TWENTIETH CONGRESS OF THE 
REPUBLIC OF THE PHILIPPINES 
First Regular Session
)
SENATE
S. No. S64
of tiif c'.ftar;
25 AUG-4 P5:48
m-CEIVfcDBV:
Introduced by Senator Jinggoy Ejercito Estrada
AN ACT
AMENDING REPUBLIC ACT NO. 11223, OTHERWISE KNOWN AS THE 
"UNIVERSAL HEALTH CARE ACT"
EXPLANATORY NOTE
Republic Act No. 11223, or the Universal Health Care (UHC) Act, marked a 
major milestone in the government's commitment to deliver equitable and quality 
health care to all Filipinos. Since its enactment, the law has initiated critical reforms 
to broaden access and improve service delivery through the National Health Insurance 
Program. However, implementation has revealed several areas requiring immediate 
legislative intervention to ensure the program's effectiveness, sustainability, and 
responsiveness to our people's needs.
This measure proposes to strengthen the UHC Act by expanding the benefit 
package to include dental services and clarifying the definition of legal dependents to 
ensure wider family coverage. It reinforces the principle of immediate eligibility, 
regardless of identification or premium payment status, and mandates a periodic 
review of benefit packages every three years to align with changing health needs and 
economic conditions.
To ease financial burdens, particularly for Overseas Filipino Workers, the bill 
revises the premium rate schedule starting in 2025, ensures a 50% government 
subsidy for OFWs, and exempts distressed migrant workers from premium collections
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upon their return. It also authorizes the President to suspend scheduled premium 
hikes during national emergencies or calamities.
The measure safeguards PhilHealth's reserve funds by prohibiting their 
diversion to the general fund or any government entity and by requiring that excess 
reserves be used to reduce contributions or expand benefits. A mechanism for 
lowering premiums must also be included in the law's implementing rules and 
regulations.
Governance reforms include expanding the PhilHealth Board from 13 to 15 
members with broader sectoral representation, including medical professionals, 
dentists, and local executives. Gender representation is institutionalized, and the 
Secretary of Health is designated as the ex officio Chairperson of the Board.
To promote transparency, PhilHealth will be required to submit annual audit 
reports and a fund viability plan to Congress and the Department of Budget and 
Management. A third-party auditor will independently review the institution's actuarial 
projections and benefit designs, subject to oversight by the Commission on Audit and 
Bureau of Internal Revenue.
Lastly, the proposed bill calls for the reorientation of medical and allied health 
education toward public health and primary care, ensuring that health professionals 
are better equipped to meet the objectives of universal health care.
This proposed legislation strengthens the foundations of the UHC Act and 
advances its core vision: that every Filipino, regardless of status, can access essential 
health services without suffering financial hardship.


In view of the foregoing, the immediate passage of this measure is earnestly
sought.
L
NGGOY EJERCITO ESTRADA


TWENTIETH CONGRESS OF THE 
REPUBLIC OF THE PHILIPPINES 
First Regular Session
)
SENATE
S. No. 864
C.*4> 1“ .Ti
of the
25 AUG -4 P5 '49
Introduced by Senator Jinggoy Ejercito Estrada
AN ACT
AMENDING REPUBLIC ACT NO. 11223, OTHERWISE KNOWN AS THE 
"UNIVERSAL HEALTH CARE ACT"
Be it enacted by the Senate and the House of Representatives of the Philippines 
in Congress assembled:
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Section 1. Section 4 of Republic Act No. 11223 is hereby amended to read as
follows:
"SEC. 4. Definition of Terms. - As used in this 
Act:
"x X X
"(i) Essential health benefit package refers to a 
set of individual-based entitlements covered by the 
National Health Insurance Program (NHIP) which 
includes primary care; medicines, diagnostics and 
laboratory; and preventive, curative, [and] 
rehabilitative services; AND DENTAL SERVICES;
"x X X
"(V) DEPENDENTS OF A MEMBER REFER 
TO: (1) THE LEGITIMATE SPOUSE WHO IS NOT 
A MEMBER; (2) THE UNMARRIED AND 
UNEMPLOYED LEGITIMATE, LEGITIMATED, 
ILLEGITIMATE, LEGALLY ADOPTED, OR


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STEPCHILDREN TWENTY- THREE (23) YEARS OF 
AGE AND BELOW."
Sec 2. Section 9 of Republic Act No. 11223 is hereby amended to read as 
follows:
"SEC. 9. Entitlement to Benefits. - Every 
member shall be granted immediate eligibility for 
health benefit package under the Program: Provided,
That PhilHealth Identification Card shall not be 
required in the availment of any health service:
Provided, further, That no co-payment shall be charged 
for services rendered in basic or ward accommodation:
Provided, furthermore. That co-payments and co- 
insurance for amenities in public hospitals shall be 
regulated by the DOH and PhilHealth: PROVIDED, 
FURTHERMORE, THAT THE PHILHEALTH 
BOARD, IN CONSULTATION WITH THE 
INSURANCE COMMISSION, SHALL CONDUCT 
PERIODIC REVIEW AND ADJUSTMENT OF 
BENEFIT PACKAGES NOT LATER THAN THREE 
(3) YEARS FROM THE EFFECTIVITY OF THIS ACT 
AND EVERY THREE (3) YEARS THEREAFTER:
Provided, finaiiy. That the current PhilHealth package 
for members shall not be reduced.
"PhilHealth shall provide additional Program 
benefits for direct contributors, where applicable:
Provided, That failure to pay premiums shall not 
prevent the enjoyment of any Program benefits:
Provided, further. That employers [and self- employed 
direct contributors] shall be required to pay all missed 
contributions with an interest, compounded monthly, 
of at least three percent (3%) [for employers and not


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exceeding—tr5%—fef—self-earning,—professional
practitioners, and migrant workers]."
Sec 3. Section 10 of Republic Act No. 11223 is hereby amended to read as
follows:
"SEC. 10. Premium Contributions. - For direct 
contributors, premium rates shall be in accordance 
with the following schedule, and monthly income floor 
and ceiling:
[Year
202G
2022
2023
2024
2025
Premium Rate
2t75%
3.00%
3t50%
4t00%
4t50%
5t00%
5t00%
Income Floor
P10,000.00
P10,000.00
P10,000.00
P10,000.00
P10,000.00
P10,000.00
P10,000.00
Income Ceiling
P50,000.00
P60,000.00
P70,000.00
P80>-000-.00
P9O,OOO.O0
P100,000.00
P100,000.00]
YEAR
PREMIUM RATE
INCOME FLOOR
INCOME CEILING
2026
5.00%
P10,000.00
P100,000.00
2027
3.25%
P10,000.00
P100,000.00
2028
3.50%
P10,000.00
P100,000.00
2029
3.75%
P10,000.00
P100,000.00
2030
4.00%
P10,000.00
P100,000.00
"FOR MIGRANT WORKERS, PREMIUM 
CONTRIBUTIONS SHALL BE BASED ON THE 
INCOME FLOOR: PROVIDED, THAT FIFTY 
PERCENT (50%) OF THE PREMIUM 
CONTRIBUTION OF MIGRANT WORKERS SHALL 
BE SHOULDERED BY THE NATIONAL 
GOVERNMENT: PROVIDED, FURTHER, THAT 
EMPLOYERS OF SEAFARERS, THROUGH THE 
LOCAL MANNING AGENCIES, SHALL CONTINUE


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TO SHOULDER FIFTY PERCENT (50%) OF THE 
PREMIUM CONTRIBUTION OF THE SEAFARERS: 
PROVIDED, FURTHERMORE, THAT UNPAID 
PREMIUM CONTRIBUTIONS OF MIGRANT 
WORKERS IN DISTRESS UNDER REPUBLIC ACT 
NO. 8042, OR 'THE MIGRANT WORKERS AND 
OVERSEAS FILIPINOS ACT OF 1995', AS 
AMENDED BY REPUBLIC ACT NO. 10022, SHALL 
NOT BE COLLECTED UPON THEIR ARRIVAL IN 
THE COUNTRY: PROVIDED, FINALLY, THAT 
FAILURE TO PAY PHILHEALTH CONTRIBUTIONS 
SHALL NOT BE A GROUND FOR THE NON­
ISSUANCE OF AN OVERSEAS EMPLOYMENT 
CERTIFICATE OF A MIGRANT WORKER. FOR 
THIS PURPOSE, 'OVERSEAS FILIPINO IN 
DISTRESS' REFERS TO AN OVERSEAS FILIPINO 
WHO HAS A MEDICAL, PSYCHO-SOCIAL, OR 
LEGAL ASSISTANCE PROBLEM REQUIRING 
TREATMENT, HOSPITALIZATION, COUNSELING, 
LEGAL REPRESENTATION, OR ANY OTHER KIND 
OF INTERVENTION BY THE AUTHORITIES IN 
THE COUNTRY WHERE HE OR SHE IS FOUND. 
FILIPINOS WITH DUAL CITIZENSHIP (FDC), OR 
THOSE WHO HAVE RETAINED AND RE­
ACQUIRED FILIPINO CITIZENSHIP BY VIRTUE 
OF REPUBLIC ACT NO. 9225, OR THE 
'CITIZENSHIP 
RETENTION 
AND
REACQUISITION ACT OF 2003', MAY ENJOY THE 
BENEFITS PROVIDED BY THE STATE HEALTH 
INSURER: PROVIDED, THAT FAILURE TO PAY 
PREMIUMS SHALL NOT PREVENT THE FDC AND


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THEIR LEGAL DEPENDENTS FROM ENJOYING 
ANY PROGRAM BENEFIT.
'‘'[Provided, That f]For indirect contributors, 
premium subsidy shall be gradually adjusted and 
included annually In the General Appropriations Act 
(GAA): Provided, [further,'] That the funds shall be 
released to PhilHealth: Provided, furthei[more]\ That 
the DOH, in coordination with PhilHealth, may request 
Congress to appropriate supplemental funding to meet 
targeted milestones of this Act: Provided, finally. That 
for every increase in the rate of contribution of direct 
contributors and premium subsidy of indirect 
contributors, PhilHealth shall provide for a 
corresponding increase in benefits.
"IN THE EVENT OF A STATE OF NATIONAL 
EMERGENCY, PUBLIC HEALTH EMERGENCY, OR 
STATE OF CALAMITY, THE PRESIDENT OF THE 
PHILIPPINES, UPON RECOMMENDATION OF 
THE PHILHEALTH BOARD AFTER 
CONSULTATION WITH STAKEHOLDERS, MAY 
SUSPEND THE INCREASE IN PREMIUM 
CONTRIBUTION RATES PROVIDED UNDER THIS 
SECTION. THE MANDATED INCREASE SHALL BE 
IMPLEMENTED UPON LIFTING OF THE STATE OF 
EMERGENCY, PUBLIC HEALTH EMERGENCY, OR 
CALAMITY. IN THE EVENT OF SUSPENSION, ALL 
SUBSEQUENT SCHEDULED INCREASES IN 
CONTRIBUTION RATES SHALL BE 
IMPLEMENTED ACCORDINGLY IN THE 
SUCCEEDING YEARS."
Sec. 4. Section 11 of Republic Act No. 11223 is hereby amended to read as
follows:


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"SEC. 11. Program Reserve Funds. - PhilHealth 
shall set aside a portion of its accumulated revenues
AS MENTIONED IN SECTION 37 OF THIS ACT 
AND ANY OTHER INCOME FROM ANY SOURCE
not needed to meet the cost of the current year's 
expenditures as reserve funds: Provided, That the total 
amount of reserves shall not exceed a ceiling 
equivalent to the amount actuarially estimated for two 
(2) years' projected Program expenditures: Provided, 
further. That whenever actual reserves exceed the 
required ceiling at the end of the fiscal year, the excess 
of the PhilHealth reserve fund shall be used to increase 
the Program's benefits and to decrease the [amount of
membefs--------------contributions] 
PREMIUM
CONTRIBUTION RATES OF MEMBERS: 
PROVIDED, FINALLY, THAT THE DOH AND 
PHILHEALTH SHALL INCLUDE A MECHANISM 
FOR LOWERING PREMIUM CONTRIBUTION 
RATES IN THE IMPLEMENTING RULES AND 
REGULATIONS OF THIS ACT.
"x X X
"a) XXX 
"b)x X X 
"C) XXX 
"d) XXX 
"e) XXX 
nf) XXX
"g)In debt instruments and other securities 
traded in the secondary markets with the 
same intrinsic quality as those enumerated 
in paragraphs (a) to (e) hereof, subject to 
the approval of the PhilHealth Board.


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"[No portion of the reserve fund or income 
thereof shall accrue to the general fund of the National
Government—or—to—any—of—its—agencies—or
instrumentalities—including—government-owned—©r-
eontrolled corporations.]
"As part of its investments operations,
PhilHealth may hire institutions with valid trust licenses 
as its external local fund managers to manage the 
reserve fund, as it may deem appropriate, through 
public bidding. The fund manager shall submit an 
annual report on investment performance to 
PhilHealth.
"x X X
"The PhilHealth shall manage the supplemental 
benefits fund to the minimum required to ensure that 
the supplemental benefit payments are secure.
"NOTWITHSTANDING ANY LAW TO THE 
CONTRARY, NO PORTION OF ANY FUND OR 
INCOME OF PHILHEALTH, INCLUDING THE 
PROVIDENT FUND UNDER SECTION 16(C) AND 
THE SPECIAL HEALTH FUND UNDER SECTION 20 
OF THIS ACT, SHALL ACCRUE TO THE GENERAL 
FUND OF THE NATIONAL GOVERNMENT OR TO 
ANY OF ITS AGENCIES OR 
INSTRUMENTALITIES, 
INCLUDING
GOVERNMENT-OWNED 
OR-CONTROLLED
CORPORATIONS."
Sec. 5. Section 13 of Republic Act No. 11223 is hereby amended to read as
follows:
"SEC. 13. PhilHealth Board of Directors- (a) The 
PhilHealth Board of Directors, hereinafter referred to 
as the Board, is hereby reconstituted to have a


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maximum of [tNrtccn (13)] FIFTEEN (15) members, 
consisting of the following: (1) five (5) ex officio 
members, namely: the Secretary of Health, Secretary 
of Social Welfare and Development, Secretary of 
Budget and Management, Secretary of Finance, AND 
Secretary of Labor and Employment; (2) three (3) 
expert panel members with expertise in public health, 
management, finance, and health economics; and (3) 
[five (5)] SEVEN (7) sectoral panel members 
REPRESENTING THE FOLLOWING SECTORS: 
[representing the] (A) direct contributors, (B) indirect 
contributors WHERE THE REPRESENTATIVE IS 
HIMSELF/HERSELF 
AN 
INDIRECT
CONTRIBUTOR, (C) employers group, (D) 
MEDICAL DOCTORS ENDORSED BY THEIR 
PROFESSIONAL ASSOCIATIONS, (E) HEALTH 
CARE PROFESSIONALS, OTHER THAN MEDICAL 
DOCTORS, ENDORSED BY THEIR NATIONAL 
ASSOCIATIONS OF HEALTH CARE 
PROFESSIONALS, (F) DENTISTS ENDORSED BY 
THEIR PROFESSIONAL ASSOCIATIONS, AND 
[health care providers to be endorsed by their national
associations ef-health care institutions and health car-e
professionals7and] (G) [representative of the] elected 
local chief executives to be endorsed by the League of 
Provinces of the Philippines, League of Cities of the 
Philippines and League of Municipalities of the 
Philippines: Provided, That at least one (1) of the 
expert panel members and at least two (2) of the 
sectoral panel members are women.
"X X X


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"(b) The Secretary of Health shall be an ex 
officio [nonvoting] Chairperson of the Board
"(C) XXX 
"x X X."
Sec. 6. Section 25 of Republic Act No. 11223 is hereby amended to read as
follows:
"Sec. 25. Schoiarship and Training Program.
- X X X
"x X X
"(d) The CHED, PRC, and DOH, in coordination 
with duly-registered medical and allied professional 
societies, shall reorient medical and allied medical 
professional education, and health professional 
certification and regulation towards producing health 
workers with competencies in the provision of primary 
care services AND PUBLIC HEALTH."
Sec. 7. Republic Act No. 11223 is hereby amended by inserting a new section 
after Section 37 which shall read as follows:
"SEC. 37-A. SUBMISSION OF AUDIT 
REPORT AND FUND VIABILITY PLAN. - THE 
PHILHEALTH SHALL SUBMIT THE FOLLOWING 
REPORTS ANNUALLY TO THE DBM, THE SENATE,
AND THE HOUSE OF REPRESENTATIVES:
"(A) MANAGEMENT AUDIT REPORT 
DETAILING POLICIES AND REFORMS TO 
CONTROL FRAUDULENT PRACTICES; AND
"(B) FUND VIABILITY PLAN, INCLUDING 
POLICIES AND REFORMS TO STRENGTHEN 
PREMIUM COLLECTION, INCREASE PROGRAM 
BENEFITS, AND MINIMIZE THE RISK OF 
DEFICITS."


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Sec. 8. Republic Act No. 11223 is hereby amended by inserting a new section
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after the Section 37 which shall read as follows:
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"SEC. 37-B. THIRD-PARTY AUDITOR. -
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THE PHILHEALTH SHALL ENGAGE A THIRD-
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PARTY AUDITOR TO REVIEW ITS ACTUARIAL
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PROJECTIONS AND BENEFIT PACKAGES
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ANNUALLY TO ENSURE THE EFFECTIVE
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IMPLEMENTATION OF ITS MANDATE:
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PROVIDED, THAT THE THIRD- PARTY AUDITOR
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SHALL BE INDEPENDENT, REPUTABLE, AND
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DULY ACCREDITED AS SUCH BY AN
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ACCREDITING OR SIMILAR AGENCY
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RECOGNIZED BY INDUSTRY EXPERTS:
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PROVIDED, FURTHER, THAT NOTHING HEREIN
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SHALL PREVENT THE BUREAU OF INTERNAL
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REVENUE AND THE COMMISSION ON AUDIT
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FROM UNDERTAKING A POST-AUDIT
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INDEPENDENT VERIFICATION OF THE GROSS
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REVENUE OF PHILHEALTH AS DETERMINED BY
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THE THIRD-PARTY AUDITOR."
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Sec. 9. Continuity of Benefits. - Nothing in this Act shall be construed to
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eliminate or diminish any benefits or entitlements already granted to members of
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PhilHealth.
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Sec 10. Separability Clause. - If any provision of this Act is declared invalid or
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unconstitutional, the remainder thereof not otherwise affected shall remain in full force
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and effect.
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Sec 11. Repealing Clause. - All laws, presidential decrees, executive orders,
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letters of instruction, proclamations, and administrative regulations that are
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inconsistent with the provisions of this Act are hereby repealed, amended, or modified
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accordingly.
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Sec 12. Effectivity Clause. - This Act shall take effect after fifteen (15) days
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following the completion of its publication in the Official Gazette or in any newspaper
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of general circulation.
Approved,
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