAL 
SUSTAINABILITY, AND ALIGNMENT WITH PROGRAM 
OBJECTIVES.
Sec. 8. Section 24 of Republic Act No. 7875, as amended, is hereby amended 
read as follows:
Sec. 20. Creation of the National Health Insurance Fund. —
There is hereby created a National Health Insurance Fund, 
hereinafter referred to as the Fund, that shall consist of:
(a) Contribution from Program members;
(b) Other appropriations earmarked by the national and local 
governments purposely for the implementation of the 
Program;
(c) Subsequent appropriations provided for under Sections 
46 and 47 of this Act;
(d) Donations and grants-in-aid;
(e) All accruals thereof; and
(f) 
Funds earmarked for the PMRP DESIGNATED FOR 
THE ENHANCEMENT OF PMRP BENEFITS as may be
determined by the Corporation.
Sec. 9. Section 25 of Republic Act No. 7875, as amended, is hereby amended 
read as follows:
Sec. 25. Components of the National Health Insurance Fund. —
The National Health Insurance Fund shall have the following 
components:
XXX XXX XXX
(C) PMRP BENEFIT SUB-FUND - A DEDICATED SUB­
FUND WITHIN THE NATIONAL HEALTH INSURANCE
13


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FUND SHALL BE CREATED TO SUPPORT THE
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ADDITIONAL AND SUPPLEMENTARY BENEFITS OF
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ELIGIBLE LONG-TERM CONTRIBUTORS UNDER THE
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PHILHEALTH MEMBER RECOGNITION PROGRAM
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(PMRP). THIS SUB-FUND SHALL BE FINANCED
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THROUGH A PORTION OF REGULAR CONTRIBUTIONS
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FROM ELIGIBLE PMRP MEMBERS, GRANTS,
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DONATIONS, GOVERNMENT ALLOCATIONS, RESERVE
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SURPLUSES, AND OTHER DESIGNATED SOURCES, AS
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MAY BE DETERMINED BY THE CORPORATION.
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THE PMRP BENEFIT SUB-FUND SHALL BE USED
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EXCLUSIVELY FOR ADDITIONAL BENEFITS AND
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REWARDS ACCRUED THROUGH THE PMRP, INCLUDING
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SUPPLEMENTARY NON-MEDICAL HEALTH-RELATED
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BENEFITS, SUBJECT TO BOARD APPROVAL AND THE
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PRINCIPLES OF FISCAL SUSTAINABILITY AND EQUITY.
17
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Sec. 10. Section 27 of Republic Act No. 7875, as amended, is hereby amended
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to read as follows:
20 
Sec. 27. Reserve Fund. — The Corporation shall set aside a
21 
portion of its accumulated revenues not needed to meet the cost
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of the current year's expenditures as reserve funds: Provided,
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That the total amount of reserves shall not exceed a ceiling
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equivalent to the amount actuarially estimated for two (2) years'
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projected Program expenditures: Provided, further. That
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whenever actual reserves exceed the required ceiling at the end
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of the Corporation's fiscal year, the excess of the Corporation's
28 
reserve fund shall be used to increase the Program's benefits,
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decrease the member's contributions, and augment the health
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facilities enhancement program of the DOH, OR SUPPORT THE
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PMRP BENEFIT SUB-FUND, IN ACCORDANCE WITH
32 
SECTIONS 25 AND 43 OF THIS ACT, SUBJECT TO
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ACTUARIAL EVALUATION AND BOARD APPROVAL, IN 
ACCORDANCE WITH SECTIONS 25 AND 43 OF THIS ACT.
The remaining portion of the reserve fund that is not needed to 
meet the current expenditure obligations or used for the 
abovementioned programs shall be placed in investments to 
earn an average annual income at prevailing rates of interest 
and shall be known as the 'Investment Reserve Fund' which shall 
be invested in any or all of the following:
(a) In interest-bearing bonds, securities or other evidences of 
indebtedness of the Government of the Philippines, or in 
bonds, securities, promissory notes, and other evidences 
of indebtedness to which full faith and credit and 
unconditional guarantee of the Republic of the Philippines 
is pledged;
(b) In debt securities and corporate bond issuances: 
Provided, That such securities and bonds are rated triple 
'A' by authorized accredited domestic rating agencies: 
Provided, further. That the issuing or assuming entity or 
its predecessor shall not have defaulted in the payment 
of interest on any of its securities and that during each of 
any three (3), including the last two (2), of the five (5) 
fiscal years next preceding the date of acquisition by the 
Corporation of such bonds, securities, or other evidences 
of indebtedness, the net earnings of the issuing or 
assuming institution available for its recurring expenses, 
such as amortization of debt discount and rentals for 
leased properties, including interest on funded and 
unfunded debt, shall have been not less than one and one 
quarter (1 1/4) times the total of the recurring expenses 
for such year: Provided, further. That such investment 
shall not exceed fifteen percent (15%) of the investment 
reserve fund;
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(c) In interest-bearing deposits and loans to or securities in 
any domestic bank doing business in the Philippines: 
Provided, That in the case of such deposits, this shall not 
exceed at any time the unimpaired capital and surplus or 
total private deposits of the depository bank, whichever 
is smaller: Provided, further. That said bank shall first 
have been designated as a depository for this purpose by 
the Monetary Board of the Bangko Sentral ng Pilipinas;
(d) In preferred stocks of any solvent corporation or 
institution created or existing under the laws of the 
Philippines: Provided, That the issuing, assuming, or 
guaranteeing entity or its predecessor has paid regular 
dividends upon its preferred or guaranteed stocks for a 
period of at least three (3) years immediately preceding 
the date of investment in such preferred or guaranteed 
stocks: Provided, further. That if the stocks are 
guaranteed, the amount of stocks so guaranteed is not in 
excess of fifty percent (50%) of the amount of the 
preferred common stocks, as the case may be, of the 
issuing corporation: Provided, furthermore. That if the 
corporation or institution has not paid dividends upon its 
preferred stocks, the corporation or institution has 
sufficient retained earnings to declare dividends for at 
least two (2) years on such preferred stocks and in 
common stocks of any solvent corporation or institution 
created or existing under the laws of the Philippines in the 
stock exchange with a proven track record of profitability 
and payment of dividends over the last three (3) years; 
and;
(e) In bonds, securities, promissory notes, or other evidences
of indebtedness of accredited and financially sound 
medical institutions 
exclusively to finance the
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construction, improvement, and maintenance of hospitals 
and other medical facilities: Provided, That such securities 
and instruments are backed up by the guarantee of the 
Republic of the Philippines or the issuing medical 
institution and the issued securities and bonds are both 
rated triple 'A' by authorized accredited domestic rating 
agencies: Provided, further. That said investments shall 
not exceed ten percent (10%) of the total investment 
reserve fund.
As part of its investments operations, the Corporation may hire 
institutions with valid trust licenses as its external local fund 
managers to manage the investment reserve fund, as it may 
deem appropriate, through public bidding. The fund managers 
shall submit annual reports on investment performance to the 
Corporation.
The Corporation shall set up the following funds: (1) A fund to 
secure benefit payouts to members prior to their becoming 
lifetime members; (2) A fund to secure payouts to lifetime 
members; aM (3) A fund for any optional supplemental benefits 
that are subject to additional contributions. AND (4) A FUND 
TO SUPPORT THE PMRP, INCLUDING LOYALTY-BASED 
BENEFITS AND ADDITIONAL COVERAGE FOR LONG­
TERM CONTRIBUTORS, SUBJECT TO ACTUARIAL 
ANALYSIS AND APPROVED CRITERIA TO ENSURE 
FINANCIAL SUSTAINABILITY.
A portion of each of the above funds shall be identified as current 
and kept in liquid instruments. In no case shall said portion be 
considered part of invested assets.
Another portion of the said funds shall be allocated for lifetime 
members within six (6) months after the effectivity of this Act. 
Said amount shall be determined by an actuary or pre-calculated 
based on the most recent valuation of liabilities.
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The Corporation shall allocate a portion of all contributions to
2 
the fund for lifetime members based on an allocation to be
3 
determined by the PHIC actuary based on a pre-determined
4 
percentage using the current average age of members and the
5 
current life expectancy and morbidity curve of Filipinos.
6 
The Corporation shall manage the supplemental benefits and the
7 
lifetime members' fund in an actuarially sound manner.
8 
The Corporation shall manage the supplemental benefits fund to
9 
the minimum required to ensure that the supplemental benefit
10 
payments are secure.
11 
Sec. 11. Section 34 of Republic Act No. 7875, as amended, is hereby amended
12 
to read as follows:
13 
Sec. 34 Provider Payment Mechanisms. — The following
14 
mechanisms for public and private providers shall be allowed in
15 
the Program:
16 
(a) Fee-for-service payments — payments made by the
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Corporation for professional fees or hospital charges, or
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both, based on arrangements with health care providers.
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This fee shall be based on a schedule to be established
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by the Board which shall be reviewed periodically but not
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less than every three (3) years;
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(b) Capitation of health care professionals and facilities, or
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networks of the same including HMOs, medical
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cooperatives, and other legally formed health service
25 
groups;
26 
(c) Case-based payment;
27 
(d) Global budget; and
28 
(e) Such other provider payment mechanisms 
that may be
29 
determined and adopted by the Corporation.
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PAYMENT MECHANISMS SHALL ALSO ACCOUNT FOR THE
31 
DELIVERY OF ADDITIONAL BENEFITS UNDER THE
32 
PMRP, INCLUDING REIMBURSEMENTS OR INCENTIVES
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to
FOR SERVICES RENDERED TO PMRP PARTICIPANTS, 
SUBJECT TO GUIDELINES SET BY THE BOARD.
Subject to the approval of the Board, the Corporation may adopt 
other payment mechanism that are most beneficial to the 
members and the Corporation.
Each PhilHealth local office shall recommend the appropriate 
payment mechanism within its jurisdiction for approval by the 
Corporation. Special consideration shall be given to payment for 
services rendered by public and private health care providers 
serving remote or medically underserved areas. SPECIAL 
CONSIDERATION SHALL ALSO BE GIVEN TO PAYMENT 
FOR ADDITIONAL SERVICES OFFERED UNDER THE 
PMRP IN REMOTE OR MEDICALLY UNDERSERVED 
AREAS.
Sec. 12. Section 35 of Republic Act No. 7875, as amended, is hereby amended 
read as follows:
Sec. 35. Reimbursement and Period to File Claims. — All claims 
for reimbursement or payment for services rendered shall be 
filed within a period of sixty (60) calendar days from the date of 
discharge of the patient from the health care provider.
The period to file the claim may be extended for such reasonable 
causes determined by the Corporation.
TO ADDRESS DELAYS IN PAYMENT AND ENSURE THE 
SUSTAINABILITY OF MEDICAL SERVICES, THE 
CORPORATION SHALL PROCESS AND RELEASE VALID 
CLAIMS, INCLUDING THOSE FILED UNDER THE 
PMRP, WITHIN A MAXIMUM PERIOD OF SIXTY (60) 
WORKING DAYS FROM THE RECEIPT OF COMPLETE 
CLAIM DOCUMENTS. FAILURE TO MEET THIS TIMELINE 
WITHOUT JUSTIFIABLE REASONS SHALL INCUR 
INTEREST PAYMENTS TO THE AFFECTED HEALTH CARE 
PROVIDERS, AS DETERMINED BY THE BOARD. THE
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CORPORATION SHALL IMPLEMENT A DIGITALIZED
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SYSTEM TO MONITOR, TRACK, AND EXPEDITE THE
3 
RESOLUTION OF PAYMENT DELAYS EFFICIENTLY.
4 
Sec. 13. A new ARTICLE IX shall be established covering Sections 39 to Section
5 
48 are as follows:
6 
ARTICLE IX: PHILHEALTH MEMBER RECOGNITION
7 
PROGRAM
8 
Sec. 39. ESTABLISHMENT OF THE PMRP. - THE PMRP IS
9 
HEREBY ESTABLISHED TO ACKNOWLEDGE AND
10 
REWARD LONG-TERM AND CONSISTENT
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CONTRIBUTORS TO THE NHIP. THE PROGRAM SHALL
12 
OPERATE AS AN ADDITIONAL AND COMPLEMENTARY
13 
COMPONENT TO THE NHIP, PROVIDING PAYMENT FOR
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CO-CONTRIBUTIONS, INCENTIVES AND ADDITIONAL
15 
BENEFITS TO FOSTER EQUITY, LOYALTY, AND MEMBER
16 
ENGAGEMENT.
17 
(a) Sec. 40. OBJECTIVES. - THE PMRP SHALL HAVE
18 
THE 
FOLLOWING 
OBJECTIVES:
19 
TO RECOGNIZE AND REWARD CONSISTENT AND
20 
SUSTAINED CONTRIBUTIONS BY LONG-TERM
21 
MEMBERS;
22 
(b) TO PROVIDE EQUITABLE AND ADDITIONAL
23 
BENEFITS THAT ENHANCE THE VALUE OF
24 
PHILHEALTH MEMBERSHIP;
25 
(c) TO INCENTIVIZE PREVENTIVE HEALTHCARE AND
26 
PROACTIVE MEMBER PARTICIPATION;
27 
(d) TO STRENGTHEN PUBLIC TRUST IN THE NHIP AND
28 
ENCOURAGE MEMBER RETENTION; AND
29 
(e) TO ENSURE FINANCIAL SUSTAINABILITY AND
30 
ALIGNMENT WITH THE PRINCIPLES OF EQUITY
31 
AND UNIVERSALITY.
32 
Sec. 41. CORE FEATURES. - THE PMRP SHALL OPERATE
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UNDER THE FOLLOWING CORE FEATURES:
(a) MEMBERS EARN POINTS BASED ON SUSTAINED 
PREMIUM CONTRIBUTIONS, WITH ADDITIONAL 
LOYALTY BONUSES AWARDED FOR REACHING 
CONTINUOUS MEMBERSHIP MILESTONES SUCH 
AS EVERY FIVE YEARS OR OTHER PERIODS AS 
MAY BE IDENTIFIED BY THE CORPORATION.
(b) POINTS MAY BE REDEEMED FOR:
(1) COVERAGE OF OUT-OF-POCKET EXPENSES 
NOT INCLUDED IN CASE RATE COVERAGE;
(2) ENHANCED MEDICAL ACCOMMODATIONS IN 
PUBLIC AND PRIVATE FACILITIES BEYOND 
STANDARD HEALTHCARE PACKAGES;
(3) NON-MEDICAL 
HEALTHCARE-RELATED
EXPENSES, INCLUDING CONSUMABLES OR 
DURABLE EQUIPMENT;
(4) PREVENTIVE HEALTHCARE INCENTIVES 
BEYOND THE STANDARD HEALTHCARE 
PACKAGE CURRENTLY PROVIDED BY THE 
CORPORATION.
Sec. 42. ELIGIBILITY. - ELIGIBILITY FOR THE PMRP 
SHALL BE DETERMINED BY THE CORPORATION BASED 
ON THE FOLLOWING CRITERIA:
(a) SUSTAINED AND CONSISTENT PAYMENT OF 
DIRECT CONTRIBUTIONS OVER A DEFINED 
PERIOD;
(b) COMPLIANCE WITH NHIP RULES AND 
REGULATIONS; AND
(c) NO OUTSTANDING PENALTIES OR VIOLATIONS 
OF NHIP PROVISIONS.
Sec 43. PMRP BENEFIT FUND. - A DEDICATED PMRP 
BENEFIT FUND SHALL BE ESTABLISHED TO FINANCE
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SUPPLEMENTARY BENEFITS UNDER THE PROGRAM. 
THIS FUND SHALL BE SOURCED FROM:
(A) A PORTION OF REGULAR CONTRIBUTIONS FROM 
ELIGIBLE LONG-TERM MEMBERS, AS DETERMINED BY 
THE CORPORATION AND SUPPORTED BY ACTUARIAL 
ANALYSIS;
(B) ALLOCATIONS FROM RESERVE SURPLUSES BEYOND 
THE STATUTORY CEILING UNDER SECTION 27;
(C) 
GOVERNMENT APPROPRIATIONS, GRANTS, 
DONATIONS, AND COUNTERPART CONTRIBUTIONS 
FROM LG US OR OTHER STAKEHOLDERS; AND
(D) EARNINGS FROM INVESTMENTS OF THE PMRP- 
DESIGNATED ASSETS, WHICH SHALL ACCRUE 
EXCLUSIVELY TO THE PMRP BENEFIT SUB-FUND.
TO ENSURE FINANCIAL SUSTAINABILITY, THE 
CORPORATION SHALL IMPLEMENT CONTROLS SUCH AS 
REDEMPTION CAPS, EXPIRY PERIODS, AND TIERED 
BENEFITS AS MAY DEEMED PROPER BY THE 
CORPORATION. PERIODIC ACTUARIAL EVALUATIONS 
SHALL BE CONDUCTED TO ADJUST PROGRAM 
FEATURES, POINTS ALLOCATION, AND REDEMPTION 
MECHANISMS BASED ON PERFORMANCE AND 
ENGAGEMENT.
TO PRESERVE FINANCIAL INTEGRITY, THE 
CORPORATION SHALL ENSURE THAT THE PMRP 
BENEFIT SUB-FUND IS MANAGED SEPARATELY FROM 
THE CORE NHIP BENEFIT FUNDS AND SHALL NOT BE 
USED TO OFFSET REGULAR PHILHEALTH OBLIGATIONS. 
THE CORPORATION MAY IMPOSE REDEMPTION CAPS, 
DEFER BENEFIT REDEMPTION, OR ADJUST 
SUPPLEMENTARY BENEFIT VALUES BASED ON 
ACTUARIAL RECOMMENDATIONS, SUBJECT TO BOARD
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APPROVAL, TO MAINTAIN LONG-TERM FISCAL 
SUSTAINABILITY.
THE CORPORATION SHALL ESTABLISH A MECHANISM 
FOR THE CONDITIONAL TRANSFER OF UNREDEEMED 
PMRP POINTS OR BENEFITS TO THE NOMINEE, IN 
ACCORDANCE WITH THE RULES SET FORTH UNDER THIS 
ACT.
SUCH TRANSFER SHALL BE LIMITED TO THE MEMBER'S 
DECLARED IMMEDIATE NEXT OF KIN, SPECIFICALLY 
SPOUSE, CHILDREN OR PARENTS, SUBJECT TO 
VERIFICATION REQUIREMENTS, APPLICABLE CAPS, 
AND OTHER SAFEGUARDS TO BE DEFINED IN THE 
IMPLEMENTING RULES.
Sec 44. PREVENTIVE HEALTHCARE INCENTIVES. - THE 
PMRP SHALL PROMOTE PREVENTIVE HEALTHCARE BY 
AWARDING ADDITIONAL POINTS FOR MEMBERS 
AVAILING PREVENTIVE SERVICES SUCH AS ANNUAL 
CHECK-UPS, VACCINATIONS, AND SCREENINGS, WHILE 
ENCOURAGING HEALTHIER LIFESTYLES TO REDUCE 
LONG-TERM HEALTHCARE COSTS.
Sec 45. DIGITAL INTEGRATION AND ACCESSIBILITY. - 
A DEDICATED DIGITAL PLATFORM, ACCESSIBLE VIA A 
MOBILE APP AND WEB PORTAL, SHALL BE DEVELOPED 
TO FACILITATE PMRP OPERATIONS. THE PLATFORM 
SHALL ENABLE MEMBERS TO:
(a) TRACK THEIR CONTRIBUTIONS, POINTS, AND 
REDEMPTION HISTORY;
(b) REDEEM POINTS FOR ELIGIBLE SERVICES;
(c) NOMINATE BENEFICIARIES FOR TRANSFERABLE 
POINTS.
Sec 46. MONITORING AND EVALUATION. - THE 
CORPORATION SHALL CONDUCT REGULAR
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MONITORING AND EVALUATION OF THE PMRP TO 
ENSURE:
(a) ALIGNMENT WITH THE OBJECTIVES OF THE NHIP;
(b) FINANCIAL SUSTAINABILITY AND EQUITY IN 
BENEFIT DISTRIBUTION;
(c) RESPONSIVENESS TO THE NEEDS OF LONG-TERM 
CONTRIBUTORS; AND
(d) TRANSPARENCY AND ACCOUNTABILITY IN 
PROGRAM OPERATIONS.
REPORTS ON THE PERFORMANCE AND IMPACT OF THE 
PMRP SHALL BE SUBMITTED ANNUALLY TO THE BOARD 
AND MADE AVAILABLE TO THE PUBLIC. THE 
CORPORATION SHALL ESTABLISH MECHANISMS TO 
GATHER AND INCORPORATE FEEDBACK FROM 
MEMBERS AND STAKEHOLDERS, ENSURING 
CONTINUOUS IMPROVEMENT AND ALIGNMENT OF THE 
PROGRAM WITH MEMBER NEEDS AND EXPECTATIONS. 
THE CORPORATION SHALL INCLUDE THE FINANCIAL 
STATUS AND UTILIZATION REPORT OF THE PMRP 
BENEFIT SUB-FUND IN ITS ANNUAL REPORTS TO THE 
BOARD, THE DEPARTMENT OF FINANCE, AND 
CONGRESS. THIS REPORT SHALL INCLUDE ITEMIZED 
FUND INFLOWS, BENEFIT REDEMPTIONS, INVESTMENT 
EARNINGS, ADMINISTRATIVE COSTS, AND RESULTS OF 
PERIODIC ACTUARIAL EVALUATIONS. THE 
CORPORATION SHALL ALSO PUBLISH A SUMMARY OF 
THESE FINANCIAL REPORTS ON ITS OFFICIAL WEBSITE 
FOR PUBLIC TRANSPARENCY.
Sec 47. PARTNERSHIPS AND INTEGRATION. - THE 
CORPORATION MAY PARTNER WITH ACCREDITED 
HOSPITALS, CLINICS, PHARMACIES, AND OTHER
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HEALTHCARE PROVIDERS TO FACILITATE SEAMLESS 
REDEMPTION OF PMRP BENEFITS. ADDITIONAL 
PARTNERSHIPS WITH PRIVATE AND PUBLIC ENTITIES 
MAY BE PURSUED TO ENHANCE THE PROGRAM'S SCOPE 
AND SUSTAINABILITY PARTICULARLY IN 
UNDERSERVED AREAS.
Sec 48. PROGRAM REVIEW AND POTENTIAL EXPANSION 
TO INDIRECT CONTRIBUTORS. - FIVE (5) YEARS AFTER 
THE IMPLEMENTATION OF THE PMRP, THE PHILHEALTH, 
IN COORDINATION WITH THE DEPARTMENT OF HEALTH 
(DOH) AND THE DEPARTMENT OF FINANCE (DOF), 
SHALL CONDUCT A COMPREHENSIVE REVIEW OF THE 
PROGRAM. THIS REVIEW SHALL INCLUDE AN 
ACTUARIAL ANALYSIS OF THE PROGRAM'S FINANCIAL 
SUSTAINABILITY, IMPACT ON THE NHIF, AND BENEFITS 
DELIVERED TO DIRECT CONTRIBUTORS.
BASED ON THE FINDINGS OF THIS REVIEW, 
PHILHEALTH, IN CONSULTATION WITH THE DOH AND 
DOF, MAY CONSIDER THE FEASIBILITY OF EXTENDING 
SIMILAR SUPPLEMENTARY BENEFITS UNDER THE PMRP 
TO INDIRECT CONTRIBUTORS, SUBJECT TO THE 
FINANCIAL HEALTH OF THE CORPORATION AND OTHER 
RELEVANT CONSIDERATIONS.
THE FINDINGS AND RECOMMENDATIONS OF THIS 
REVIEW SHALL BE SUBMITTED TO CONGRESS FOR 
LEGISLATIVE ACTION, ENSURING THAT ANY 
EXPANSION ALIGNS WITH THE PRINCIPLES OF EQUITY, 
INCLUSIVITY, AND SUSTAINABILITY UNDER THE NHIP. 
Sec. 49. IMPLEMENTATION GUIDELINES. - THE 
CORPORATION SHALL ISSUE THE NECESSARY 
GUIDELINES FOR THE IMPLEMENTATION OF THE PMRP 
WITHIN SIX (6) MONTHS FROM THE EFFECTIVITY OF
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THIS ACT, WHICH WILL COVER:
(a) DETAILED RULES ON POINTS ACCUMULATION, 
REDEMPTION, AND TRANSFER;
(b) SPECIFIC SUPPLEMENTARY BENEFITS AND 
SERVICES COVERED;
(c) MECHANISMS FOR INTEGRATING PMRP 
OPERATIONS INTO EXISTING NHIP SYSTEMS;
(d) COMMUNICATION AND INFORMATION 
CAMPAIGNS TO EDUCATE MEMBERS ABOUT THE 
PROGRAM;
(e) RULES ON RETROACTIVITY RECOGNITION OF 
POINTS; AND
(f) EQUITABLE MECHANISMS TO ENSURE 
UNIFORMITY IN THE POINTS SYSTEM ACROSS 
ALL GEOGRAPHICAL AREAS, WITH STANDARDS 
THAT PROMOTE FAIRNESS, INCLUSIVITY, AND 
ACCESSIBILITY FOR ALL MEMBERS.
THE FULL IMPLEMENTATION OF THE PROGRAM SHALL 
BE COMPLETED WITHIN TWELVE MONTHS FROM THE 
DATE THE GUIDELINES ARE ISSUED.
THE CORPORATION, IN CONSULTATION WITH THE 
DEPARTMENT OF FINANCE AND RELEVANT 
STAKEHOLDERS, SHALL ISSUE IMPLEMENTING RULES 
AND REGULATIONS ON THE FINANCIAL MANAGEMENT 
OF THE PMRP BENEFIT SUB-FUND. THESE SHALL 
INCLUDE GUIDELINES ON THE EARMARKING OF 
CONTRIBUTIONS, FUND INVESTMENT STRATEGIES, 
REDEMPTION ELIGIBILITY, CAPS OR LIMITS BASED ON 
FUND PERFORMANCE, AND ANNUAL REVIEW 
MECHANISMS TO ENSURE FISCAL DISCIPLINE AND 
PROGRAM CONTINUITY.
SEC. 50. RETROACTIVE RECOGNITION OF
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CONTRIBUTIONS FOR THE PMRP. - TO ACKNOWLEDGE 
THE SUSTAINED CONTRIBUTIONS OF EXISTING 
PHILHEALTH MEMBERS PRIOR TO THE 
IMPLEMENTATION OF THE PMRP, THE CORPORATION 
SHALL APPLY THE FOLLOWING GUIDELINES FOR 
RETROACTIVE RECOGNITION:
1. ELIGIBILITY FOR RETROACTIVE RECOGNITION:
A. ALL DIRECT CONTRIBUTORS WHO ARE
ACTIVE MEMBERS AT THE TIME OF THE 
PROGRAM'S IMPLEMENTATION SHALL BE 
ELIGIBLE 
FOR 
RETROACTIVE
RECOGNITION.
B. RETROACTIVE RECOGNITION SHALL 
CONSIDER THE MEMBER'S PAID 
CONTRIBUTIONS WITHIN THE TEN (10) 
YEARS PRECEDING THE EFFECTIVITY OF 
THIS ACT OR THE COMMENCEMENT OF 
THEIR MEMBERSHIP, WHICHEVER IS 
SHORTER.
2. POINTS ALLOCATION FOR RETROACTIVE 
CONTRIBUTIONS:
A. MEMBERS SHALL EARN POINTS FOR EACH 
MONTH OF CONTRIBUTIONS PAID DURING 
THE RETROACTIVE PERIOD.
B. LOYALTY BONUSES FOR CONTINUOUS 
CONTRIBUTIONS SHALL ALSO APPLY 
RETROACTIVELY, SUBJECT TO THE SAME 
THRESHOLDS AND MULTIPLIERS 
ESTABLISHED UNDER THE PMRP RULES.
3. VERIFICATION OF CONTRIBUTIONS:
A. PHILHEALTH SHALL CONDUCT A 
VALIDATION OF CONTRIBUTIONS BASED
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ON EXISTING RECORDS.
2 
B. MEMBERS WITH INCOMPLETE RECORDS
3 
MAY SUBMIT SUPPORTING DOCUMENTS TO
4 
VALIDATE THEIR CONTRIBUTIONS,
5 
SUBJECT TO GUIDELINES SET BY THE
6 
CORPORATION.
7 
4. TIMELINE FOR RETROACTIVE ALLOCATION:
8 
A. RETROACTIVE POINTS SHALL BE CREDITED
9 
TO ELIGIBLE MEMBERS' ACCOUNTS WITHIN
10 
ONE (1) YEAR FROM THE IMPLEMENTATION
11 
OF THE PMRP.
12 
B. PHILHEALTH SHALL NOTIFY MEMBERS OF
13 
THEIR RETROACTIVE POINTS AND
14 
BENEFITS 
THROUGH 
OFFICIAL
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COMMUNICATION CHANNELS, INCLUDING
16 
DIGITAL PLATFORMS.
17 
5. LIMITATIONS ON RETROACTIVE BENEFITS:
18 
A. RETROACTIVE POINTS SHALL ONLY BE
19 
REDEEMABLE FOR SUPPLEMENTARY
20 
BENEFITS UNDER THE PMRP AND SHALL
21 
NOT ENTITLE MEMBERS TO MONETARY
22 
REIMBURSEMENT FOR PAST MEDICAL
23 
EXPENSES.
24 
B. POINTS ACCUMULATED RETROACTIVELY
25 
SHALL BE SUBJECT TO THE SAME
26 
REDEMPTION CAPS AND GUIDELINES AS
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THOSE EARNED PROSPECTIVELY.
28 
Sec. 14. - The article on Grievance and Appeal shall now be renumbered as
29 
ARTICLE X, Penalties as ARTICLE XI, Appropriations as ARTICLE XII, and
30 
Transitory Provisions as ARTICLE XIII, with the corresponding sections under each
31 
article adjusted accordingly.
32 
Sec. 15. Section 40 of Republic Act No. 7875, as amended, is hereby amended
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2 
Sec. 40 52. Grounds for Grievances. — The following acts shall
3 
constitute valid grounds for grievance action:
4 
XXX XXX XXX
5 
(F) ERRORS, DELAYS, OR DISPUTES IN THE
6 
CALCULATION, ALLOCATION, OR REDEMPTION OF
7 
POINTS AND SUPPLEMENTARY BENEFITS UNDER THE
8 
PMRP.
9 
Sec. 16. Section 41 of Republic Act No. 7875, as amended, is hereby amended
10 
to read as follows:
11 
Sec. 44 53. Grievance and Appeal Procedures. — A member, a
12 
dependent, or a health care provider may file a complaint for
13 
grievance based on any of the above grounds, in accordance
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with the following procedures:
15 
(a) A complaint for grievance, INCLUDING THOSE RELATED
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TO THE PMRP, MUST BE FILED WITH THE
17 
CORPORATION, which shall refer such complaint to the
18 
Grievance and Appeal Review Committee. The Grievance and
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Appeal Review Committee shall rule on the complaint through a
20 
notice of resolution within sixty (60) calendar days from receipt
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thereof.
22 
XXX XXX XXX
23 
Sec. 17. Section 44 of Republic Act No. 7875, as amended, is hereby amended
24 
to read as follows:
25 
Sec. 44 56. Penal Provisions. — Any violation of the provisions
26 
of this Act, after due notice and hearing, shall suffer the
27 
following penalties:
28 
XXX XXX XXX
29 
(e) VIOLATIONS RELATED TO THE PMRP. - ANY
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MEMBER, HEALTHCARE PROVIDER, OR THIRD-PARTY
31 
PARTNER 
WHO COMMITS FRAUD,
32 
MISREPRESENTATION, OR UNAUTHORIZED
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REDEMPTION OF POINTS UNDER THE PMRP SHALL BE
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PUNISHED WITH A FINE OF NOT LESS THAN FIVE
3 
THOUSAND PESOS (P5,000.00) BUT NOT MORE THAN
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FIFTY THOUSAND PESOS (P50/000.00) OR SUSPENSION
5 
FROM PARTICIPATION IN THE PMRP FOR NOT LESS
6 
THAN SIX (6) MONTHS BUT NOT MORE THAN ONE (1)
7 
YEAR, OR BOTH, AT THE DISCRETION OF THE
8 
CORPORATION. REPEAT OFFENDERS MAY BE
9 
PERMANENTLY BARRED FROM PARTICIPATING IN THE
10 
PMRP."
11 
XXX XXX XXX
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Sec. 18. Section 55 of Republic Act No. 7875, as amended, is hereby amended
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to read as follows:
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SECTION 55 67. Information Campaign. — There shall be
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provided-a-substantiol period of time to undertake an intensive
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public information campaign prior to the implementation of the
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rules and regulations of this Act. THE CORPORATION SHALL
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DEVELOP AND IMPLEMENT AN EXTENSIVE AND
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EFFECTIVE INFORMATION CAMPAIGN TO EDUCATE THE
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PUBLIC ON ALL PROGRAMS, SERVICES, AND BENEFITS
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PROVIDED BY PHILHEALTH, INCLUDING BUT NOT
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LIMITED TO THE NHIP AND THE PMRP. THIS CAMPAIGN
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SHALL UTILIZE A WIDE RANGE OF COMMUNICATION
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PLATFORMS, INCLUDING TRADITIONAL MEDIA SUCH
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AS TELEVISION, RADIO, AND PRINT; DIGITAL
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PLATFORMS INCLUDING SOCIAL MEDIA, MOBILE
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APPLICATIONS, AND THE OFFICIAL PHILHEALTH
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WEBSITE; AND ONSITE EFFORTS AT PARTNER HEALTH
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FACILITIES, LOCAL GOVERNMENT UNITS, AND
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COMMUNITY CENTERS.
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PARTNER HEALTH FACILITIES SHALL ACTIVELY
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PARTICIPATE BY DISSEMINATING PROMOTIONAL
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1 
MATERIALS, TRAINING PERSONNEL ON PHILHEALTH
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PROGRAMS, AND PROVIDING FEEDBACK MECHANISMS
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FOR MEMBER CONCERNS. THE CAMPAIGN SHALL
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PRIORITIZE INCLUSIVITY BY TRANSLATING
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MATERIALS INTO LOCAL DIALECTS, ENSURING
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ACCESSIBILITY FOR PERSONS WITH DISABILITIES,
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AND COLLABORATING WITH LOCAL GOVERNMENT
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UNITS AND NON-GOVERNMENTAL ORGANIZATIONS TO
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REACH UNDERSERVED COMMUNITIES.
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A DEDICATED EFFORT SHALL BE MADE FOR THE PMRP,
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FOCUSING ON EDUCATING MEMBERS ABOUT POINTS
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ACCUMULATION, REDEMPTION MECHANISMS, AND
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ELIGIBLE BENEFITS, AS WELL AS PROMOTING
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PREVENTIVE HEALTHCARE INCENTIVES.
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Sec 19. Separability Clause. — If any part or provision of this Act is held
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unconstitutional or invalid, other provisions which are not affected thereby shall
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continue to be in full force and effect.
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Sec. 20. Repealing Clause. — All laws, issuances, or parts thereof inconsistent
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with this Act are hereby repealed or modified accordingly.
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Sec 21. Effectivity. — This Act shall take effect fifteen (15) days after its
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publication in the Official Gazette or in at least two (2) newspapers of general
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circulation.
Approved,
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