Republic of the Philippines!
House of Representativ:
Quezon City

SIXTEENTH CONGRESS
First Regular Session

x)
“i

2
HB. No. “©

Introduced by HONORABLE CINCHONA CRUZ-GONZALES

EXPLANATORY NOTE

It is the policy of the State to “adopt an integrated and comprehensive approach to health
development which shall endeavor to make essentail goods, health and other social services
available to all people at affordable costs”. Although Republic Act 7875, otherwise known as the
“National Health Insurance Act of 1995”, mandates that an affordable and accessible health care
coverage shoud be made available to all citizens, access to health care remains to be a problem,
most specially to the poor segments of the population.

This bill aims to hasten the process of identifying the indigent Filipinos through the use of a
means test set by the national government. In doing so, this will allow the national government to
effectively use funds to provide health insurance coverage for the said group. Finally, the bill
seeks to establish a roadmap towards universal health care through a refocused and strengthened
PhilHealth

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

HON. CINCHONA CRUZ-GONZALES,

Representative, CIBAC Party list


Republic of the Philippines
House of Representatives
Quezon City

SIXTEENTH CONGRESS
First Regular Session

227

HB. No.

Introduced by HONORABLE CINCHONA CRUZ-GONZALES

AN ACT AMENDING REPUBLIC ACT NO. 7875 OTHERWISE KNOWN AS “THE
NATIONAL HEALTH INSURANCE ACT OF 1995” AS AMENDED AND FOR OTHER,
PURPOSES

Be it enacted by the Senate and the House of Representative of the Philippine in
Congress assembled:

SECTION 1. Sub-paragraph (q) of Paragraph (a), Section 4, Article Il of Republic Act
No. 7875 as amended, is hereby further amended to read as follows

“Sec. 4. Definition of Terms.- For the purpose of this act, the folowing terms shall be
defined as follows:

a) Beneficiary — Any person entitled to health care benefits of this Act.
b) Xxx
©) Xxx

Xxx

Indigent — A person who has no visible means of income, or whose income is sufficient
for the subsistence of his family [,as identified by the Local Health Insurance Office and] based
on specific criteria set by the [Corporation] NATIONAL GOVERNMNET in accordance with
the guiding principles set forth in Article I of this Act.”

Xxx

SEC. 2. Paragraph (z), Section 4, Article II of the same Act is further amended by
adding one (1) sub-paragraph to be denominated as paragraph (MM) to read as folows:

“(2) Philippine National Drug Formulary — The essential drugs list for the Philippines
which is prepared by the Natioanl Drug Committee of the Department of Health in consultation
with experts and specialists.

aa) xxx

bb) xxx


co) xxx
Xxx

MM) INFORMAL SECTOR- REFERS TO THAT SECTOR CONSISTING OF
ECONOMIC UNITS ENGAGED IN THE PRODUCTION OF GOODS AND SERVICES
WITH THE PRIMARY OBJECTIVE OF GENERATING EMPLOYMENT AND INCOMES
TO THE PERSONS CONCERNED IN ORDER TO EARN A LIVING, INCLUDING
HOUSEHOLD UNINCORPORATED ENTERPRISES THAT ARE MARKET AND NON-
MARKET PRODUCERS OF GOODS AS WELL AS MARKET PRODUCERS OF
SERVICES. TO TIS SECTOR BELONG, AMONG OTHERS, STREET HAWKERS,
MARKET VENDORS, PEDICAB AND TRICYCLE DRIVERS, SMALL CONSTRUCTION
WORKERS AND HOME-BASED INDUSTRIES AND SERVICES.”

SEC. 3. Sec. 16, Article IV of the same Act is hereby amended to read as follows:

“Section 16. Powers and Functions. — The Corporation shall have the following powers
and functions:

a) To administer the national Health Insurance Program
b) xxx
©) xxx

xxx

(m) [to supervise the provision of health benefits with the power] to VISIT, ENTER
AND inspect FACILITIES OF HEALTH CARE PROVIDERS AND EMPLOYERS AND TO.
SECURE COPIES OF THEIR medical, [and] financial AND OTHER records PERTINENT TO
THE CLAIMS, ACCREDITATION, PREMIUM CONTRIBUTION AND THAT OF THEIR
PATIENTS OR EMPLOYEES, WHERE APPLICABLE, [health care providers and patients]
who are [participants in] members or DEPENDENTS of the Program; [and the power to enter
and inspect accredited health care institutions, subject to the rules and regulations to be
promulgated by the Corporation;]”

Xxx

SEC. 4. Sec. 16, Article IV of the same Act is also hereby further amended by inserting
two (2) paragraphs to be denominated as paragraphs (Q) and (R) and the subsisting paragraph (q)
be denominated as paragraph (S) to read as follows:

“(Q) TO ENTER INTO AGREEMENTS WITH NATIONAL AGENCIES AND
LOCAL GOVERNMENTS TO REQUIRE PROOF OF PHILHEALTH MEMBERSHIP
BEFORE TRANSACTING WITH PRIVATE INDIVIDUALS OR GROUPS.

(R) NOTWITSTANDING THE PROVISIONS OF ANY LAW TO THE CONTRARY,
THE CORPORATION MAY IMPOSE INTEREST AND/ OR SURCHARGES OF THREE
PERCENT (3%) PER MONTH OR AT ANY RATE AS MAY BE FIXED BY THE
CORPORATION IN CASE OF ANY DELAY IN REMITTANCE OF CONTRIBUTIONS
WHICH ARE DUE WITHIN THE PRESCRIBED PERIOD. NOTWITHSTANDING THE
PROVISIONS OF ANY LAW TO THE CONTRARY, THE CORPORATION MAY ALSO
COMPROMISE, WAIVE OR RELEASE, IN WHOLE OR IN PART, SUCH INTERESTS OR
SURCHARGES IMPOSED UPON EMPLOYERS REGARDLESS OF THE AMOUNT
INVOLVED UNDER SUCH VALID TERMS AND CONDITIONS IT MAY PRESCRIBE.


[a] (S) to perform such other acts as it may deem appropriate for the attainment of the
objectives of the corporation and for the proper enforcement of the provisions of this Act.”

SEC. 5 Sec. 18, Article IV of the same Act is hereby further amended to read as
follows:

“Sec. 18. The Board of Directors.

(a) Composition — The Corporation shall be governed by a Board of Directors
hereinafter referred to as the Board, composed of the following members:

The Secretary of Health;

The Secretary of Labor and Employment or his representative;

The Secretary of the Interior and Local Government or his representative;
The Secretary of Social Welfare and Development or his representative;
The President of the Corporation;

A representative of the labor sector;

A representative of employers;

The SSS Administrator or his representative;

The GSIS General Manager or his representative;

The Vice Chairperson for the basic sector of the National Anti-Poverty Commission or
his Represntative;

A representative of Filipino overseas workers;

A representative of health care providers ton be endorsed by the National associations
of health care institutions and medical health professionals;

A representative of the self-employed sector, and
A REPRESENTATIVE OF THE ELECTED LOCAL CHIEF EXECUTIVES

The Secretary of Health shall be the ex-officio Chairperson while the President of the
Corporation shall be the Vice Chairperson of the Board.”

SEC. 6. Sec. 28, Article VII of the same Act, is hereby amended read as follows:

“Section 28. Contributions. - ALL ENROLLED members [of the program] WHO CAN
AFFORD TO PAY shall contribute to the Fund, in accordance with a reasonable,
equitable and progressive contribution schedule to be determined by the Corporation on
the basis of applicable actuarial studies and in accordance with the following
guidelines

a) Formal sector employees and current Medicare members and their employers
shall continue paying the same monthly contributions...

b) Contributions from [self-employed members] THE INFORMAL SECTOR shall
be based primarily on household earnings and assets. [; their total contributions
for one year shall not, however, exceed three percent (3%) of their estimated
actual net income for the preceding year.]


o) Xxx

D) NOTWITHSTANDING ANY LAW TO THE CONTRARY, ALL
GOVERNMENT AGENCIES ISSUING PROFESSIONAL OR BUSINESS LICENSE OR
PERMIT, SHALL REQUIRE ALL APPLICANTS TO SUBMIT CERTIFICATE OR PROOF
OF PAYMENT OF PHILHEALTH PREMIUM CONTRIBUTIONS, PRIOR TO THE
ISSUANCE OR RENEWAL OF SUCH LICENSE OR PERMIT.”

SEC. 7. Sec. 29, Article VII of the same Act is hereby further amended to read as
follows:

“ SECTION 29. Payment for Indigent Contributions. ~ Contributions for [indgent
members] THE PHILIPPINE POPULATION BELONGING TO THE POOREST TWENTY
PERCENT (20%) OF THE POPULATION AS IDENTIFIED BY A MEANS TEST
DETERMINED BY THE NATIONAL GOVERNMENT shall be subsidized [partially by the
local government unit where the member resides.) ENTIRELY BY THE NATIONAL
GOVERNMENT. [The Corporation shall provide counterpart financing equal to the LGU’s
subsidy for indigents: Provided, That in the case of fourth, fifth and sixth class_ municipalities,
National Government shall provide up to ninety percent (90%) of the subsidy for indigents until
such time that they have been upgraded to first, second or third class municipalities. The share of
the LGU’s shall be progressively increased until such time that its share becomes equal to that of
the National Government] ALLOCATION FOR THE ENROLLMENT OF THESE
INDIGENTS SHALL BE APPROPRIATED IN THE GENERAL APPROPRIATIONS ACT AS
A SEPARATE LINE ITEM IN THE BUDGET OF THE DEPARTMENT OF HEALTH AND
SHALL BE INCREASED ANNUALLY TO COVER FOR THE PROPORTIONATE
INCREASE IN THER NUMBER OF THE POOR BASED ON THE POVERTY INCIDENCE
RATE, THE NEXT POOREST 20% OF THE POPULATION OR THE POOR AS
IDENTIFIED BY THE SAME MEANS TEST SHALL BE SUBSIDIZED ENTIRELY BY THE
LOCAL GOVERNMENT UNITS OR BY COST SHARING MECHANISMS BETWEEN THE
LOCAL GOVERNMENT AND THE PRIVATE SECTOR.”

SEC. 8. Effectivity. ~ This Act shall take effect fifteen (15) days after its publication in
at least two (2) national newspapers of general circulation

Approved,