Republic of the Philippines
HOUSE OF REPRESENTATIVES,
Quezon City

FIFTEENTH CONGRESS
First Regular Session

4339

House Biil No.

Introduced by Representatives
DIOSDADO MAGAPAGAL ARROYO and GLORIA MAGAPAGAL ARROYO

AN ACT
INSTITUTING MECHANISMS FOR THE ESTABLISHMENT OF A CHILDREN'S.
HEALTH INSURANCE PROGRAM, AMENDING FOR THE PURPOSE
REPUBLIC ACT NO. 7875, OTHERWISE KNOWN AS "THE NATIONAL
HEALTH INSURANCE ACT OF 1995", AS AMENDED BY R.A. 9241 AND FOR
OTHER PURPOSES

EXPLANATORY NOTE

Article Il, Section 13 of the 1987 Constitution provides that the State
recognizes the vital role of the youth in nation-building and shall promote and
protect their physical, moral spiritual, intellectual and social well-being.

Access to basic health services is one of the major challenges for children
everywhere. According to a U.S.-based charity, more than 200 million children
worldwide do not get basic health care, leading to nearly 10 million deaths
annually of children under the age of 5 from treatabie ailments like diarrhea and
pneumonia.

In the Philippines, a UNICEF study shows that roughly 2.4 million Filipino
children 0 to 5 years old are underweight, and 26.3 per cent are stunted. The
study also reveals that 23 out of 1,000 children die before reaching the age of 1;
28 out of 1,000 children die before reaching the age of 5; and, only 7 out of 10
infants are immunized.


The 2006 UNDP Human Development Report reveals 19 per cent of total
population is undernourished. All of these are critical issues that seek immediate
solutions to improve children's health care.

This bill aims to increase and expand the caverage of our National Health
Insurance Program to include children. The proposed Children's Health
Insurance Program seeks to benefit around 14 million Filipino children by
providing eligible children with a wide range of health care services like regular
check-ups, immunizations, prescription drugs, laboratory tests and hospital or
clinic visits,

Hence, the immediate passage of this bill is earnestly sought

DIOSDADO MATAI AL ARROYO GLORIA APAGAL ARROYO
Second District, Camarines Sur Secon@ District, Pampanga


Republic of the Philippines
HOUSE OF REPRESENTATIVES
Quezon City

FIFTEENTH CONGRESS
First Regular Session

House Bill No. 4339

Introduced by Representatives
DIOSDADO MACAPAGAL ARROYO and GLORIA MACAPAGAL ARROYO

——_ I.

AN ACT
INSTITUTING MECHANISMS FOR THE ESTABLISHMENT OF A CHILDREN’S
HEALTH INSURANCE PROGRAM, AMENDING FOR THE PURPOSE
REPUBLIC ACT NO. 7875, OTHERWISE KNOWN AS “THE NATIONAL
HEALTH INSURANCE ACT OF 1995”, AS AMENDED BY R.A. 9241 AND FOR
OTHER PURPOSES,

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

SECTION 1. Section 4 of Republic Act No. 7875 is hereby amended to
read as follows:

“SEC. 4. Definition of Terms. — For the purposes of this Act, the
following terms shall be defined as follows:

(4) CHILD HEALTH ASSISTANCE - A RANGE OF
HEALTH CARE AND SUPPORT SERVICES INCLUDING, BUT
NOT LIMITED TO, PHYSICIAN SERVICES AND ANY OTHER
MEDICAL, DIAGNOSTIC, SCREENING, PREVENTIVE,
RESTORATIVE, REMEDIAL, THERAPEUTIC OR
REHABILITATIVE SERVICES;


700K

(s) Member - Any person whose premiums have been
regularly paid to the National Health insurance Program. He may
be a paying member, an indigent member, A QUALIFIED CHILD
MEMBER, or a pensioner/etiree member,

70K

(dd) QUALIFIED CHILD MEMBER — ANY CHILD OF A
LOW- INCOME FAMILY UNDER 6 YEARS OF AGE OR OVER
BUT WHO ARE UNABLE TO FULLY TAKE CARE OF
THEMSELVES OR PROTECT THEMSELVES FROM ABUSE,
NEGLECT, CRUELTY, EXPLOITATION OR DISCRIMINATION
BECAUSE OF A PHYSICAL, MENTAL DISABILITY OR
CONDITION AND WHOSE FAMILY IS BELOW POVERTY LINE,
AND DETERMINED AS SUCH 8Y THE PERTINENT
GOVERNMENT AGENCY.”

SECTION 2. Section 5 of the same Act shall now read as follows:

"Sec, 5. Establishment and Purpose. — There is hereby created the
National Health Insurance Program which shail provide health insurance
coverage and ensure affordable, acceptable, available and accessible
health care services for all citizens of the Philippines, in accordance with
the policies and specific provisions of this Act. This social insurance
program shall serve as the means for the healthy to help pay for the care
of the sick and for those who can afford medical care to subsidize those
who cannot. It shall initially consist of programs | and II of Medicare and
be expanded progressively to constitute one universal heaith insurance
program for the entire population. IT SHALL INITIATE AND EXPAND
THE PROVISION OF CHILD HEALTH ASSISTANCE TO INCLUDE A
CHILD HEALTH INSURANCE PROGRAM FOR UNINSURED, LOW-
INCOME CHILDREN IN AN EFFECTIVE AND EFFICIENT MANNER
THAT {S COORDINATED WITH OTHER SOURCES OF HEALTH
BENEFITS COVERAGE FOR CHILDREN. xxx."

SECTION 3. Section 6 of the same Act shall now read as follows:

"SEC. 6. Coverage. — Alll citizens of the Philippines, WHETHER
GHILD OR ADULT, shall be covered by the National Health Insurance
Program. In accordance with the principles of universality and compulsory
coverage enunciated in Section 2 (b) and 2 (1) hereof, implementation of
the Program shail, furthermore, be gradual and phased in over a period of
not more than fifteen (15) years: Provided, That the Program shall not be


made compulsory in certain provinces and cities untii the Corporation shall
be able to ensure that members in such localities shall have reasonable
access to adequate and acceptable health care services."

SECTION 4. Section 7 of the same Act shall now read as follows:

"SEC. 7. Enrollment. - The Program shall enroll beneficiaries in
order for them to be placed under coverage that entities them to avail of
benefits with the assistance of the financial arrangements provided by the
Program. ‘The process of enrollment shall include the identification of
beneficiaries, issuance of appropriate documentation specifying eligibility
to benefits, and indicating how membership was obtained or is being
maintained. The enrollment shall proceed in accordance with these
specific policies:

a) 00;
b) xxx
6) xxx; and
8) 1x.

All indigents AND QUALIFIED CHILD MEMBER not enrolled in the
Program shail have priority in the use and availment of the services and
facilities of goverment hospitals, health care personnel, and other health
organizations: Provided, however, That such govemment health care
providers shall ensure that said indigents AND QUALIFIED CHILD
MEMBER shail subsequently be enrolled in the Program."

SECTION 5. Section 12 of the same Act shall now read as follows:
“SEC.12. Entitlement to Benefits. -xxx

The following need not pay the monthly contributions to be entitled
to the Program's benefits

a) Retirees and pensioners of the SSS and GSIS prior to the
effectivity of this Act,

b) Members who reach the age of retirement as provided for by law
and have paid at least one hundred twenty (120) monthly contributions;
[and]

c} Enrolled indigents; AND

D) QUALIFIED CHILD OF LOW-INCOME FAMILIES.


SECTION 6. Section 28 of the same Act is hereby amended to read as
follows:

"SEC. 28. Contributions. — All members of the Program 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) xxx
b) xx
) xxx

D) CONTRIBUTIONS MADE IN BEHALF OF A QUALIFIED
CHILD MEMBER SHALL NOT EXCEED THE MINIMUM
CONTRIBUTIONS SET FOR EMPLOYED MEMBERS.”

SECTION 7. A new Section 30 is hereby added to read as follows:

SEC. 30. PAYMENT FOR A CHILD  BENEFICIARY’S.
CONTRIBUTIONS. - AN INITIAL AMOUNT OF THIRTY MILLION
PESOS (P30,000,000.00) 1S HEREBY APPROPRIATED FOR THIS
PURPOSE FOR THE FIRST YEAR OF ITS IMPLEMENTATION.
THEREAFTER, THE CONTRIBUTIONS FOR QUALIFIED CHILDREN
BENEFICIARIES SHALL BE SUBSIDIZED PARTIALLY BY THE LOCAL
GOVERNMENT UNIT WHERE THE MEMBER RESIDES. THE
CORPORATION SHALL PROVIDE COUNTERPART FINANCING
EQUAL TO THE LGUS SUBSIDY FOR CHILDREN. THE SHARE OF
THE LGUS SHALL BE PROGRESSIVELY INCREASED UNTIL SUCH
TIME THAT ITS SHARE BECOMES EQUAL TO THAT OF THE
NATIONAL GOVERNMENT.

SECTION 8. implementing Rules and Regulations. - Within thirty (30)
days from the effectivity of this Act, the Board of Directors of the Philippine
Health Insurance Corporation (PHIC) shall convene to formulate the rules and
regulations for the implementation of this Act.

SECTION 9. Separability Clause. — If any part or provision of this Act shall
be held unconstitutional or invalid, other provisions which are not affected
thereby shall continue to be in full force and effect.

SECTION 10. Repealing Clause. - All laws, presidential decrees,
executive orders, rules and regulations or parts thereof which are deemed
inconsistent with the provisions of this Act are hereby repealed, amended, or
modified accordingly.


SECTION 11 Effectivity Clause. — This Act shall take effect fifteen (15)
days following its full and complete publication in an Official Gazette or in at least
two (2) newspapers of general circulation, whichever comes first.

Approved,