NINETEENTH CONGRESS )
REPUBLIC OF THE PHILIPPINES )
Third Regular Session )

HOUSE OF REPRESENTATIVES

Introduced by Representative Rufus B. Rodriguez

No. 114456

EXPLANATORY NOTE

House

Article Il Section 11 of the 1987 Philippine Constitution state that “The State shall adopt an
integrated and comprehensive approach to health development which shall endeavor to make essential
goods, health and other social services available to all the people at affordable cost. There shall be
priority for the needs of the under-privileged, sick, elderly, disabled, women, and children. The State
shall endeavor to provide free medical care to paupers.”

In this vein, PhilHealth was mandated by Congress to expand its benefits and had recently resulted
to the increase of their case rate packages by approximately ninety-five percent (95%) (PhilHealth
Circular Nos. 2024-0012 and 2024-0037), and the roll-out of new benefits, such as, but not limited to:

1. Physical Medicine, Rehabilitation Services, and Assistive Mobility Devices (PhilHealth Circular

No. 2025-0003)

2. Benefit Package for Optometric Services for Children (PhilHealth Circular No. 2025-00002)

3. Benefits Package for Extracapular Cataract Extraction with IOL (PhilHealth Circular No. 2025-

0001)

4, Z Benefit Package for Peritoneal Dialysis (PhilHealth Circular No. 2024-0036)

5. Z Benefit for Kidney Transplantation (PhilHealth Circular No. 2024-0036)

6. Benefit for Preventive Oral Health Care Services (PhilHealth Circular No. 2024-0034)

However, there remains the cultural fear among Filipinos in seeking healthcare due to the lack of
financial resources. Most often than not, our countrymen only seek medical care during desperate
moments that would usually require admission in health facilities, expounding the debilitating effect of
healthcare cost to their meager finances.

It is thus appropriate to ensure that Filipinos, especially poor, be given access to free and quality
inpatient healthcare services as intended by the Constitution, To realize this, PhilHealth, as the
country's administrator of the National Health Insurance Program, should expand the benefits for
inpatient admission in ward accommodation, setting guidelines that will guarantee that those admitted
in wards will have absolute zero out-of-pocket (OOP) payment for any and all healthcare products and
services, including supplies and medicines, diagnostic services, medical and surgical services, and
other analogous products and services.

The package increase in ward accommodation will also serve as a catalyst for the improvement of
‘small and underfunded health facilities and will enable them to procure the necessary supplies,
equipment, and pharmaceutical items, and manpower compensation, which shall thus improve the
quality of their healthcare services.

This may also encourage private health facilities to convert their private rooms to ward
‘accommodation which will enable them to accept more inpatients, and remove the fear of the common-
folk in accessing healthcare in private health facilities.

This bill seeks to support of the progressive realization of universal health care in the country and
transform the health-seeking behavior of Filipinos.

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

Y Mie
RUFUS B. ROD!

‘


NINETEENTH CONGRESS )
REPUBLIC OF THE PHILIPPINES )
Third Regular Session )

HOUSE OF REPRESENTATIVES

Introduced by Representative Rufus B. Rodriguez
House Bill No. 11456

AN ACT
MANDATING THE PHILIPPINE HEALTH INSURANCE CORPORATION (PHILHEALTH) TO
INCREASE BY FIFTY PERCENT THE PHILHEALTH BENEFITS FOR WARD
ACCOMMODATION

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

SECTION 1. Short Title - This act shall be known as the “Expanded Philhealth Ward
Accommodation Act”

SECTION 2. Declaration of Principle It is the policy of the State to adopt an integrated and
‘comprehensive approach to health development which shall endeavor to make essential
goods, health and other social services available to all people at affordable cost. There shall
be priority for the needs of the under-privileged, sick, elderly, disabled, women, and children.
The State shall endeavor to provide free medical care to paupers.

SECTION 3. Coverage. - This Act shall cover PhilHealth members, and their qualified
dependents as defined in Section V, Rule |, Tittle III of the Revised Implementing Rules and
Regulations (IRR) of Republic Act 7875, as amended.

SECTION 4. Definition of Terms. - The following terms, as used in this Act, shall mean:

Drugs and Medicines - Pharmaceutical products prescribed by licensed health
professionals and dispensed by licensed pharmacies within or outside health facilities
where the patient is admitted.

Diagnostic Procedures - Tests required by licensed medical professionals to determine
a person's physical and medical condition, and identify illnesses and diseases. This may
be done within or outside the health facility where the patient is admitted.

Health Facilities - Refers to hospitals, clinics, and other healthcare institutions accredited
by PhilHealth to provide healthcare services to PhilHealth members. These facilities are
responsible for the submission of claims for reimbursement of services rendered to
PhilHealth members

In-patient -refers to an individual who requires treatment and observation and
accommodated inside a health facility.

PhilHealth Benefits - Refers to the wide-range of benefits provided by PhilHealth to its
members which may be availed at accredited health facilities.

Ward — A room inside a health facility that is used for accommodating inpatients on a shared
basis of three (3) or more beds per room, and usually includes shared areas such as but
Not limited to bath/comfort rooms.


SECTION 5. Fifty Percent (50%) in Ward Accommodation - PhilHealth shall increase all
applicable PhilHealth benefits for in-patient ward accommodation in accredited and capable
health facilities.

SECTION 6. Zero Out-of-Pocket Payment — PhilHealth, in coordination with other regulatory
bodies and government agencies, shall ensure that all their member and dependents admitted
in the said ward accommodations shall have zero out-of-pocket payment, including the
availment of drugs and medicines, diagnostic procedures, and analogous goods and services
related to the admission.

SECTION 7. Implementing Rules and Regulations — PhilHealth shall promulgate the
necessary rules and regulations for the proper implementation of this Act not later than ninety
(90) days from its effectivity

SECTION 8. Separability Clause - If any provision or part of this Act is declared
unconstitutional, the remaining parts or provisions not affected shall remain in full force and
effect.

SECTION 9. Repealing Clause. - All laws, executive orders, rules and regulations, and
issuances or parts thereof which are inconsistent to and contrary with the provisions of this
Act are hereby repealed and amended accordingly

SECTION 10. Effectivity. - This Act shall take effect fifteen (15) days after its publication in
the Official Gazette or in a newspaper of general circulation.

Approved,