, 
FIFTEENTH CONGRESS OF THE REPUBLIC 
OF THE PHILIPPINES 
First Regular Session 
SENATE 
) 
) 
) 
COMMITTEE REPORT NO. _-,4...,0",---
'11 
l'lAY 30 !, 6 :08 
Submitted jointly by the Committees on Health and Demography; Finance; Local Government; 
Labor, Employment & Human Resources Development; Youth, Women & Family Relations; 
and Banks, Financial Institutions and Currencies MAY 3 a 2011 
Re: Senate Bill No. 
2849 
Rec>Jmmending its approval in substitution of Senate Bill Nos. 4, 18,55,58, 143, 189,549,726, 
1012, 1222, 1340, 1971,2126,2130,2140,2653 and 2714 
Sponsors 
Senators (P.) Cayetano, Drilon, Marcos, Jr., Estrada and Osrnena III 
MR. PRESIDENT: 
The Committees on Health and Demography; Finance; Local Government; Labor, 
Employment & Human Resources Development; Youth, Women & Family Relations; and 
Banks, Financial Institutions and Currencies, to which were referred, Senate Bill No.4, 
introduced by Sen. Legarda, entitled: 
AN ACT 
TO ENSURE THAT INDIGENT FILIPINOS ARE GRANTED WITH BASIC 
HEALTHCARE SERVICES, PROVIDING FORA UNIVERSAL HEALTHCARE 
COVERAGE AMENDING FOR THIS PURPOSE REPUBLIC ACT NO. 7875 
OTHERWISE KNOWN AS THE NATIONAL HEALTH INSURANCE ACT OF 1995 AS 
AMENDED AND FOR OTHER PURPOSES 
Senate Bill No. 18, introduced by Sen. Trillanes IV, Sen. Marcos, Jr. and Sen. (P). Cayetano, 
entitled: 
AN ACT 
PROVIDING THAT ALL CITIZENS OF THE PHILIPPINES SHALL 
AUTOMATICALLY BE ENROLLED IN THE NATONAL HEALTH INSURANCE 
PROGRAM AMENDING FOR THE PURPOSE THE NATIONAL HEALTH 
INSURANCE ACT OF 1995 
Senate Bill No. 55, introduced by Sen. Angara and Sen. Recto entitled: 
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 
Senate Bill No. 58, introduced by Sen. Zubiri, entitled: 
• 
AN ACT 
TO ENSURE THAT EVERY FILIPINO IS GRANTED WITH BASIC HEALTHCARE 
SERVICES, PROVIDING FOR THE PURPOSE A MANDATORY UNIVERSAL 
HEALTH CARE COVERAGE, AND FOR OTHER PURPOSES 
Senate Bill No. 143, introduced by Sen. (P.) Cayetano, entitled: 


2 
AN ACT 
GRANTING COMPULSORY COVERAGE TO ACCREDITED BARAN GAY HEALTH 
WORKERS IN THE NATIONAL HEALTH INSURANCE PROGRAM AND THE 
GOVERNMENT SERVICE INSURANCE SYSTEM, AMENDING FOR THIS PURPOSE 
REPUBLIC ACT NO. 7883 AND FOR OTHER PURPOSES 
Senate Bill No. 189, introduced by Sen. Trillanes IV, entitled: 
AN ACT 
REQUIRING THE PHILIPPINE HEALTH INSURANCE CORPORATION TO 
PROVIDE COVERAGE FOR THE DIAGNOSTIC SERVICES FOR BREAST AND 
CERVICAL CANCER, PROVIDING FUNDS THEREFOR, AND FOR OTHER 
PURPOSES 
Senate Bill No. 549, introduced by Sen. Estrada, entitled: 
AN ACT 
TO ENSURE THAT EVERY FILIPINO IS GRANTED WITH BASIC HEALTHCARE 
SERVICES, PROVIDING FOR THE PURPOSE A MANDATORY UNIVERSAL 
HEALTHCARE COVERAGE, AND FOR OTHER PURPOSES 
Senate Bill No. 726, introduced by Sen. Estrada, entitled: 
AN ACT 
TO ENSURE THAT EVERY FILIPINO IS GRANTED WITH BASIC HEALTHCARE 
SERVICES, PROVIDING FOR THE PURPOSE A MANDATORY UNIVERSAL 
HEALTHCARE COVERAGE, AND FOR OTHER PURPOSES 
Senate Bill No. 1012, introduced by Sen. Lapid, entitled: 
AN ACT 
REQUIRING THE MANDATORY COVERAGE OF ALL PUBLIC UTILITY DRIVERS 
IN THE NATIONAL HEALTH INSURANCE PROGRAM (NHIP) UNDER THE 
PHILIPPINE HEALTH INSURANCE CORPORATION (PHILHEALTH) 
Senate Bill No. 1222, introduced by Sen. Villar and Sen. Escudero, entitled: 
AN ACT 
REQUIRING THE MANDATORY COVERAGE OF ALL HOUSEHELPERS IN THE 
NATIONAL HEALTH INSURANCE PROGRAM (NHIP) UNDER THE PHILIPPINE 
HEALTH INSURANCE CORPORATION (PHILHEALTH) 
Senate Bill No. 1340, introduced by Sen. Legarda, entitled: 
AN ACT 
GRANTING COMPULSORY COVERAGE TO ACCREDITED BARAN GAY HEALTH 
WORKERS IN THE NATIONAL HEALTH INSURANCE PROGRAM, AMENDING 
FOR THE PURPOSE REPUBLIC ACT NO. 7883, AND FOR OTHER PURPOSES 
Senate Bill No. 1971, introduced by Sen. Revilla, Jr., entitled: 
AN ACT 
UPGRADING THE BENEFITS AND INCENTIVES TO ACCREDITED BARANGAY 
HEALTH WORKERS, AMENDING FOR THE PURPOSE REPUBLIC ACT NO. 7883 
AND FOR OTHER PURPOSES 
Senate Bill No. 2126, introduced by Sen. Legarda, entitled: 
AN ACT 
INSTITUTING MECHANISMS FOR THE ESTABLISHMENT OF A CHILDREN'S 
HEALTH INSURANCE PROGRAM, AMENDING FOR THE PURPOSE REPUBLIC 


3 
• 
ACT NO. 7875, OTHERWISE KNOWN AS "THE NATIONAL HEALTH INSURANCE 
• 
ACT OF 1995," AS AMENDED, AND FOR OTHER PURPOSES 
Senate Bill No. 2130, introduced by Sen. Recto, entitled: 
AN ACT 
PROMOTING THE TREATMENT AND ERADICATION OF TUBERCULOSIS, 
AMENDING FOR THE PURPOSE SECTION 12 OF REPUBLIC ACT NO. 7875, AS 
AMENDED, OTHERWISE KNOWN AS "AN ACT INSTITUTING A NATIONAL 
HEALTH INSURANCE PROGRAM FOR ALL FILIPINOS AND ESTABLISHING THE 
PHILIPPINE HEALTH INSURANCE CORPORATION FOR THE PURPOSE" 
Senate Bill No. 2140, introduced by Sen. Recto, entitled: 
AN ACT 
REMOVING FIFTH AND SUBSEQUENT NORMAL OBSTETRICAL DELIVERIES 
AMONG THE EXCLUDED PERSONAL HEALTH SERVICES UNDER THE 
NATIONAL HEALTH INSURANCE PROGRAM, AMENDING FOR THE PURPOSE 
SECTION 2 OF REPUBLIC ACT NO. 9241 
• 
Senate Bill No. 2653, introduced by Sen. Recto, entitled: 
AN ACT 
EARMARKING FIFTY PERCENT (50%) OF PHILHEALTH'S EXCESS RESERVE 
FUNDS TO FUND PUBLIC HEALTHCARE INFRASTRUCTURE DEFICIT, 
AMENDING FOR THE PURPOSE REPUBLIC ACT NO. 7875, OTHERWISE KNOWN 
AS 'AN ACT INSTITUTING A NATIONAL HEALTH INSURANCE PROGRAM FOR 
ALL FILIPINOS AND ESTABLISHING THE PHILIPPINE HEALTH INSURANCE 
CORPORATION 
and Senate Bill No. 2714, introduced by Sen. Recto, entitled: 
AN ACT 
PROVIDING A DEFINITE TARGETING STRATEGY IN IDENTIFYING THE POOR, 
AMENDING FOR THE PURPOSE REPUBLIC ACT NO. 7875, OTHERWISE KNOWN 
AS 'THE NATIONAL HEALTH INSURANCE ACT OF 1995', AS AMENDED, AND 
FOR OTHER PURPOSES 
• 
have considered the same and have the honor to report them back to the Senate with the 
recommendation that the attached bill, Senate Bill No. 2849, prepared by the Committees, 
entitled: 
AN ACT 
AMENDING REPUBLIC ACT NO. 7875, OTHERWISE KNOWN AS THE 
NATIONAL HEALTH INSURANCE ACT OF 1995, AS AMENDED, AND FOR OTHER 
PURPOSES 
be approved in substitution of Senate Bill Nos. 4, 18,55,58, 143, 189, 549,726, 1012, 1222, 
1340, 1971,2126,2130,2140,2653 and 2714 with Senators Legarda, Trillanes IV, Marcos, Jr., 
(P). Cayetano, Angara, Recto, Zubiri, Estrada, Lapid, Villar, Escudero, Revilla, Jr ., Drilon, 
and Osmena III as authors thereof. 
• 


4 
Respectfully Submitted: 
SEN~ILON 
Cha~p rson, Committee on Finance 
MeIb , Health and Demography 
Chairpersons 
Vic -C air, Labor, Employment and Human 
Res 1l~ es Development 
SEN. FERDINA 
R. MtRCOS JR. 
Chairperson, Co mittee on Local Government 
Member, Finan e; Health and Demography; 
Youth, Wome and Family Relations; 
Labor, Employment and Human Resources 
Development 
S 
s~·ll's.c 
ETANO 
Chairperson, Co lmittees on Health 
and Demography; Youth, Women 
and Family Relations 
Member, Finance; Local Government; 
Labor, Employment and Human 
Resources Development 
IJ~'---L 
SEN~RGIO R. OSMENA III 
Chairperson, Committee on Banks, 
Financial Institutions and Currencies 
Member, Finance 
airperson, Committee on Labor, Employment 
an 
esources Development 
S~RDot~ 
Vice-Chair, Health and Demography 
Member, Youth, Women and 
Family Relations; Finance; 
Local Govermnent 
SEN. MANNY VILLAR 
Vice-Chair, Youth, Women and 
Family Relations 
Member, Health and Demography; 
Finance; Local Government; 
Labor, Employment and Human 
Resources Development; Banks, 
Financial Institutions and Currencies 
Vice-Chairpersons 
---~~~~~~==~~~-==~ -------- ~ 
SEN. LOR~DA--
Vice-Chair, Health and Demography 
Vice-Chair, Youth, Women and 
and Family Relations 
Member, Finance; Local Government; 
Labor, Employment and Human 
Resourc 
Development; Banks, 
Financ' 
Institutions and Currencies 
SEN. REGORIO B. HONASAN II 
Vice- hair, Health and Demography 
Me ber, Youth, Women and 
Family Relations; Finance; 
Local Government; Labor, 
Employment and Human 
Resources Development 


ISTO L. GUINGONA III 
Vice-
air, Health and Demography; Banks, 
Finf;lfiy' al Institutions and Currencies 
.. fiber, Finance; Labor, Employment and 
Human Resources Development 
Members 
SEN. RAMON "BONG" REVILLA, JR. 
5 
C~S~E~rv~N MIGUEL F. ZUBIRI 
Health and Demography; Finance; 
Youth, Women and Family Relations; 
Labor, Employment and Human 
Resources Development; Local 
Government 
Finance; 
·-jI!A~-~ 
Labor, Employment and Human Resources 
Development; Local Government; Banks, 
Financial Institutions and Currencies 
~N~~ 
~R~LANES IV 
Health and Demography; 
Youth, Women and Family Relations; 
Local Government; BRol_-.... _ 
Financial Institutio 
and CurrenCl 
" 
SEN. 
ANUE "LITO" M. LAPID 
Youth, Women and Family Relatioll,s("'1 
Finance; Local Government; Labor; 
Employment and Human Resources 
Development 
N. P ANGILINAN 
Financ . C-;a=or::-i'omployment and 
Human Resources Development; 
Banks, Financial Institutions and Currencies 
=--16 
SEN. FRANCIS G. ESCUDERO 
Finance; Local Govermnent; Banks, 
Financial Institutions and Currencies 
~ 
SEN. JOKER P. ARROYO 
Finance; Local Government; Banks, 
Financial Institutions and Currencies 
&fJ' 
'fIv £ /I 
() 'i I; c'; /1 
SEN. 
ANFI~-M. LACS~ 
Fina e: Local Government: 
HealtH 
nd Demography 


Majority Floor 
E C. SOTTO III 
Ex-Officio Members 
~)-
SEN.~~CAYETANO 
Minority Floor Leader 
SEN. JINGGOY EJERCITO ESTRADA 
President Pro-Tempore 
HON. JUAN PONCE ENRILE 
Senate President 
6 


FIFTEENTH CONGRESS OF THE REPUBLIC 
OF THE PHILIPPINES 
First Regular Session 
) 
) 
) 
'11 
MAY 30 
? 6 :09 
SENATE 
S. B. No. 2849 
(In substitution of Senate Bill Nos. 4,18,55,58,143,189,549,726,1012,1222,1340, 
1971,2126,2130,2140,2653 and 2714) 
Prepared Jointly by the Committees on Health and Demography; Finance; Local 
Government; Labor, Employment & Human Resources Development; Youth, Women & 
Family Relations; and Banks, Financial Institutions and Currencies 
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 Representatives of the Philippines 
in Congress assembled: 
1 
SECTION 1. Section 2, Article I of Republic Act No. 7875, is hereby amended to 
2 
read as follows: 
3 
"SECTION 2. Declaration of Principles and Policies. - Section II, Article 
4 
XIII of the 1987 Constitution XXX 
5 
XXX 
6 
q) Cost Containment -
The Program shall incorporate features of cost 
7 
containment in its design and operations and provide a viable means of helping 
8 
the people pay for health care services AS WELL AS LESSEN THEIR OUT OF 
9 
POCKET EXPENDITURES TO LESS THAN 20% BY YEAR 2020; and" 
10 
XXX 
11 
SEC. 2. Section 4 of the same Act is hereby further amended by adding the 
12 
following definitions accordingly. 
13 
"SECTION 4. Definition of Terms. -
For the purpose of this Act, the 
14 
following terms shall be defined as follows: 
15 
XXX 
16 
I) Fee-far-service -
[A reasonable and equitable health care payment system 
17 
under which physicians and other] A FEE PRE-DETERMINED BY THE 
18 
CORPORATION FOR EACH SERVICE DELIVERED BY A health care 
19 
provider[s] BASED ON [receive a payment that does not exceed] the[ir] bill[ed 
20 
charge for each unit of service provided] SUBMITTED TO THE CORPORATION 
21 
FOR THE COSTS OF DELIVERING THE SERVICE. 
22 
XXX 
1 


1 
q) Indigent - A person who has no visible means of income, or whose income is 
2 
insufficient for the subsistence of his family, as identified by [the Local Health 
3 
Insurance Office and based on specific criteria set by the Corporation] A MEANS 
4 
TEST DETERMINED BY THE NATIONAL GOVERNMENT in accordance with 
5 
the guiding principles set forth in Article I of this Act. 
6 
XXX 
7 
s) [Member] ENROLLEE - Any person whose premiums have been regularly 
8 
paid to the National Health Insurance Program. [He may be a paying member, 
9 
an indigent member, or a pensioner/retiree member.] HE MAY BELONG TO 
10 
THE 
FORMAL 
OR 
INFORMAL 
SECTOR, 
OR 
IS 
A 
PRACTICING 
11 
PROFESSIONAL, 
SELF-EARNING 
INDIVIDUAL, 
INDIGENT, 
AN 
12 
ABANDONED CHILD, OR PENSIONER I RETIREE. 
13 
XXX 
14 
MM) ABANDONED CHILDREN -
CHILDREN WHO HAVE NO KNOWN 
15 
FAMILY WILLING AND CAPABLE TO TAKE CARE OF THEM AND ARE 
16 
UNDER THE CARE OF THE DEPARTMENT OF SOCIAL WELFARE AND 
17 
DEVELOPMENT (DSWD). 
18 
NN) CASE-BASED PAYMENT -
HOSPITAL PAYMENT METHOD THAT 
19 
REIMBURSES TO HOSPITALS A PRE-DETERMINED FIXED RATE FOR 
20 
EACH TREATED CASE OR DISEASE; ALSO CALLED PER CASE PAYMENT. 
21 
00) ESSENTIAL HEALTH PACKAGES - A VARIETY OF HEALTH CARE 
22 
PACKAGES CONSISTING OF PROMOTIVE, PREVENTIVE, DIAGNOSTIC, 
23 
CURATIVE, AND REHABILITATIVE SERVICES THAT RESPOND TO THE 
24 
NEEDS 
OF 
THE 
COMMUNITY, 
ESPECIALLY 
THE 
POOR 
AND 
25 
MARGINALIZED. 
26 
PP) HEALTH TECHNOLOGY ASSESSMENT - A FIELD OF SCIENCE THAT 
27 
INVESTIGATES THE VALUE OF A HEALTH TECHNOLOGY SUCH AS 
28 
PROCEDURE, PROCESS, PRODUCTS, OR DEVICES, SPECIFICALLY ON 
29 
THEIR QUALITY, RELATIVE COST-EFFECTIVENESS AND SAFETY. 
IT 
30 
USUALLY INVOLVES THE SCIENCE OF EPIDEMIOLOGY AND ECONOMICS. 
31 
IT HAS IMPLICATIONS ON POLICY, DECISION TO ADOPT AND INVEST IN 
32 
THESE TECHNOLOGIES, OR IN HEALTH BENEFIT COVERAGE. 
33 
QQ) INFORMAL SECTOR - UNITS ENGAGED IN THE PRODUCTION OF 
34 
GOODS 
AND 
SERVICES 
WITH 
THE 
PRIMARY 
OBJECTIVE 
OF 
35 
GENERATING 
EMPLOYMENT 
AND 
INCOME 
FOR 
THE 
PERSONS 
36 
CONCERNED. 
IT CONSISTS OF 
HOUSEHOLDS, 
UNINCORPORATED 
37 
ENTERPRISES THAT ARE MARKET AND NON-MARKET PRODUCERS OF 
38 
GOODS, AS WELL AS MARKET PRODUCERS OF SERVICES. 
39 
THESE 
ENTERPRISES 
ARE 
OPERATED 
BY 
OWN-ACCOUNT 
40 
WORKERS, WHICH MAY EMPLOY UNPAID FAMILY WORKERS AS WELL 
41 
AS OCCASIONAL, SEASONALLY HIRED WORKERS. 
42 
TO THIS SECTOR BELONG, AMONG OTHERS, STREET HAWKERS, 
43 
MARKET 
VENDORS, 
PEDICAB 
AND 
TRICYCLE 
DRIVERS, 
SMALL 
44 
CONSTRUCTION 
WORKERS 
AND 
HOME-BASED 
INDUSTRIES AND 
45 
SERVICES. 
2 


1 
RR) OTHER SELF·EARNING INDIVIDUALS - INDIVIDUALS WHO RENDER 
2 
SERVICES OR SELL GOODS AS A MEANS OF LIVELIHOOD OUTSIDE OF 
3 
AN EMPLOYER-EMPLOYEE RELATIONSHIP, OR AS A CAREER, BUT DO 
4 
NOT 
BELONG 
TO 
THE 
INFORMAL 
SECTOR. 
THESE 
INCLUDE 
5 
BUSINESSMEN, ENTREPRENEURS, ACTORS, ACTRESSES AND OTHER 
6 
PERFORMERS, NEWS CORRESPONDENTS, PROFESSIONAL ATHLETES, 
7 
COACHES, 
TRAINERS, 
AND 
OTHER 
INDIVIDUALS 
THAT 
THE 
8 
CORPORATION DEEM PART OF THIS GROUP. 
9 
SS) OUT-PA T1ENT SERVICES - HEALTH SERVICES SUCH AS DIAGNOSTIC 
10 
CONSULTATION, 
EXAMINATION, 
TREATMENT, 
SURGERY 
AND 
11 
REHABILITATION ON AN OUT-PATIENT BASIS. 
12 
TT) PER CAPITA PAYMENT- A PRE-DETERMINED FIXED RATE PAID TO A 
13 
HEALTH CARE PROVIDER TO PROVIDE A DEFINED SET OF SERVICES IN 
14 
THE COMMUNITY FOR A FIXED PERIOD OF TIME FOR EACH INDIVIDUAL 
15 
ENROLLED IN THE PROGRAM. 
16 
UU) PROFESSIONAL PRACTITIONERS - INCLUDE DOCTORS, LAWYERS, 
17 
CERTIFIED 
PUBLIC ACCOUNTANTS, 
AND OTHER PRACTITIONERS 
18 
REQUIRED TO PASS GOVERNMENT LICENSURE EXAMINATION IN ORDER 
19 
TO PRACTICE THEIR PROFESSIONS." 
20 
SEC. 3. Section 6 of the same Act is hereby further amended to read as follows: 
21 
"SEC. 6. Coverage. -
All citizens of the Philippines shall be 
22 
covered by the National Health Insurance Program. In accordance with 
23 
the principles of universality and compulsory coverage enunciated in 
24 
Section 2 (b) and 2 (I) hereof, implementation of the Program shall 
25 
[,furthermore, be gradual and phased in over a period of not more than 
26 
fifteen (15) years] ENSURE SUSTAINABILITY OF COVERAGE AND 
27 
CONTINUOUS ENHANCEMENT OF THE QUALITY OF SERVICE; 
28 
Provided, That the [Program shall not be made compulsory in certain 
29 
provinces and cities until the] Corporation, DEPARTMENT OF HEALTH 
30 
(DOH), LOCAL GOVERNMENT UNITS (LGUs), and OTHER AGENCIES 
31 
INCLUDING NON-GOVERNMENTAL ORGANIZATIONS (NGOs) AND 
32 
OTHER NATIONAL GOVERNMENT AGENCIES (NGAs) shall [be able 
33 
to] ensure that [members in such localities shall] THE ENROLLEES have 
34 
[reasonable] access to [adequate and acceptable] QUALITY AND COST-
35 
EFFECTIVE health care services." 
36 
SEC. 4. Section 7 of the same Act is hereby deleted. 
37 
SEC. 5. Section 8 of the same Act is hereby further amended to read as follows: 
38 
"SEC. 8. Health Insurance 10 Card - In conjunction with the enrollment 
39 
provided above, the Corporation through its local office shall issue a health 
40 
insurance ID which shall be used for purposes of identification, eligibility 
41 
verification, and utilization recording. The issuance of this 10 card shall be 
42 
accompanied by a clear explanation to the enrollee of his rights, privileges and 
43 
obligations as [a member] AN ENROLLEE. A list of health care providers 
44 
accredited by the Local Health Insurance Office shall likewise be attached 
45 
thereto. 
46 
THIS HEALTH INSURANCE ID CARD SHALL BE RECOGNIZED AS A 
47 
VALID GOVERNMENT IDENTIFICATION AND SHALL BE PRESENTED AND 
3 


1 
HONORED IN TRANSACTIONS REQUIRING THE VERIFICATION OF A 
2 
PERSON'S IDENTITY." 
3 
SEC. 6. 
Section 10 of the same Act is hereby further amended to read as 
4 
follows: 
5 
"SEC. 10. Benefit Package. - NO FILIPINO CITIZEN SHALL BE DENIED 
6 
BASIC HEALTH CARE SERVICES BY BOTH THE NATIONAL AND LOCAL 
7 
GOVERNMENTS, SUCH AS, BUT NOT LIMITED TO: 
8 
1) BASIC IMMUNIZATION FOR INFANTS AND CHILDREN; 
9 
2) PRE-NATAL CARE WHICH INCLUDES PROVISION OF VITAMINS, 
10 
TETANUS IMMUNIZATION, ORAL CARE, URINALYSIS AND 
11 
HEMOGLOBIN DETERMINATION; 
12 
3) POST-NATAL CARE; 
13 
4) VITAMIN A SUPPLEMENTATION FOR CHILDREN NINE (9) 
14 
MONTHS TO FIVE (5) YEARS OLD; 
15 
5) FAMILY PLANNING COUNSELING, INCLUDING PAP SMEARING; 
16 
6) MEDICAL CONSULTATIONS; 
17 
7) INFECTIOUS DISEASE CONTROL AND PREVENTION CONTROL 
18 
PROGRAM SUCH AS BUT NOT LIMITED TO TUBERCULOSIS, 
19 
MALARIA, SEXUALLY TRANSMITTED INFECTION, DENGUE; 
20 
8) HEALTH EDUCATION PROGRAM FOR MOTHERS, STUDENTS 
21 
AND OTHER TARGET GROUPS; 
22 
9) DENTAL SERVICES; 
23 
10)HEAL THY LIFESTYLE COUNSELING; 
24 
11)NUTRITION INCLUDING 
OPERATION 
TIMBANG 
ACTIVITIES, 
25 
INTERVENTION FOR IDENTIFIED MALNOURISHED CHILDREN, 
26 
AND MOTHERS' CLASSES; AND 
27 
12)SANITATION PROGRAM SUCH AS WATER ANALYSIS AND 
28 
TREATMENT. 
29 
THE CORPORATION SHALL DEVELOP A MECHANISM WHEREBY 
30 
NON-ENROLLEES ARE TO BE ENROLLED IMMEDIATELY. 
31 
NO WOMAN WHO IS ABOUT TO GIVE BIRTH SHALL BE DENIED 
32 
MATERNAL AND NEWBORN BENEFITS ON THE GROUNDS THAT SHE IS 
33 
NOT ENROLLED OR HAS NOT PAID THE MINIMUM REQUIREMENT OF 
34 
PREMIUM CONTRIBUTIONS; PROVIDED, THAT THEREAFTER, SHE SHALL 
35 
BE ENROLLED IN THE PROGRAM AND CONTINUE TO PAY HER MONTHLY 
36 
PREMIUM CONTRIBUTIONS. 
37 
ENROLLEES AND THEIR DEPENDENTS ARE ENTITLED TO THE 
38 
FOLLOWING: 
4 


1 
(1) ESSENTIAL HEALTH PACKAGES AND OTHER OUT-PATIENT SERVICES IN 
2 
THE COMMUNITY. WITHIN ONE (1) YEAR AFTER THE EFFECTIVITY OF 
3 
THIS ACT, THE CORPORATION AND THE DOH SHALL IDENTIFY THE 
4 
VARIOUS ESSENTIAL HEALTH PACKAGES WHICH SHALL BE SUBJECT 
5 
TO BENCHMARKING AGAINST INTERNATIONAL HEALTH STANDARDS 
6 
TAKING INTO CONSIDERATION DISEASE EPIDEMIOLOGY AND HEALTH 
7 
ECONOMICS. 
8 
(2) HEALTH CARE SERVICES IN A HEALTH CARE FACILITY. 
9 
ENROLLEES 
AND 
THEIR 
DEPENDENTS 
ARE 
ENTITLED 
TO 
THE 
10 
FOLLOWING MINIMUM SERVICES, [S]subject to the limitations specified in this Act 
11 
and as may be determined by the Corporation [,the following categories of personal 
12 
health services granted to the member or his dependent as medically necessary or 
13 
appropriate shall include] AND THE DOH: 
14 
a) Inpatient hospital care: 
15 
1) room and board; 
16 
2) services of health care professionals 
17 
3) diagnostic, laboratory, and other medical examination services; 
18 
4) use of surgical or medical equipment and facilities; 
19 
5) prescription drugs and biologicals, subject to the limitations stated in 
20 
Section 37 of this Act; 
21 
6) inpatient education packages; 
22 
b) Outpatient care: 
23 
1) services of health care professionals; 
24 
2) diagnostic, laboratory, and other medical examination services; 
25 
3) personal preventive services; and 
26 
4) prescription drugs and biologicals, subject to the limitations described 
27 
in Section 37 of this Act; 
28 
c) Emergency and transfer services; and 
29 
d) Such other health care services that the Corporation AND THE DOH shall 
30 
determine to be appropriate and cost-effective. [: Provided, That the 
31 
Program, during its initial phase of implementation, which shall not be more 
32 
than five (5) years, shall provide a basic minimum package of benefits which 
33 
shall be defined according to the following guidelines; 
34 
1) the cost providing said package is such that the available national and 
35 
local government subsidies for premium payments of indigents are 
36 
sufficient to extend coverage to the widest possible population. 
37 
2) the initial set of services shall not be less than half of those provided 
38 
under the current Medicare Program I in terms of overall average cost 
39 
of claims paid per beneficiary household per year. 
40 
3) the services included are prioritized, first according to its cost 
41 
effectiveness and, second, according to its potential of providing 
42 
maximum relief from the financial burden on the beneficiary: Provided, 
43 
That in addition to the basic minimum package , the Program shall 
44 
provide supplemental health benefit coverage to beneficiaries of 
45 
contributory funds: 
Provided further, 
That the 
Program 
shall 
46 
progressively expand the basic minimum benefit package as the 
5 


1 
proportion of the population covered reaches targeted milestones so 
2 
that the same benefits are extended to all members of the Program 
3 
within five (5) years after the implementation of this Act. Such 
4 
expansion will provide for the gradual incorporations of supplementary 
5 
health benefits previously extended only to some beneficiaries into the 
6 
basic minimum package extended to all beneficiaries: and Provided, 
7 
finally, that in the phased implementation of this Act, there should be 
8 
no reduction or interruption in the benefits currently enjoyed by present 
9 
members of Medicare.]" 
10 
THESE SERVICES AND PACKAGES SHALL BE REVIEWED ANNUALLY TO 
11 
DETERMINE ITS FINANCIAL SUSTAINABILITY AND RELEVANCE TO HEALTH 
12 
INNOVATIONS, WITH THE END IN VIEW OF QUALITY ASSURANCE, INCREASED 
13 
BENEFITS AND REDUCED OUT-OF-POCKET EXPENDITURE. 
14 
SEC. 7. Section 11 of the same Act, is hereby amended to read as follows: 
15 
"Sec. 11. Excluded Personal Health Services. - [The benefits granted 
16 
under this Act shall not cover expenses for the services enumerated hereunder 
17 
except when the Corporation, after actuarial studies, recommends their inclusion 
18 
subject to the approval of the Board: 
19 
a) non-prescription drugs and devices; 
20 
b) alcohol abuse or dependency treatment; 
21 
c) cosmetic surgery; 
22 
d) optometric services; 
23 
e) fifth and subsequent normal obstetric deliveries; and 
24 
f) cost-ineffective procedures which shall be defined by the Corporation. 
25 
Provided, That, such actuarial studies must be done within a period of 
26 
three (3) years, and then periodically reviewed, to determine the financial 
27 
sustainability of including the foregoing personal health services in the benefit 
28 
package provided for under Section 10 of this Act.] 
29 
THE CORPORATION SHALL NOT COVER EXPENSES FOR HEALTH 
30 
SERVICES WHICH THE CORPORATION AND THE DOH CONSIDER COST-
31 
INEFFECTIVE THROUGH HEALTH TECHNOLOGY ASSESSMENT." 
32 
SEC. 8. Section 12 of the same Act is hereby further amended to read as 
33 
follows: 
34 
"SEC. 12. Entitlement to Benefits. - [A member] AN ENROLLEE whose 
35 
premium contributions for at least three (3) months have been paid within six (6) 
36 
months prior to the first day of his or his availment, shall be entitled to the 
37 
benefits of the Program: Provided, That such [member] ENROLLEE can show 
38 
that he contributes thereto with sufficient regularity, as evidenced in his health 
39 
insurance ID card: and Provided, further, That he is not currently subject to legal 
40 
penalties as provided for in Section 44 of this Act. 
41 
The fOllowing need not pay the monthly contributions to be entitled to the 
42 
Program's benefits: 
43 
a) Retirees and pensioners of the SSS and GSIS prior to the effectivity of this 
44 
Act; AND 
45 
b) ENROLLEES [Members] who reach the age of retirement as provided for by 
46 
law and have paid at least one hundred twenty (120) contributions.[;and] 
6 


1 
[C) Enrolled indigents.];" 
2 
SEC. 9. Section 16 of the same Act is hereby further amended to read as 
3 
follows: 
4 
"SEC. 16. 
Powers and Functions. -
The Corporation shall have the 
5 
following powers and functions: 
6 
XXX 
7 
c) TO SUPERVISE THE PROVISION OF HEALTH BENEFITS AND to set 
8 
standards, rules, and regulations necessary to ensure quality of care, appropriate 
9 
utilization of services, fund viability, [member] ENROLLEE satisfaction, and 
10 
overall accomplishment of Program objectives; 
11 
XXX 
12 
j) to negotiate and enter into contracts with health care institutions, professionals, 
13 
and other persons, juridical or natural, regarding the pricing, payment 
14 
mechanisms, design and implementation of administrative and operating 
15 
systems and procedures, financing, and delivery of health services IN BEHALF 
16 
OF ITS ENROLLEES; 
17 
XXX 
18 
m) 
[to supervise the provision of health benefits with the power] to VISIT, 
19 
ENTER AND inspect FACILITIES OF HEALTH CARE PROVIDERS AND 
20 
EMPLOYERS DURING OFFICE HOURS, UNLESS THERE IS REASON TO 
21 
BELIEVE THAT INSPECTION HAS TO BE DONE BEYOND OFFICE HOURS, 
22 
AND WHERE APPLICABLE, SECURE COPIES OF THEIR medical, [and] 
23 
financial, AND OTHER records AND DATA [of health care providers and 
24 
patients] PERTINENT TO THE CLAIMS, ACCREDITATION, PREMIUM 
25 
CONTRIBUTION, AND THAT OF THEIR PATIENTS OR EMPLOYEES, who are 
26 
[participants in or members] ENROLLEES of the Program [, and the power to 
27 
enter and inspect accredited health care institutions, subject to the rules and 
28 
regulations to be promulgated by the Corporations]; 
29 
XXX 
30 
p) to keep records of the operations of the Corporation and investments of the 
31 
National Health Insurance Fund; [and] 
32 
Q) TO MAINTAIN AND SECURE AN ELECTRONIC DATABASE OF ALL ITS 
33 
ENROLLEES WITHIN ONE (1) YEAR AFTER THE EFFECTIVITY OF THIS 
34 
ACT; 
35 
R) TO INVEST IN THE ACCELERATION OF THE CORPORATION'S 
36 
INFORMATION TECHNOLOGY SYSTEMS; 
37 
S) TO CONDUCT AN INFORMATION CAMPAIGN ON THE PRINCIPLES OF 
38 
THE NATIONAL HEALTH INSURANCE PROGRAM TO THE PUBLIC AND TO 
39 
ACCREDITED HEALTH CARE PROVIDERS. THIS CAMPAIGN MUST 
40 
INCLUDE THE CURRENT BENEFIT PACKAGES PROVIDED BY THE 
41 
CORPORATION, THE MECHANISMS TO AVAIL OF THE CURRENT BENEFIT 
42 
PACKAGES, THE LIST OF ACCREDITED AND DISACCREDITED HEALTH 
43 
CARE PROVIDERS, AND THE LIST OF OFFICES/BRANCES WHERE 
7 


1 
ENROLLEES CAN PAY OR CHECK THE STATUS OF PAID HEALTH 
2 
PREMIUMS; 
3 
T) TO CONDUCT POST-AUDIT ON THE QUALITY OF SERVICES RENDERED 
4 
BY HEALTH CARE PROVIDERS; 
5 
U) 
TO ESTABLISH AN OFFICE, OR WHERE IT IS NOT FEASIBLE, 
6 
DESIGNATE A FOCAL PERSON IN EVERY PHILIPPINE CONSULAR OFFICE 
7 
IN ALL COUNTRIES WHERE THERE ARE FILIPINO CITIZENS. THE OFFICE 
8 
OR THE FOCAL PERSON SHALL, AMONG OTHERS, PROCESS, REVIEW 
9 
AND PAY THE CLAIMS OF THE OVERSEAS FILIPINO WORKERS (OFWs); 
10 
V) NOTWITHSTANDING THE PROVISIONS OF ANY LAW TO THE 
11 
CONTRARY, TO IMPOSE INTEREST AND I OR SURCHARGES OF NOT 
12 
MORE THAN TWELVE PERCENT (12%) PER ANNUM, AS MAY BE FIXED BY 
13 
THE CORPORATION, IN CASE OF ANY DELAY IN THE REMITTANCE OF 
14 
CONTRIBUTIONS WHICH ARE DUE WITHIN THE PRESCRIBED PERIOD. 
15 
NOTWITHSTANDING THE PROVISIONS OF ANY LAW TO THE CONTRARY, 
16 
THE CORPORATION MAY ALSO COMPROMISE, WAIVE OR RELEASE, IN 
17 
WHOLE OR IN PART, SUCH INTEREST OR SURCHARGES IMPOSED UPON 
18 
EMPLOYERS REGARDLESS OF THE AMOUNT INVOLVED UNDER SUCH 
19 
VALID TERMS AND CONDITIONS IT MAY PRESCRIBE; AND 
20 
W) 
TO ENDEAVOR TO SUPPORT THE USE OF TECHNOLOGY IN THE 
21 
DELIVERY OF HEAL THCARE SERVICES ESPECIALLY IN FAR-FLUNG 
22 
AREAS, SUCH AS BUT NOT LIMITED TO TELEMEDICINE, ELECTRONIC 
23 
HEALTH RECORD, AND THE ESTABLISHMENT OF A COMPREHENSIVE 
24 
HEALTH DATA BASE; AND 
25 
[q)] X) to perform such other acts as it may deem appropriate for the attainment 
26 
of the objectives of the Corporation and for the proper enforcement of the 
27 
provisions of this Act." 
28 
SEC. 10. Section 17 of the same Act, is hereby amended to read as follows: 
29 
"SEC. 17. Quasi-Judicial Powers. - The Corporation, to carry out its tasks 
30 
more effectively, shall be vested with the following powers: 
31 
a) 
SUBJECT TO THE RESPONDENT'S RIGHT TO DUE PROCESS, to 
32 
conduct investigations for the determination of a question, controversy, 
33 
complaint, or unresolved grievance brought to its attention, and render decisions, 
34 
orders, or resolutions thereon. It shall proceed to hear and determine the case 
35 
even in the absence of any party who has been properly served with notice to 
36 
appear. It shall conduct its proceedings or any part thereof in public or in 
37 
executive session; adjourn its hearings to any time and place; refer technical 
38 
matters or accounts to an expert and to accept his reports as evidence; direct 
39 
parties to be joined in or excluded from the proceedings; and give all such 
40 
directions as it may deem necessary or expedient in the determination of the 
41 
dispute before it; 
42 
XXX 
43 
c) SUBJECT TO THE RESPONDENT'S RIGHT TO DUE PROCESS, to 
44 
suspend temporarily, revoke permanently, or restore the accreditation of a health 
45 
care provider or the right to benefits of [a member] AN ENROLLEE and/or 
46 
impose fines [after due notice and hearing). The decision shall immediately be 
47 
executory, even pending appeal, when the public interest so requires and as may 
8 


1 
be provided for in the implementing rules and regulations. Suspension of 
2 
accreditation shall not exceed [twenty-four (24)] SIX months. Suspension of the 
3 
rights of [members] ENROLLEES shall not exceed six (6) months. 
4 
The revocation of a health care provider's accreditation shall operate to 
5 
disqualify him from obtaining another accreditation in his own name, under a 
6 
different name, or through another person, whether natural or juridical. 
7 
The Corporation shall not be bound by the technical rules of evidence." 
8 
SEC. 11. Section 18 of the same Act, is hereby amended to read as follows: 
9 
"Sec. 18. The Board of Directors. -
10 
a) Composition -
The Corporation shall be governed by a Board of 
11 
Directors hereinafter referred to as the Board, composed of the following 
12 
members: 
13 
The Secretary of Health; 
14 
The Secretary of Labor and Employment or his representative; 
15 
The Secretary of Interior and Local Government or his Representative; 
16 
The Secretary of Social Welfare and Development or his Representative; 
17 
The President of the Corporation; 
18 
The SSS Administrator or his representative; 
19 
The GSIS General Manager or his representative; 
20 
The Vice Chairperson for the basic sector of the National Anti-Poverty 
21 
Commission or his representative; 
22 
THE CHAIRPERSON OF THE CIVIL SERVICE COMMISSION OR HIS 
23 
REPRESENTATIVE; 
24 
A representative of [Filipino overseas workers] THE OVERSEAS 
25 
WORKERS 
WELFARE 
ADMINISTRATION 
(OWWA) 
OR 
HIS 
26 
REPRESENTATIVE; 
27 
[A representative of the self-employed sector; and] 
28 
A representative of the [labor] FORMAL sector; 
29 
A representative of employers; 
30 
A representative of health care providers to be endorsed by their national 
31 
associations of health care institutions and medical health professionals; 
32 
AND 
33 
A REPRESENTATIVE OF THE LOCAL CHIEF EXECUTIVES TO BE 
34 
ENDORSED BY THEIR NATIONAL ASSOCIATIONS. 
35 
The Secretary of Health shall be the ex-officio Chairperson while the 
36 
President of the Corporation shall be the Vice Chairperson of the Board. 
9 


1 
AFTER THEIR APPOINTMENT, MEMBERS OF THE BOARD ARE 
2 
MANDATED TO UNDERGO AN EXHAUSTIVE BACKGROUND COURSE ON 
3 
INTEGRATION OF PUBLIC HEALTH AND CLINICAL MEDICINE, INCLUDING 
4 
HEALTH 
SERVICE 
DELIVERY; 
HEALTH GOVERNANCE, INCLUDING 
5 
UNDERSTANDING CENTRAL AND DEVOLVED HEALTH CARE SYSTEM; 
6 
HEALTH REGULATION AND TECHNOLOGY ASSESSMENT; 
HEALTH 
7 
INFORMATION TECHNOLOGY AND APPLICATIONS; HEALTH SYSTEMS 
8 
FINANCING; AND HUMAN RESOURCES FOR HEALTH, TO BE GIVEN BY A 
9 
REPUTABLE INSTITUTION. 
10 
BOARD 
MEMBERS 
ARE 
ALSO 
MANDATED 
TO 
ATTEND 
A 
11 
COMPREHENSIVE COURSE ON TRANSPARENCY AND ACCOUNTABILITY 
12 
OF A CORPORATE DIRECTOR. 
13 
THE FAILURE OF THE MEMBERS OF THE BOARD TO UNDERGO 
14 
THESE 
COURSES WILL 
BE 
A GROUND 
TO 
TERMINATE 
THEIR 
15 
MEMBERSHIP THEREIN." 
16 
XXX 
17 
SEC. 12. Section 20 of the same Act, is hereby further amended to read as 
18 
follows: 
19 
"SEC. 20. Health Finance Policy Research. - Among the staff XXX 
20 
XXX 
21 
f) submission for consideration of program of quality assurance, utilization 
22 
review, and technology assessment; [and] 
23 
g) submission of recommendations on policy and operational issues that will help 
24 
the Corporation meet the objectives of this Act; AND 
25 
H) CONDUCT OF CLIENT-SATISFACTION SURVEYS AND RESEARCH IN 
26 
ORDER TO ASSESS OUTCOMES OF SERVICE RENDERED BY HEALTH 
27 
CARE PROVIDERS." 
28 
SEC. 13. Section 24 of the same Act, is hereby further amended to read as 
29 
follows: 
30 
"SEC. 24. Creation of the National Health Insurance Fund - There is 
31 
hereby created a National Health Insurance Fund, hereinafter referred to as the 
32 
Fund, that shall consist of: 
33 
a) Contribution from Program [members] ENROLLEES; 
34 
[b) Current balances of the Health Insurance Funds of the 8S8 and G81S 
35 
collected under the Philippine Medical Care Act of 1969, as amended, including 
36 
arrearages of the Government of the Philippines with the GSIS for the said 
37 
Fund;] 
38 
[c)] B) Other appropriations earmarked by the national and local governments 
39 
purposely for the implementation of the Program; 
40 
41 
[d)] C) Subsequent appropriations provided for under Sections 46 and 47 of this 
42 
Act; 
10 


1 
[e)] D) Donations and grants-in-aid; and 
2 
[f)] E) All accruals thereof." 
3 
SEC. 14. Section 26 of the same Act, is hereby further amended to read as 
4 
follows: 
5 
"SEC. 26. Financial Management. - The use, disposition, investment, 
6 
disbursement, administration and management of the National Health Insurance 
7 
Fund, including any subsidy, grant or donation received for program operations 
8 
shall be governed by APPLICABLE LAWS AND IN THE ABSENCE THEREOF, 
9 
EXISTING resolutionS of the Board of Directors of the Corporation, subject to the 
10 
following limitations: 
11 
XXX" 
12 
SEC. 15. Section 27 of the same Act, is hereby further amended to read as 
13 
follows: 
14 
"SEC. 27. Reserve Fund. - The Corporation shall set aside a portion of its 
15 
accumulated revenues not needed to meet the cost of the current year's 
16 
expenditures as reserve funds: Provided, That the total amount of reserves shall 
17 
not exceed a ceiling equivalent to the amount actuarially estimated for [two 
18 
years'] ONE YEAR'S projected Program expenditures[:]; Provided, further, That 
19 
whenever actual reserves exceed the required ceiling at the end of the 
20 
Corporation's fiscal year, the [Program's benefits] EXCESS RESERVES shall be 
21 
UTILIZED FOR PROGRAMS CONSISTENT WITH THE PRINCIPLES STATED 
22 
IN THIS ACT; 
[increased or member-contributions decreased prospectively] 
23 
PROVIDED, 
FINALLY, 
THAT 
INVESTMENTS 
IN 
HEALTH 
24 
INFRASTRUCTURES IN 
POPULATED AREAS OR AREAS WITHOUT 
25 
SUFFICIENT HEALTH CARE SHALL BE PRIORITIZED, in order to adjust 
26 
expenditures or revenues to meet the required ceiling for reserve funds. Such 
27 
portions of the reserve fund as are not needed to meet the current expenditure 
28 
obligations shall be invested in short-term investments to earn an average 
29 
annual income at prevailing rates of interest and shall be known as the 
30 
"Investment Reserve Fund" which shall be invested in any or all of the following: 
31 
a) In interest-bearing bonds, securities or other evidences of indebtedness of the 
32 
Government of the Philippines, or in bonds, securities, promissory notes and 
33 
other evidences of indebtedness to which full faith and credit and unconditional 
34 
guarantee of the Republic of the Philippines is pledged OR IN DEBT 
35 
SECURITIES AND CORPORATE BONDS ISSUANCES: PROVIDED, THAT 
36 
SUCH SECURITIES AND BONDS ARE RATED TRIPLE "An BY AUTHORIZED 
37 
ACCREDITED DOMESTIC RATING AGENCIES; PROVIDED, FURTHER, 
38 
THAT THE ISSUING OR ASSUMING ENTITY OR ITS PREDECESOR SHALL 
39 
NOT HAVE DEFAULTED IN THE PAYMENT OF INTEREST ON ANY OF ITS 
40 
SECURITIES AND THAT DURING EACH OF ANY THREE (3) INCLUDING 
41 
LAST TWO (2) OF THE FIVE (5) FISCAL YEARS NEXT PRECEDING THE 
42 
DATE OF ACQUISITION BY THE CORPORATION OF SUCH BONDS, 
43 
SECURITIES OR OTHER EVIDENCES OF INDEBTEDNESS, THE NET 
44 
EARNINGS OF THE ISSUING OR ASSUMING INSTITUTION AVAILABLE 
45 
FOR ITS RECURRING EXPENSES, SUCH AS AMORTIZATION OF DEBT 
46 
DISCOUNT AND RENTALS FOR LEASED PROPERTIES, INCLUDING 
47 
INTEREST ON FUNDED AND UNFUNDED DEBT, SHALL HAVE BEEN NOT 
48 
LESS THAN ONE (1) 
AND ONE QUARTER TIMES THE TOTAL OF THE 
49 
RECURRING EXPENSES FOR SUCH YEAR; PROVIDED, FURTHER, THAT 
11 


1 
SUCH INVESTMENT SHALL NOT EXCEED 15% OF THE INVESTMENT 
2 
RESERVE FUND; 
3 
b) XXX; [and] 
4 
c) In preferred stocks of any solvent corporation or institution created or existing 
5 
under the laws of the Philippines: Provided, That the issuing, assuming, or 
6 
guaranteeing entity or its predecessor has paid regular dividends upon its 
7 
preferred or guaranteed stocks for a period of at least three (3) years 
8 
immediately preceding the date of investment in such preferred guaranteed 
9 
stocks: Provided, further, That if the corporation or institution has not paid 
10 
dividends upon its preferred stocks, the corporation or institution has sufficient 
11 
retained earnings to declare dividends for at least two (2) years on such 
12 
preferred stocks and in common stocks [option or warrants to common stocks] of 
13 
any solvent corporation or institution created or existing under the laws of the 
14 
Philippines in the stock exchange with proven track record of profitability and 
15 
payment of dividends over the last three (3) years [or in common stocks of a 
16 
newly organized corporation about to be listed in the stock exchange: Provided, 
17 
finally, That such duly organized corporation shall have been rated 'A' double 
18 
'A's or triple 'A's by authorized accredited domestic rating agencies or by the 
19 
Corporation or in mutual funds including allied investments]; AND 
20 
D) IN BONDS, SECURITIES, PROMISSORY NOTES OR OTHER EVIDENCE 
21 
OF 
INDEBTEDNESS 
OF 
HEALTH 
FACILITIES 
TO 
FINANCE 
THE 
22 
CONSTRUCTION, 
IMPROVEMENT AND MAINTENANCE OF 
HEALTH 
23 
FACILITIES 
AND 
THEIR 
EQUIPMENT; 
PROVIDED, 
THAT 
SUCH 
24 
INVESTMENTS SHALL NOT EXCEED TEN PERCENT (10%) OF THE 
25 
INVESTMENT RESERVE FUND." 
26 
SEC. 16. There is hereby added another provision numbered SECTION 27-A to 
27 
read as follows: 
28 
SECTION 27-A. FUND MANAGERS - AS PART OF ITS INVESTMENTS 
29 
OPERATIONS, THE CORPORATION MAY HIRE EXTERNAL LOCAL FUND 
30 
MANAGERS TO MANAGE THE INVESTMENT RESERVE FUND, AS IT MAY 
31 
DEEM APPROPRIATE, THROUGH PUBLIC BIDDING. 
32 
SEC. 17. Section 28 of the same Act, is hereby amended as follows: 
33 
"SEC. 28. ENROLLMENT AND Contributions. - ALL CITIZENS SHALL 
34 
BE ENROLLED IN THE PROGRAM. All 
[members of the program] 
35 
ENROLLEES shall contribute to the Fund, in accordance with a reasonable, 
36 
equitable and progressive contribution schedule to be determined by the 
37 
Corporation on the basis of applicable actuarial studies and in accordance with 
38 
the following guidelines: 
39 
a) Formal sector employees [and current Medicare members] and their 
40 
employers shall PAY THE MONTHLY PREMIUM 
CONTRIBUTION IN 
41 
ACCORDANCE WITH THE CONTRIBUTION SCHEDULE AS DETERMINED 
42 
BY THE CORPORATION [continue paying the same monthly contributions as 
43 
provided for by law until such time that the Corporation shall have determined the 
44 
contribution 
schedule mentioned herein]: Provided, 
That their monthly 
45 
contributions shall not exceed three AND A HALF percent [(3%)] (3.5%) of their 
46 
respective monthly salaries. 
47 
THE GOVERNMENT OF THE REPUBLIC OF THE PHILIPPINES 
48 
HEREBY GUARANTEES THE FULFILLMENT OF THE OBLIGATIONS OF 
12 


1 
THE NATIONAL GOVERNMENT AGENCIES TO THE CORPORATION AS, 
2 
AND WHEN, THEY FALL DUE. 
3 
B) CONTRIBUTIONS FROM PROFESSIONAL PRACTITIONERS AND OTHER 
4 
SELF-EARNING INDIVIDUALS SHALL BE BASED PRIMARILY ON THEIR 
5 
GROSS INCOME AS DECLARED IN THE INCOME TAX RETURN OF THE 
6 
PRECEDING YEAR; PROVIDED, THAT IN THE ABSENCE OF AN INCOME 
7 
TAX RETURN, IT SHALL BE BASED PRIMARILY ON HOUSEHOLD 
8 
EARNINGS AND ASSETS. THEY SHALL PAY THE MONTHLY PREMIUM 
9 
CONTRIBUTION IN ACCORDANCE WITH THE CONTRIBUTION SCHEDULE 
10 
AS DETERMINED BY THE CORPORATION; PROVIDED, THAT THOSE 
11 
EARNING ONE MILLION PESOS (P1,000,000) TO FIVE MILLION PESOS 
12 
(P5,000,000) SHALL PAY DOUBLE THE HIGHEST PREMIUM PAID BY THE 
13 
FORMAL SECTOR, THOSE EARNING MORE THAN FIVE MILLION PESOS 
14 
(P5,OOO,OOO) TO TEN MILLION PESOS (P10,OOO,OOO) SHALL PAY TRIPLE 
15 
THE SAME AMOUNT, AND THOSE EARNING MORE THAN TEN MILLION 
16 
PESOS (P10,OOO,OOO) SHALL PAY FOUR TIMES THAT AMOUNT. 
17 
C) [b)) Contributions from [self-employed members] THE INFORMAL SECTOR 
18 
shall be based ON THEIR GROSS INCOME AS DECLARED IN THE INCOME 
19 
TAX RETURN FOR THE PRECEDING YEAR; PROVIDED, THAT IN THE 
20 
ABSENCE OF AN INCOME TAX RETURN, CONTRIBUTIONS SHALL BE 
21 
BASED primarily on household earnings and assets; [; their total contributions 
22 
for one year shall not, however, exceed three percent (3%) of their estimated 
23 
actual net income for the preceding year.] PROVIDED, FURTHER, THAT 
24 
THOSE FROM THE LOWEST INCOME SEGMENT WHO DO NOT QUALIFY 
25 
FOR FULL SUBSIDY UNDER THE MEANS TEST RULES OF THE NATIONAL 
26 
GOVERNMENT SHALL BE SUBSIDIZED ENTIRELY BY THE LOCAL 
27 
GOVERNMENT UNITS OR THROUGH COST SHARING MECHANISMS 
28 
BETWEENIAMONG LOCAL GOVERNMENT UNITS ANDIOR LEGISLATIVE 
29 
SPONSORS, ANDIOR OTHER SPONSORS ANDIOR THE ENROLLEE; 
30 
PROVIDED, FURTHER, THAT THE ANNUAL PREMIUM CONTRIBUTIONS OF 
31 
HOUSEHELPERS SHALL BE FULLY PAID BY THEIR EMPLOYERS; 
32 
PROVIDED, FINALLY, THAT THE NEEDED PREMIUM CONTRIBUTIONS OF 
33 
ALL BARAN GAY HEALTH WORKERS, NUTRITION SCHOLARS AND OTHER 
34 
BARANGA Y WORKERS AND VOLUNTEERS SHALL BE FULLY BORNE BY 
35 
THE LOCAL GOVERNMENT UNITS CONCERNED. 
36 
D) [c)] Contributions made in behalf of indigent [members] ENROLLEES shall 
37 
not exceed 
the 
minimum 
contributions for the 
employed 
[members] 
38 
ENROLLEES. 
39 
NOTWITHSTANDING 
ANY 
LAW 
TO 
THE 
CONTRARY, 
ALL 
40 
GOVERNMENT AGENCIES ISSUING PROFESSIONAL OR BUSINESS 
41 
LICENSE OR PERMIT, SHALL REQUIRE ALL APPLICANTS TO SUBMIT 
42 
CERTIFICATE 
OR 
PROOF 
OF 
PAYMENT 
OF 
THEIR 
PREMIUM 
43 
CONTRIBUTIONS AND THOSE OF THEIR EMPLOYEES, PRIOR TO THE 
44 
ISSUANCE OR RENEWAL OF SUCH LICENSE OR PERMIT." 
45 
SEC. 18. Section 29 of the same Act is hereby amended to read as follows: 
46 
"SEC. 29. Payment for Indigent Contributions. - Contributions for indigent 
47 
[members] ENROLLEES shall be subsidized [partially by the local government 
48 
unit 
where 
the 
memqer 
resides] 
ENTIRELY 
BY 
THE 
NATIONAL 
49 
GOVERNMENT. [The Corporation shall provide counterpart financing equal to 
50 
the LGU's subsidy for indigents: Provided, That in the case of fourth, fifth and 
13 


1 
sixth class municipalities, the National Government shall provide up to ninety 
2 
percent (90%) of the subsidy for indigents until such time that they have been 
3 
upgraded to first, second or third class municipalities. The share of the LGU's 
4 
shall be progressively increased until such time that its share becomes equal to 
5 
that of the National Government.] ALLOCATION FOR THE ENROLLMENT OF 
6 
THESE INDIGENTS SHALL BE APPROPRIATED IN 
THE GENERAL 
7 
APPROPRIATIONS ACT AS A SEPARATE LINE ITEM IN THE DOH BUDGET 
8 
AND ADJUSTED ANNUALLY TO COVER THE CORRESPONDING NUMBER 
9 
OF INDIGENTS." 
10 
SEC. 19. A new Section 29-A, shall be added to read as follows: 
11 
SEC. 29-A. PA YMENT FOR ABANDONED CHILDREN. -
CONTRIBUTIONS 
12 
FOR ABANDONED CHILDREN SHALL BE SUBSIDIZED BY THE NATIONAL 
13 
GOVERNMENT. A SEPARATE LINE ITEM IN THE ANNUAL BUDGET OF THE 
14 
DSWD SHALL BE ALLOCATED FOR THE PAYMENT OF THEIR PREMIUM 
15 
CONTRIBUTIONS. 
16 
SEC. 20. Section 34 of the same Act is hereby amended to read as follows: 
17 
"SEC. 34. Provider Payment Mechanisms. - The following mechanisms for 
18 
public and private providers shall be allowed in the Program: 
19 
a) Fee-for-service PAYMENTS [based on mechanisms established by the 
20 
Corporation] 
-
PAYMENTS 
MADE 
BY 
THE 
CORPORATION 
FOR 
21 
PROFESSIONAL FEES OR HOSPITAL CHARGES, OR BOTH, BASED ON 
22 
ARRANGEMENTS WITH HEALTH CARE PROVIDERS. THIS FEE SHALL BE 
23 
BASED ON A SCHEDULE TO BE ESTABLISHED BY THE BOARD WHICH 
24 
SHALL BE REVIEWED PERIODICALLY BUT NOT LESS THAN EVERY 
25 
THREE (3) YEARS. 
26 
[b) Capitation of health care professionals and facilities, or networks of the same 
27 
including HMOs, medical cooperatives, and other legally formed health service 
28 
groups;] 
29 
B) [c) A combination of both; and] CASE-BASED PAYMENT; 
3D 
C) PER CAPITA PAYMENT; 
31 
d) [Any or all of the above, subject to global budget] 
A COMBINATION OF 
32 
TWO (2) OR MORE OF THE ABOVEMENTIONED BENEFIT PAYMENT 
33 
SCHEMES; AND 
34 
E) SUCH OTHER PROVIDER PAYMENT MECHANISMS THAT MAY BE 
35 
DETERMINED AND ADOPTED BY THE CORPORATION. 
36 
THE CORPORATION, IN COORDINATION WITH THE DOH, SHALL 
37 
STUDY THE VIABILITY OF PROVIDING A CASE-BASED PAYMENT 
38 
SCHEME FOR HEALTH CARE SERVICES COVERING ALL DISEASES AND 
39 
ILLNESSES, AND ENDEAVOR TO IMPLEMENT THE SAME WITHIN SIX (6) 
40 
MONTHS FROM THE EFFECTIVITY OF THIS ACT. 
41 
THE CORPORATION, IN COORDINATION WITH THE LGUs, SHALL 
42 
LIKEWISE STUDY THE VIABILITY OF IMPLEMENTING A PER CAPITA 
43 
PAYMENT IN THE COMMUNITY LEVEL AND APPLY THE SAME WITHIN SIX 
44 
(6) MONTHS FROM THE EFFECTIVITY OF THIS ACT. 
14 


1 
[Each Office shall recommend the appropriate payment mechanism within 
2 
its jurisdiction for approval by the Corporation. Special consideration shall be 
3 
given to payment for services rendered by public and private health care 
4 
providers serving remote or medically undeserved areas.] 
5 
FEES PAID FOR PROFESSIONAL SERVICES RENDERED BY 
6 
SALARIED PUBLIC PROVIDERS SHALL BE ALLOWED TO BE RETAINED 
7 
BY THE HEALTH FACILITY IN WHICH SERVICES ARE RENDERED AND BE 
8 
POOLED AND DISTRIBUTED AMONG HEALTH PERSONNEL. CHARGES 
9 
PAID TO PUBLIC FACILITIES SHALL BE RETAINED BY THE INDIVIDUAL 
10 
FACILITY IN WHICH SERVICES WERE RENDERED AND FOR WHICH 
11 
PAYMENT WAS MADE. SUCH REVENUES SHALL BE USED TO PRIMARILY 
12 
DEFRAY OPERATING COSTS OTHER THAN SALARIES, TO MAINTAIN OR 
13 
UPGRADE EQUIPMENT, PLANT OR FACILITY, AND TO MAINTAIN OR 
14 
IMPROVE THE QUALITY OF SERVICE IN THE PUBLIC SECTOR. 
15 
SEC. 21. Section 35 of the same Act is hereby deleted and replaced with a new 
16 
section to read as follows: 
17 
SEC. 34. REIMBURSEMENT AND PERIOD TO FILE CLAIMS. - ALL 
18 
CLAIMS FOR REIMBURSEMENT SHALL BE FILED WITHIN A PERIOD OF 
19 
SIXTY (60) CALENDAR DAYS FROM THE DATE OF DISCHARGE OF THE 
20 
PATIENT, OTHERWISE, THE CLAIM SHALL BE DENIED; PROVIDED, THAT 
21 
SUCH PERIOD MAY BE EXTENDED FOR SUCH CAUSES AS MAY BE 
22 
DETERMINED BY THE CORPORATION." 
23 
THE CORPORATION SHALL ENSURE THAT HEALTH PROVIDERS 
24 
ARE ADEQUATELY COMPENSATED WITHIN SIXTY (60) CALENDAR DAYS 
25 
FROM THE DATE THE CLAIM FOR REIMBURSEMENT IS FILED, FAILURE 
26 
OF WHICH, ANNUAL INTEREST OR SURCHARGE OF NOT MORE THAN 
27 
TWELVE PERCENT (12%) SHALL BE IMPOSED UPON THE CORPORATION. 
28 
SEC. 22. Section 36 of the same Act is hereby deleted and replaced with a new 
29 
section to read as follows: 
30 
SEC. 35. ROLE OF LOCAL GOVERNMENT UNITS (LGUS) -
31 
CONSISTENT WITH THE MANDATES FOR EACH POLITICAL SUBDIVISION 
32 
UNDER REPUBLIC ACT NO. 7160 OR "THE LOCAL GOVERNMENT CODE 
33 
OF 1991", LGUs SHALL PROVIDE BASIC HEALTH CARE SERVICES. 
34 
TO 
AUGMENT 
THEIR 
FUNDS, 
LGUs 
SHALL 
INVEST 
THE 
35 
CAPITATION PAYMENTS GIVEN TO THEM BY THE CORPORATION ON 
36 
HEALTH INFRASTRUCTURES OR EQUIPMENT, PROFESSIONAL FEES, 
37 
DRUGS 
AND 
SUPPLIES, 
OR 
INFORMATION 
TECHNOLOGY 
AND 
38 
DATABASE; PROVIDED, THAT BASIC HEALTH CARE SERVICES, AS 
39 
DEFINED BY THE DOH ,SHALL BE ENSURED ESPECIALLY WITH THE END 
40 
IN VIEW OF IMPROVING MATERNAL, INFANT AND CHILD HEALTH. 
41 
SEC. 23. Section 42 of the same Act is hereby amended to read as follows: 
42 
"SEC. 42. Grievance and Appeal Review Committee. - The Board shall 
43 
create a Grievance and Appeal Review Committee, composed of three (3) to five 
44 
(5) members, hereinafter referred to as the Committee, which, subject to the 
45 
procedures enumerated above, shall receive and recommend appropriate action 
46 
on complaints from [members] ENROLLEES and health care providers relative 
47 
to this Act and its implementing rules and regulations. THE COMMITTEE SHALL 
15 


1 
HAVE 
AS 
ONE 
OF 
ITS 
MEMBERS 
AT 
LEAST 
ONE 
MEDICAL 
2 
PRACTITIONER AND ONE EXPERT IN HOSPITAL ADMINISTRATION." 
3 
SEC. 24. Section 44 of the same Act is hereby amended to read as follows: 
4 
"SEC. 44. Penal Provisions. - Any violation of the provisions of this Act, 
5 
after due notice and hearing, shall suffer the following penalties: 
6 
A) VIOLATIONS OF HEALTH CARE PROVIDERS - A fine of not less than 
7 
[Ten] FIFTY thousand pesos [(P 10,000)] (P50,OOO) [nor] BUT NOT more than 
8 
[Fifty] ONE HUNDRED thousand pesos [(P50,000)] (P100,OOO) in case the 
9 
violation, OFFENSES, ABUSES AND/OR UNETHICAL PRACTICES AND/OR 
10 
FRAUDULENT ACTS THAT MAY BE DETERMINED AND / OR IDENTIFIED 
11 
BY THE CORPORATION WHICH TENDS TO UNDERMINE OR DEFEAT THE 
12 
OBJECTIVES OF THE PROGRAM is committed by the [hospital management 
13 
or] ERRING HEALTH CARE provider, [.In addition, its accreditation shall be 
14 
suspended or revoked] OR SUSPENSION OF ACCREDITATION from three (3) 
15 
months to the whole term of accreditation, OR BOTH SUCH FINE AND 
16 
SUSPENSION/REVOCATION, 
AT 
THE 
DISCRETION 
OF 
THE 
17 
CORPORATION; Provided, [however], That recidivists may NO LONGER [not 
18 
anymore] be accredited as a participant of the Program; 
19 
B) VIOLATION OF AN ENROLLEE -
[A fine of not less than Five hundred 
20 
pesos (P500) nor more than Five thousand pesos (P5,000) and] ANY 
21 
ENROLLEE WHO, FOR PURPOSES OF CLAIMING PROGRAM'S BENEFITS 
22 
OR ENTITLEMENT THERETO, SHALL COMMIT ANY OF THE OFFENSES 
23 
PROVIDED FOR IN THIS ACT, INDEPENDENTLY OR IN CONNIVANCE WITH 
24 
THE HEALTH CARE PROVIDER, SHALL SUFFER SUSPENSION FROM 
25 
AVAILMENT OF PROGRAM'S BENEFITS OF NOT LESS THAN THREE (3) 
26 
MONTHS BUT NOT MORE THAN SIX (6) MONTHS AND/OR A FINE OF FIVE 
27 
THOUSAND PESOS (P5,OOO) AND/OR imprisonment of not less than six (6) 
28 
months nor more than one (1) year [in case the violation is committed by the 
29 
member]. 
30 
C) VIOLATIONS OF AN EMPLOYER -
31 
1) FAILURE/REFUSAL 
TO 
REGISTERIDEDUCT/REMIT 
THE 
32 
CONTRIBUTIONS- [Where the violations consist of failure or refusal to deduct 
33 
contributions from the employee's compensation or to remit the same to the 
34 
Corporation, the penalty shall be a fine of not less than Five hundred pesos 
35 
(P500) but not more than One thousand pesos (P1,000) multiplied by the total 
36 
number of employees employed by the firm and imprisonment of not less than 
37 
six (6) months but not more than one (1) year:] ANY EMPLOYER WHICH 
38 
FAILS OR REFUSES TO REGISTER ITS EMPLOYEES OR TO DEDUCT 
39 
CONTRIBUTIONS FROM THE EMPLOYEE'S COMPENSATION AND / OR 
40 
TO REMIT THE SAME TO THE CORPORATION SHALL BE PENALIZED 
41 
WITH IMPRISONMENT OF NOT LESS THAN SIX (6) YEARS AND ONE (1) 
42 
DAY TO TWELVE (12) YEARS, AND A FINE OF NOT LESS THAN FIVE 
43 
THOUSAND PESOS (P5,OOO) MULTIPLIED BY THE TOTAL NUMBER OF 
44 
EMPLOYEES OF THE FIRM. 
45 
Any employer or any officer authorized to collect contributions under this 
46 
Act who, after collecting or deducting the monthly contributions from his 
47 
employee's compensation, fails to remit the said contributions to the 
48 
Corporation within thirty (30) days from the date they become due shall be 
49 
presumed to have misappropriated such contribution and shall suffer the 
50 
penalties provided for in Article 315 of the Revised Penal Code. 
16 


1 
2) DEDUCTIONS OF EMPLOYER'S SHARE, DIRECTLY OR INDIRECTLY, 
2 
FROM THE COMPENSATION OF ITS EMPLOYEES - Any employer who 
3 
shall deduct directly or indirectly from the compensation of the covered 
4 
employees or otherwise recover from them his own contribution on behalf of 
5 
such employees shall be punished by a fine [not exceeding One] OF FIVE 
6 
thousand pesos (P5,OOO) 
multiplied by the total number of employees 
7 
employed by the firm, [or] AND imprisonment [not exceeding one (1) year, or 
8 
both fine and imprisonment, at the discretion of the Court] OF NOT LESS 
9 
THAN SIX (6) YEARS AND ONE DAY TO TWELVE (12) YEARS. 
10 
If the act or omission penalized by this Act be committed by an 
11 
association, partnership, corporation or any other institution, its managing 
12 
directors or partners or president or general manager, or other persons 
13 
responsible for the commission of the said act shall be liable for the penalties 
14 
provided for in this Act and other laws for the offense. 
15 
3) MISAPPROPRIATION 
OF 
FUNDS 
BY 
EMPLOYEES 
OF 
THE 
16 
CORPORATION - Any employee of the Corporation who receives or keeps 
17 
funds or property belonging, payable or deliverable to the Corporation, and 
18 
who shall appropriate the same, or shall take or misappropriate or shall 
19 
consent, or through abandonment or negligence shall permit any other person 
20 
to take such property or funds wholly or partially, shall likewise be liable for 
21 
misappropriation of funds or property and shall suffer imprisonment of not 
22 
less than six (6) years and ONE (1) DAY BUT not more than twelve (12) 
23 
years and a fine not less than Ten Thousand Pesos (P10,OOO) nor more than 
24 
Twenty Thousand Pesos (P20,OOO). Any shortage of the funds or loss of the 
25 
property upon audit shall be deemed prima facie evidence of the offense. 
26 
D) OTHER VIOLATIONS -
All other violations [involving funds] of the 
27 
PROVISIONS OF THIS ACT, OR OF THE RULES AND REGULATIONS 
28 
PROMULGATED BY THE Corporation, shall be [governed by the applicable 
29 
provisions of the Revised Penal Code or other laws, taking into consideration the 
30 
rules on collection, remittances, and investment of funds as may be promulgated 
31 
by the Corporation] PUNISHED BY A FINE OF NOT LESS THAN FIVE 
32 
THOUSAND PESOS (P5,OOO) NOR MORE THAN TWENTY THOUSAND 
33 
PESOS (P20,OOO), OR IMPRISONMENT OF NOT LESS THAN SIX (6) YEARS 
34 
AND ONE (1) DAY BUT NOT TO EXCEED TWELVE (12) YEARS OR BOTH, 
35 
AT THE DISCRETION OF THE COURT. 
36 
E) CRIMINAL ACTION - CRIMINAL ACTION ARISING FROM A VIOLATION 
37 
OF THE PROVISIONS OF THIS ACT MAY BE COMMENCED BY THE 
38 
CORPORATION OR THE EMPLOYEE OR HEALTH CARE PROVIDER 
39 
CONCERNED, EITHER UNDER THIS ACT OR IN APPROPRIATE CASES 
40 
UNDER THE REVISED PENAL CODE; PROVIDED, THAT SUCH CRIMINAL 
41 
ACTION MAY BE FILED IN THE CITY OR MUNICIPALITY WHERE THE 
42 
VIOLATION WAS COMMITTED OR IN PROPER COURTS IN METRO 
43 
MANILA, AT THE OPTION OF THE COMPLAINANT. 
44 
F) PROSECUTION OF OFFENSES - OFFENSES AS DEFINED IN THE 
45 
IMPLEMENTING RULES AND REGULATIONS AND OTHER ISSUANCES OF 
46 
THE CORPORATION, SHALL BE PROSECUTED IN REGULAR COURTS OF 
47 
JUSTICE WITH COMPETENT JURISDICTION WITHOUT PREJUDICE TO 
48 
ADMINISTRATIVE 
ACTION 
THAT 
MAY 
BE 
INSTITUTED 
BY 
THE 
49 
CORPORATION UNDER EXISTING LAWS. 
17 


1 
G) FILING OF OTHER LEGAL ACTIONS BEFORE THE PROPER COURTS -
2 
THE FILING OF AN ADMINISTRATIVE ACTION AGAINST ANY HEALTH 
3 
CARE PROVIDER, INSTITUTION OR PROFESSIONAL, EMPLOYER, OR 
4 
ENROLLEE UNDER THIS 
ACT IS WITHOUT PREJUDICE TO 
THE 
5 
INDEPENDENT FILING OF FURTHER LEGAL ACTIONS IN THE PROPER 
6 
COURTS. 
7 
H) EXECUTION OF PENALTY - WHEN A HEALTH CARE PROVIDER 
8 
CEASES 
OPERATION 
OR 
AN 
INDEPENDENT 
HEALTH 
CARE 
9 
PROFESSIONAL STOPS HIS/HER PRACTICE BEFORE SERVING THE 
10 
SUSPENSION, EXECUTION OF THE PENALTY SHALL BE DEFERRED, TO 
11 
BE IMPLEMENTED WHEN THE SAME OWNER OR MEDICAL DIRECTOR 
12 
OPENS OR OPERATES A NEW INSTITUTION, REGARDLESS OF THE NAME 
13 
OR LOCATION, OR WHEN THE HEALTH CARE PROVIDER PRACTICES 
14 
AGAIN WHICHEVER COMES FIRST; PROVIDED, THAT THE DISPOSITIVE 
15 
PART 
OF 
THE 
RESOLUTION 
REQUIRING 
PAYMENT 
OF 
FINES, 
16 
REIMBURSEMENT OF PAID CLAIM OR DENIAL OF PAYMENT SHALL BE 
17 
IMMEDIATELY EXECUTORY. 
18 
DESPITE THE CESSATION OF OPERATION OR PRACTICE OF A 
19 
HEALTH CARE PROVIDER OR PROFESSIONAL WHILE THE COMPLAINT IS 
20 
BEING HEARD, THE PROCEEDING SHALL CONTINUE UNTIL RENDITION 
21 
OF 
JUDGMENT 
FOR 
PURPOSES 
OF 
DETERMINING 
FUTURE 
22 
RELATIONSHIPS BETWEEN THE CORPORATION AND THE ERRING 
23 
HEAL TH CARE PROVIDER OR PROFESSIONAL. 
24 
I) APPLICABILITY OF THESE PROVISIONS - COMPLAINTS ALREADY 
25 
FILED WITH, AND UNDER DELIBERATION BY, APPROPRIATE BODIES OF 
26 
THE CORPORATION PRIOR TO THE EFFECTIVITY OF THIS ACT SHALL BE 
27 
GOVERNED IN ACCORDANCE WITH THE PREVIOUS ACTS AND THEIR 
28 
IMPLEMENTING RULES AND REGULATIONS." 
29 
SEC. 25. Section 54 of the same Act is hereby amended to read as follows: 
30 
"SEC. 54. Oversight Provision.- [Congress shall] THERE IS HEREBY 
31 
CREATED A JOINT CONGRESSIONAL OVERSIGHT COMMITTEE TO 
32 
conduct a regular review of the National Health Insurance Program which shall 
33 
entail a systematic evaluation of the Program's performance, impact or 
34 
accomplishments with respect to its objectives or goals. [Such review shall be 
35 
undertaken by the Senate and the House of RepresentatiVes, which have 
36 
legislative jurisdiction over the Program.] THE COMMITTEE SHALL BE 
37 
COMPOSED OF FIVE (5) MEMBERS FROM THE SENATE AND FIVE (5) 
38 
MEMBERS FROM THE HOUSE OF REPRESENTATIVES TO BE APPOINTED 
39 
BY THE SENATE PRESIDENT AND THE SPEAKER OF THE HOUSE OF 
40 
REPRESENTATIVES, 
RESPECTIVELY. 
THE 
OVERSIGHT 
COMMITTEE 
41 
SHALL BE JOINTLY CHAIRED BY THE CHAIRPERSONS OF THE SENATE 
42 
COMMITTEE ON HEALTH AND DEMOGRAPHY AND THE HOUSE OF 
43 
REPRESENTATIVES COMMITTEE ON HEALTH. 
44 
The National Economic and Development Authority, in coordination with 
45 
the National Statistics Office and the National Institutes of Health of the 
46 
University of the 
Philippines 
shall 
undertake studies to validate the 
47 
accomplishments of the Program. [The Budget required to undertake such study 
48 
shall come from the income of the PhiIHealth.] SUCH VALIDATION STUDIES 
49 
WHICH SHALL INCLUDE AN 
ASSESSMENT OF THE ENROLLEES' 
50 
SATISFACTION OF THE BENEFIT PACKAGE AND SERVICES PROVIDED 
51 
BY THE CORPORATION. THESE VALIDATION STUDIES, AS WELL AS AN 
18 


1 
ANNUAL REPORT ON THE PERFORMANCE OF THE CORPORATION, 
2 
SHALL 
BE 
SUBMITTED 
TO 
THE 
CONGRESSIONAL 
OVERSIGHT 
3 
COMMITTEE. 
4 
THE CORPORATION SHALL ANNUALLY TRANSFER 0.01% OF ITS 
5 
INCOME IN THE PREVIOUS YEAR FOR THE PURPOSE OF CONDUCTING 
6 
THESE STUDIES." 
7 
SEC. 26. Implementing Rules and Regulations. - Within one (1) year from the 
8 
approval of this Act, the DOH and the Corporation shall issue the necessary rules and 
9 
regulations to implement the provisions of this Act. 
10 
SEC. 27. Sections following Section 7 of R.A. No. 7875, as amended, are hereby 
11 
renumbered accordingly. 
12 
SEC. 28. Separability Clause. - If any part or provision of this Act shall be held 
13 
unconstitutional or invalid, other provisions which are not affected thereby shall continue 
14 
to be in full force and effect. 
15 
SEC. 29. Repealing Clause. - All laws, issuance or any part thereof inconsistent 
16 
with this Act are hereby repealed or modified accordingly. 
17 
SEC. 30. Effectivity. -
This Act shall take effect fifteen (15) days after its 
18 
publication in the Official Gazette or in at least two (2) newspapers of general 
19 
circulation. 
20 
Approved, 
19