SIXTEENTH CONGRESS OF THE REPUBLIC 
OF THE PHILIPPINES 
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First Regular Session 
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SEP 1\) P 3 :09 
SENAt' 
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S. No. 
1616 
Introduced by Senator Miriam Defensor Santiago 
EXPLANATORY NOTE 
The Constitution, Article 11, Section 15, provides: 
SEC. 15. The State shall protect and promote the right to health of 
the people and instill health consciousness among them. 
Millions of Filipino women and men are suffering from infertility. While recent 
improvements in therapy make pregnancy possible for more couples now than in past years, the 
majority of group health plans do not provide coverage for infertility therapy; thus, making it 
impossible for low and middle income families 10 avail of the technology. 
This bill seeks to require coverage for the lfflme!'ltJ/!l~jnfertility in any group health plan 
or individual health insurance.' 
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tfMJRIAM DEF~SOR S ~ 
• This bill was originally filed during the Thirteenth Congress, First Regular Session. 
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SIXTEENTH CONGRESS OF THE REPUBLIC 
) 
OF THE PHILIPPINES 
) 
First Regular Session 
) 
SENATE 
S.No. 
1616 
Introduced by Senator Miriam Defensor Santiago 
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SEP 10 P3:09 
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AN ACT 
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REQUIRING COVERAGE FOR THE TREATMENT OF INFERTILITY IN ANY GROUP 
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HEALTH PLAN OR HEALTH INSURANCE 
Be it enacted by the Senate and the House of Representatives of the Philippines in 
Congress assembled: 
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SECTION 1. Short Title. - This Act shall be known as the "Infertility Treatment in Health 
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Insurance Act." 
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SECTION 2. Standards Relating to Benefits for Treatment of Infertility. -
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(A) 
In General. - In cases in which a group health plan and a health insurance issuer 
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offering health insurance coverage provide coverage for obstetrical services, such plan or issuer 
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shall include coverage for treatment of infertility consistent with this Act. 
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(B) 
Infertility Defined. - For purposes of this Act, the term "infertility" means a 
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disease or condition that results in the abnormal function of the reproductive system, which 
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results in -
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14 
IS 
(C) 
(I) 
(2) 
The inability to conceive after (one) I year of unprotected intercourse, or 
The inability to carry a pregnancy to live birth. 
Required Coverage, - A group health plan and a health insurance issuer, offering 
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health insurance coverage shall provide coverage for treatment of infertility deemed appropriate 
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by a participant or beneficiary and the treating physician, Such treatment shall include ovulation 
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induction, artificial insemination, in vitro fertilization (IVF), gamete intrafallopian transfer 
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(GIFT), zygote intrafallopian transfer (ZFT), intracytoplasmic sperm injection (ICSI), and any 
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other treatment provided it has been deemed as "non-experimental" by the Secretary of Health 
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after consultation with appropriate professional medical and patient organizations. 
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(D) 
Limitation on Coverage of Assisted Reproductive Technology. -
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(1) 
In General. - In the case of assisted reproductive technology, coverage 
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shall be provided if -
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(a) 
The participant or beneficiary has been unable to bring a 
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pregnancy into a live birth through less costly medically 
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appropriate infertility treatments for which coverage is available 
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under the insured's policy, plan, or contract; 
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(b) 
The participant or beneficiary has not undergone four (4) complete 
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oocyte retrievals, except that if a live birth follows a completed 
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oocyte retrieval, then at least two (2) more completed oocyte 
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retrievals shall be covered, with a lifetime cap of 6 retrjevals; 
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(2) 
Definition of Assisted Reproductive Technology. - For purposes of this 
, 
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paragraph, the term. 'assisted reproductive technology' includes all 
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treatments or procedures that involve the handling of human egg and 
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sperm for the purpose of helping a woman become pregnant. Types of 
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Assisted Reproductive Techhblogy Ifnc1ude in vitro fertilization, gamete 
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intrafallopian 
transfer, 
zygote 
intrafallopian 
transfer, 
embryo 
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cryopreservation, egg or embryo donation, and surrogate birth. 
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(E) 
Review by the Secretary of Health. - Not later than five (5) years after the date of 
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enactment of the Family Building Act, the Secretary of Health shall review the requirements for 
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treatment of infertility established uMer paragraph (D)(l). 
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(F) 
Limitation. - Deductibles, co-insurance, and other cost-sharing or other limitations 
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for infeliility therapy may not be imposed to the extent they exceed the deductibles, co-
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insurance, and limitations that are applied to similar services under the group health plan or 
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health insurance coverage. 
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(G) 
Prohibitions. - A group health plan and a health insurance issuer, offering group 
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health insurance coverage, in connection with a group health plan may not-
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(I) 
Deny to a participant or beneficiary eligibility, or continued eligibility, to 
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enroll or to renew coverage under the terms of the plan, solely for the 
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purpose of avoiding the requirements of this section; 
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(2) 
Provide incentives, either monetary or otherwise, to a participant or 
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beneficiary to encourage such participant or beneficiary not to be provided 
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infertility treatments to which they are entitled under this section or to 
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providers to induce such providers not to provide such measurements to 
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qualified participants or beneficiaries; 
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(3) 
Prohibit a provider from ;,,\1; ~i~\)ussing with a participant or beneficiary 
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infertility treatment techni,t!I~ 
or medical treatment options relating to 
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this section; or 
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(4) 
Penalize or otherwise reduce or limit the reimbursement of a provider 
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because such provider provided infertility treatments to a qualified 
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participant or beneficiary in accordance with this section. 
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(H) 
Rule of Construction. - Nothing in this section shall be construed to require a 
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participant or beneficiary to undergo infertility the~~p)!:" 
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, 
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SECTION 3. Separability Clause. - If any provision or part thereof is held invalid or 
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unconstitutional, the remainder of the law or the provision not otherwise affected shall remain 
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valid and subsisting. 
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SECTION 4. Repealing Clause. - Any law, presidential decree or issuance, executive 
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order, letter of instruction, administrative order, rule, or regulation contrary to or inconsistent 
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with the provisions of this Act is hereby repealed, modified, or amended accordingly. 
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SECTION 5. Effectivity Clause. - This Act shall take effect fifteen (15) days after its 
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publication in at least two (2) newspapers of general circulation. 
Approved, 
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