Republic of the Philippines 
HOUSE OF REPRESENTATIVES 
Quezon City 
EIGHTEENTH CONGRESS 
Second Regular Session 
HOUSE BILL NO. ____ 
Introduced by HON. LUIS RAYMUND “LRAY” F. VILLAFUERTE, JR. 
TO REQUIRE THAT HEALTH PLANS PROVIDE COVERAGE FOR A MINIMUM 
HOSPITAL STAY FOR MASTECTOMIES, LUMPECTOMIES, AND LYMPH NODE 
DISSECTION FOR THE TREATMENT OF BREAST CANCER AND COVERAGE 
FOR SECONDARY CONSULTATIONS  
The Constitution, Article II, Section 15, provides that, “The State shall protect and 
promote the right to health of the people and instill health consciousness among 
them.” 
Every woman dreads the thought of being diagnosed with breast cancer. According to 
the National Cancer Institute of the National Institutes of Health of the United States, 
more than half a million women worldwide are diagnosed annually with breast cancer. 
Even though breast cancer is more common in older women, it also occurs in 
younger women and even in a small number of men. 
There is no known primary prevention method against breast cancer. This means that 
there is no efficient method to prevent breast cancer from developing. There are, 
however, effective secondary prevention methods or ways to detect or screen for 
breast cancer at an early stage. Detection at an early stage should be followed by 
early treatment, which eventually results to decreased mortality from the disease. 
Breast cancer can be cured when detected early and given the proper treatment.  
This bill seeks to require that health plans provide coverage for a minimum hospital 
stay for mastectomies, lumpectomies, and lymph node dissection for the treatment of 
breast cancer and coverage for secondary consultations. 
LUIS RAYMUND “LRAY” F. VILLAFUERTE, JR. 
9097
March 23, 2021
1:13 PM


Republic of the Philippines 
HOUSE OF REPRESENTATIVES 
Quezon City 
EIGHTEENTH CONGRESS 
Second Regular Session 
HOUSE BILL NO. ____ 
Introduced by HON. LUIS RAYMUND “LRAY” F. VILLAFUERTE, JR. 
AN ACT 
TO REQUIRE THAT HEALTH PLANS PROVIDE COVERAGE FOR A MINIMUM 
HOSPITAL STAY FOR MASTECTOMIES, LUMPECTOMIES, AND LYMPH NODE 
DISSECTION FOR THE TREATMENT OF BREAST CANCER AND COVERAGE 
FOR SECONDARY CONSULTATIONS 
Be it enacted by the Senate and the House of Representatives of the Philippines in 
Congress assembled: 
SECTION 1. Short Title. – This Act shall be known as the “Breast Cancer Patient 
Protection Act.” 
SECTION 2. Declaration of Policy. – It is the policy of the State to protect and promote 
the right to health of the people and instill health consciousness among them. 
SECTION 3. Definition of Terms. – As used in this Act, the term: 
(A) “Breast cancer” means any type of malignant growth in the breast tissue.
(B) “Health plan” means a medical insurance plan provided by a health insurance 
issues to certain groups in order to provide the them with medical and surgical 
benefits.
(C) “Mastectomy” means a medical operation that removes a woman’s breast.
(D) “Lumpectomy” means a medical operation that removes a lump from the 
breast. 
(E) “Lymph node” means rounded mass of lymphatic tissue that is surrounded by 
a capsule of connective tissue.
(F) “DOH” means the Department of Health. 
(G) “Secretary” means the DOH Secretary. 
9097


 
 
SECTION 4. Required Coverage For Minimum Hospital Stay For Mastectomies, 
Lumpectomies, And Lymph Node Dissections For The Treatment Of Breast Cancer 
And Coverage For Secondary Consultations. – 
 
(A) Inpatient Care. – 
 
(1) In General. – A group health plan, and a health insurance issuer providing 
health insurance coverage in connection with a group health plan, that provides 
medical and surgical benefits shall ensure that inpatient and in the case of a 
lumpectomy, outpatient coverage and radiation therapy is provided for breast 
cancer treatment. Such plan or coverage may not, except as provided for in 
paragraph (B),  
(a) Restrict benefits for any hospital length of stay in connection with a 
mastectomy or breast conserving surgery, such as a lumpectomy, for the 
treatment of breast cancer to less than 48 hours;  
(b) Restrict benefits for any hospital length of stay in connection with a lymph 
node dissection for the treatment of breast cancer to less than 24 hours; or  
(c) Require that a provider obtain authorization from the plan or the issuer for 
prescribing any length of stay required under subparagraph (1), without 
regard to paragraph (B) 
 
(2) Exception. – Nothing in this section shall be construed as requiring the 
provision of inpatient coverage if the attending physician and patient determine 
that either a shorter period of hospital stay, or outpatient treatment, is medically 
appropriate. 
 
(B) Prohibition on Certain Modifications. – In implementing the requirements of this 
section, a group health plan, and a health insurance issuer providing health insurance 
coverage in connection with a group health plan, may not modify the terms and 
conditions of coverage based on the determination by a participant or beneficiary to 
request less than the minimum coverage required under subsection (A). 
 
(C) Notice. – A group health plan and a health insurance issuer providing health 
insurance coverage in connection with a group health plan shall provide notice to 
each participant and beneficiary under such plan regarding the coverage required by 
this section in accordance with regulations promulgated by the Secretary. Such notice 
shall be in writing and prominently positioned in any literature or correspondence 
made available or distributed by the plan or issuer and shall be transmitted in the next 
mailing made by the plan or issuer to the participant or beneficiary; or as part of any 
yearly informational packet sent to the participant or beneficiary; whichever is earlier. 
  
SECTION 5. Secondary Consultations. – 
 
(A) In General. – A group health plan, and a health insurance issuer providing health 
insurance coverage in connection with a group health plan, that provides coverage 
with respect to medical and surgical services provided in relation to the diagnosis and 
treatment of cancer shall ensure that full coverage is provided for secondary 
consultations by specialists in the appropriate medical fields, including pathology, 
radiology, and oncology, provided for such secondary consultation whether such 
consultation is based on a positive or negative initial diagnosis. In any case in which 


 
 
the attending physician certifies in writing that services necessary for such a 
secondary consultation are not sufficiently available from specialists operating under 
the plan with respect to whose services coverage is otherwise provided under such 
plan or by such issuer, such plan or issuer shall ensure that coverage is provided with 
respect to the services necessary for the secondary consultation with any other 
specialist selected by the attending physician for such purpose at no additional cost to 
the individual beyond that which the individual would have paid if the specialist was 
participating in the network of the plan.  
 
(B) Exception. — Nothing in paragraph (A) shall be construed as requiring the 
provision of secondary consultations where the patient determines not to seek such a 
consultation. 
 
SECTION 6. Prohibition On Penalties Or Incentives. – A group health plan, and a 
health insurance issuer providing health insurance coverage in connection with a 
group health plan, may not — 
 
(A) Penalize or otherwise reduce or limit the reimbursement of a provider or specialist 
because the provider or specialist provided care to a participant or beneficiary in 
accordance with this Section;  
 
(B) Provide financial or other incentives to a physician or specialist to induce the 
physician or specialist to keep the length of inpatient stays of patients following a 
mastectomy, lumpectomy, or a lymph node dissection for the treatment of breast 
cancer below certain limits or to limit referrals for secondary consultations; 
 
(C) Provide financial or other incentives to a physician or specialist to induce the 
physician or specialist to refrain from referring a participant or beneficiary for a 
secondary consultation that would otherwise be covered by the plan or coverage 
involved under Section 5; or 
 
(D) Deny to a woman eligibility, or continued eligibility, to enroll or to renew coverage 
under the terms of the plan or coverage solely for the purpose of avoiding the 
requirements of this Section. 
 
SECTION 7. Effective Dates. – 
 
(A) In General. – The amendments made by this section shall apply to group health 
plans for plan years beginning on or after 90 days after the date of enactment of this 
Act. 
 
(B) Special Rule for Collective Bargaining Agreements. – In the case of a group health 
plan maintained pursuant to one (1) or more collective bargaining agreements 
between employee representatives and one (1) or more employers ratified before the 
date of enactment of this Act, the amendments made by this section shall not apply to 
plan years beginning before the date on which the last collective bargaining 
agreements relating to the plan terminates, determined without regard to any 
extension thereof agreed to after the date of enactment of this Act. For purposes of 
this paragraph, any plan amendment made pursuant to a collective bargaining 
agreement relating to the plan which amends the plan solely to conform to any 


 
 
requirement added by this section shall not be treated as a termination of such 
collective bargaining agreement.  
 
SECTION 8. Separability Clause. — If any provision, or part hereof is held invalid or 
unconstitutional, the remainder of the law or the provision not otherwise affected shall 
remain valid and subsisting. 
 
SECTION 9. Repealing Clause. — Any law, presidential decree or issuance, 
executive order, letter of instruction, administrative order, rule or regulation contrary 
to or inconsistent with the provisions of this Act is hereby repealed, modified or 
amended accordingly. 
 
SECTION 10. Effectivity Clause. — This Act shall take effect fifteen (15) days after 
its publication in at least two (2) newspapers of general circulation. 
 
Approved,