REPUBLIC OF THE PHILIPPINES
HOUSE OF REPRESENTATIVES
Quezen City, Manila

FIFTEENTH CONGRESS:
SECOND REGULAR SESSION

2060

COMMITTEE REPORT NO.

21MAR 2012

Submitted by the Committee on Health on ___

Re House Bill No. _ 6048

Recommending its approval in substitution of House Bilis No. 20, 87, 102, 150, 210, 265,
367, 495, 637, 655, 937. 961, 1083, 1202, 1267, 1566, 1567, 1512, 1628,
1847, 1854, 1965, 2099, 2174, 2441, 2547, 2711, 2939, 3090, 3142, 3143,
3144, 3405, 3499, 3544, 3545, 3795, 3921, 4116, 4150. 4168, 4235, 4236,
4238, 4339, 4340, 4430, 4590, 5003, 5038, 5047, 5177, 5270, 5283 and
5284

Sponsers : Reps. Alfredo D. Marafion Ill, Anthony T. Golez, Romeo M. Acop and Philip
A. Pichay

Mr. Speaker:

The Committee on Health to which were referred House Bill No. 20, introduced by Rep.
Marcelino R, Teodoro, entitled

“AN ACT GRANTING ADDITIONAL POWERS TO THE PHILIPPINE
HEALTH INSURANCE CORPORATION (PHILHEALTH), AMENDING
FOR THE PURPOSE REPUBLIC ACT NO. 7875, OTHERWISE KNOWN
AS THE ‘NATIONAL HEALTH INSURANCE ACT OF 1995 AS
AMENDED, AND FOR OTHER PURPOSES”

House Bill No. 87. introduced by Rep. Juan Edgardo M. Angara, 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

House Bill No. 102, introouced by Rep. Janette |. Garin, entitied:
AN ACT GRANTING ADDITIONAL POWERS TO THE PHILIPPINE

HEALTH INSURANCE CORPORATION (PHILHEALTH), AMENDING
i FOR THE PURPOSE REPUBLIC ACT NO.-7875, OTHERWISE KNOWN.



AS THE ‘NATIONAL HEALTH INSURANCE ACT OF 1995, AS
AMENDED, AND FOR OTHER PURPOSES

House Bill No. 150, introduced by Rep. Ben P Evardone, entitled:

AN ACT GRANTING COMPULSORY COVERAGE TO ACCREDITED
BARANGAY HEALTH WORKERS IN THE NATIONAL HEALTH
INSURANCE PROGRAM, AMENDING FOR THIS PURPOSE REPUBLIC
ACT NO. 7883, AND FOR OTHER PURPOSES

House Bill No. 210, introduced by Rep. Neptali M. Gonzales II, entitled:

AN ACT GRANTING COMPULSORY COVERAGE TO ACCREDITED
BARANGAY HEALTH WORKERS iN THE NATIONAL HEALTH
INSURANCE PROGRAM, AMENDING FOR THIS PURPOSE REPUBLIC
ACT 7883, AND FOR OTHER PURPOSES.

House Bill No. 265, introduced by Rep. Juan Edgardo M. Angara, entitled

AN ACT STRENGTHENING THE ROLE AND FUNCTIONS OF THE
LOCAL GOVERNMENT UNITS IN IMPLEMENTING UNIVERSAL
HEALTH CARE SYSTEM AND APPROPRIATING FUNDS THEREFOR

House Bill No, 367, introduced by Rep. Mary Mitzi L. Cajayon, entitled:

AN ACT TO ENSURE THAT INDIGENT FILIPINOS ARE GRANTED
WITH BASIC HEALTHCARE SERVICES, PROVIDING FOR A
UNIVERSAL HEALTHCARE COVERAGE AMENDING FOR THIS
PURPOSE SEC. 29 OF REPUBLIC ACT NO. 7875 OTHERWISE
KNOWN AS THE ‘NATIONAL HEALTH INSURANCE ACT OF 1995’, AND
FOR OTHER PURPOSES

House Bill No. 495, introduced by Rep. Juan Edgardo M. Angara. entitled:

AN ACT GRANTING COMPULSORY COVERAGE TO ACCREDITED
BARANGAY HEALTH WORKERS IN THE NATIONAL HEALTH
INSURANCE PROGRAM, AMENDING FOR THIS PURPOSE REPUBLIC
ACT NO. 7883, AND FOR OTHER PURPOSE

House Bill No. 637, introduced by Rep. Juan Edgardo M. Angara, 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 19957

House Bill No. 655, introduced by Rep. Juan Edgardo M. Angara, entitled:
AN ACT GRANTING ADDITIONAL POWERS TO THE PHILIPPINE

HEALTH INSURANCE CORPORATION (PHILHEALTH). AMENDING
FOR THE. PURPOSE REPUBLIC ACT NO. 7875, OTHERWISE KNOWN



AS THE ‘NATIONAL HEALTH INSURANCE ACT OF 7995 AS
AMENDED, AND FOR OTHER PURPOSES

House Bill No. 937, introduced by Rep. Susan A. Yap, 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

House Bill No. 961, introduced by Rep. Augusto Boboy Syjuco, entitled:

AN ACT REQUIRING THE MANDATORY COVERAGE OF ALL
HOUSEHELPERS IN THE NATIONAL HEALTH INSURANCE PROGRAM
(NHIP) UNDER THE PHILIPPINE HEALTH INSURANCE
CORPORATION (PHILHEALTH),

House Bill No. 1083, introduced by Rep. Bernadette R. Herrera-Dy, entitled:

AN ACT INSTITUTING A UNIVERAL HEALTH CARE, AMENDING FOR
THIS PURPOSE REPUBLIC ACT 7875, OR THE ‘NATIONAL HEALTH
INSURANCE ACT OF 1995’, REPUBLIC ACT 7392 OR THE MIDWIFERY
ACT, REPUBLIC ACT 7600 OR THE ROOMING IN AND
BREASTFEEDING ACT, AND FOR OTHER PURPOSES

House Bill No. 1202, introduced by Rep. Marcelino R. Teodoro, entitled:

AN ACT GRANTING ADDITIONAL BENEFITS AND PRIVILEGES TO
PHILHEALTH MEMBERS AMENDING FOR THE PURPOSE SECTION
10 OF REPUBLIC ACT NO. 7875 OTHERWISE KNOWN AS THE
‘NATIONAL HEALTH INSURANCE ACT OF 1995’

House Bill No. 1267, introduced by Rep. Augusto Boboy Syjuco, entitled:

AN ACT REQUIRING THE MANDATORY COVERAGE OF ALL
HOUSEHELPERS IN THE NATIONAL HEALTH INSURANCE PROGRAM
(NHIP) UNDER THE PHILIPPINE HEALTH — INSURANCE
CORPORATION (PHILHEALTH)

House Bill No. 1566, introduced by Rep. Rufus B. Rodriguez, entitled:
AN ACT APPROPRIATING FUNDS TO PROVIDE FOR UNIVERSAL
PHILIPPINE HEALTH INSURANCE CORP. (PHILHEALTH) COVERAGE
TO DESERVING INDIGENT FILIPINOS

House Bill No. 1567, introduced by Rep. Bernadette R. Herrera-Dy, entitled:
AN ACT GRANTING COMPULSORY COVERAGE TO ACCREDITED

BARANGAY HEALTH WORKERS IN THE NATIONAL HEALTH
SURANCE PROGRAM AND THE GOVERNMENT SERVICE



INSURANCE SYSTEM, AMENDING FOR THIS PURPOSE REPUBLIC
ACT NO. 7883. AND FOR OTHER PURPOSES

House Bill No. 1612, introduced by Rep. Ma. Milagros H. Magsaysay, entitled.

AN ACT FURTHER AMENDING 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 FOR THE PURPOSE"

House Bill No. 1628, introduced by Rep. Eufranio C. Eriguel, entitled:

AN ACT TO ENSURE MANDATORY UNIVERSAL HEALTHCARE
COVERAGE OF ALL FILIPINOS TO BASIC HEALTHCARE SERVICES,
AND FOR OTHER PURPOSES

House Bill No. 1847, introduced by Rep. Marcelino R. Teodoro, entitled:

AN ACT MANDATING THE COMPULSORY COVERAGE OF
BARANGAY HEALTH WORKERS TO THE NATIONAL HEALTH
INSURANCE PROGRAM. AMENDING FOR THIS PURPOSE REPUBLIC
ACT NO. 7883 AND FOR OTHER PURPOSES

House Bill No. 1854, introduced by Rep. Marceline R. Teodoro, entitled:

AN ACT INSTITUTING MECHANISM FOR THE ESTABLISHMENT OF
CHILDREN'S HEALTH INSURANCE PROGRAM, AMENDING FOR THE
PURPOSE REPUBLIC ACT NO. 7875, OTHERWISE KNOWN AS THE
‘NATIONAL HEALTH INSURANCE ACT 1995’, AS AMENDED BY RA
9241, AND FOR OTHER PURPOSES

House Bill No. 1965, introduced by Rep. Mark A. Villar, entitled:

AN ACT REQUIRING THE MANDATORY COVERAGE OF ALL
HOUSEHELPERS IN THE NATIONAL HEALTH INSURANCE PROGRAM
(NHIP) UNDER THE — PHILIPPINE HEALTH INSURANCE
CORPORATION (PHILHEALTH)

House Bill No. 2099, introduced by Rep. Mark A. Villar, entitled:

AN ACT GRANTING COMPULSORY COVERAGE TO ACCREDITED
BARANGAY HEALTH WORKERS IN THE NATIONAL HEALTH
INSURANCE OR GOVERNMENT SERVICE INSURANCE SYSTEM.
AMENDING FOR THIS PURPOSE SECTION 6 OF THE REPUBLIC ACT

NO. 7883

House Bill No. 2174, introduced by Rep. Lorenzo R. Tefiada Ill, entitled:



AN ACT AMENDING REPUBLIC ACT NO. 7875 OTHERWISE KNOWN
AS THE ‘NATIONAL HEALTH INSURANCE ACT OF 1995’, AS
AMENDED, AND FOR OTHER PURPOSES

House Bill No. 2441, introduced by Rep ignacio T. Arroyo Jr., entitled:

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

House Bill No. 2547, introduced by Rep. Joseph Victor G. Ejercito, 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

House Bill No. 2711, introduced by Rep. Emi G. Caiixto-Rubiano, entitled:

AN ACT FURTHER AMENDING REPUBLIC ACT NO. 9241 ENTITLED
"AN ACT AMENDING 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 FOR THE PURPOSE"

House Bill No. 2939, introduced by Rep. Rufus 8. Rodriguez, 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’, AS AMENDED
BY R.A. 9241 AND FOR OTHER PURPOSES

House Bill No. 3090, introduced by Rep. Wilfride Mark M. Enverga, entitled

AN ACT GRANTING ADDITIONAL BENEFITS AND PRIVILEGES TO
PHILHEALTH MEMBERS AMENDING FOR THE PURPOSE SECTION
10 OF REPUBLIC ACT NO. 7875 OTHERWISE KNOWN AS ‘NATIONAL
HEALTH INSURANCE ACT OF 1995'

House Bill No. 3142, introduced by Rep. Ma. Carmen Zamora-Apsay, entitled:

AN ACT REQUIRING THE MANDATORY COVERAGE OF ALL
BARANGAY HEALTH WORKERS IN THE NATIONAL HEALTH
INSURANCE PROGRAM (NHIP) UNDER THE PHILIPPINE HEALTH
INSURANCE CORPORATION (PHILHEALTH)

No.

43, introduced by Rep. Ma. Carmen Zamora-Apsay, entitled:



AN ACT REQUIRING THE MANDATORY COVERAGE OF ALL
BARANGAY DAY CARE WORKERS IN THE NATIONAL HEALTH
INSURANCE PROGRAM (NHIP) UNDER THE PHILIPPINE HEALTH
INSURANCE CORPORATION (PHILHEALTH)

House Bill No. 3144, introduced by Rep. Ma. Carmen Zamora-Apsay, entitled:

AN ACT REQUIRING THE MANDATORY COVERAGE OF ALL
BARANGAY NUTRITION SCHOLARS IN THE NATIONAL HEALTH
INSURANCE PROGRAM (NHIP) UNDER THE PHILIPPINE HEALTH
INSURANCE CORPORATION (PHILHEALTH)

House Bill No. 3405, introduced by Rep. George P. Amaiz, entitled

AN ACT REQUIRING THE MANDATORY COVERAGE OF ALL
BARANGAY HEALTH WORKERS IN THE NATIONAL HEALTH
INSURANCE PROGRAM (NHIP) UNDER THE PHILIPPINE HEALTH
INSURANCE CORPORATION (PHILHEALTH)

House Bill No. 3499, introduced by Rep. Emi G. Catixto-Rubiano, entitled:

AN ACT GRANTING MANDATORY PHILHEALTH BENEFITS TO ALL
INCUMBENT BARANGAY OFFICIALS, PROVIDING FUNDS THEREFOR

House Bill No. 3544, introduced by Rep. Ma. Theresa B. Bonoan-David, entitied:

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

House Bill No. 3545, introduced by Rep. Ma. Theresa B. Bonoan-David, entitled:

AN ACT GRANTING COMPULSORY COVERAGE TO ACCREDITED
BARANGAY HEALTH WORKERS IN THE NATIONAL HEALTH
INSURANCE PROGRAM, AMENDING FOR THIS PURPOSE REPUBLIC
ACT NO. 7883, AND FOR OTHER PURPOSES

House Bill No. 3795, introduced by Rep Mariano Michael M. Velarde, entitled:

AN ACY 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

House Bill No. 3921, introduced by Rep. Loreto S. Ocampos, entitled:

AN ACT PROVIDING SETTLEMENT OF HOSPITAL FEES IN EXCESS
OF THE AMOUNT COVERED BY THE NATIONAL HEALTH
INS| ROGRAM FOR INDIGENT MEMBERS



House Bill No. 4115, introduced by Rep. Alfredo D. Marafion I!l, entitled:

AN ACT AMENDING REPUBLIC ACT NO. 7875 OTHERWISE KNOWN
AS THE ‘NATIONAL HEALTH INSURANCE ACT OF 1995’, AS
AMENDED, AND FOR OTHER PURPOSES

House Bill No. 4150, introduced by Rep. Feliciano Belmonte Jr., entitled:

AN ACT PROVIDING A DEFINITE TARGETING STRATEGY IN
IDENTIFYING THE POOR, AMENDING REPUBLIC ACT NO. 7875
OTHERWISE KNOWN AS THE NATIONAL HEALTH INSURANCE ACT
OF 1995 AS AMENDED, AND FOR OTHER PURPOSES,

House Bill No. 4168, introduced by Rep. Abigail Faye C. Ferriol, 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

House Bill No, 4235, introduced by Rep. Rogelio J. Espina, entitled

AN ACT AMENDING SECTION 5 OF REPUBLIC ACT 7875
OTHERWISE KNOWN AS AN ACT INSTITUTING A NATIONAL
HEALTH INSURANCE PROGRAM FOR ALL FILIPINOS AND
ESTABLISHING THE PHILIPPINE HEALTH INSURANCE
CORPORATION FOR THE PURPOSE

House Bill No. 4236, introduced by Rep. Rogelio J. Espina, entitled

AN ACT PROVIDING FOR THE
COMPUTERALIZATION/MODERNIZATION OF THE PHILIPPINE
HEALTH INSURANCE CORPORATION AND FOR OTHER PURPOSES

House Bill No. 4238, introduced by Rep. Philip A. Pichay, entitled:

AN ACT STRENGTHENING THE IMPLEMENTATION OF THE
NATIONAL HEALTH INSURANCE PROGRAM (NHIP), AMENDING
CERTAIN PROVISIONS OF REPUBLIC ACT NO. 7875, AS AMENDED
BY RA 9241, FOR THE PURPOSE

House Bill No, 4339, introduced by Rep. Diosdado Macepagel Arroyo, 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’ AS AMENDED
BY R.A. 9241 AND FOR OTHER PURPOSES



House Bill No. 4340, introduced by Rep. Diosdado Macapagal Arroyo, 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)

House Bill No. 4430, introduced by Rep. Romeo M. Acop, entitled:

AN ACT PROVIDING FOR THE UTILIZATION OF THE EXCESS
RESERVE FUND OF THE PHILIPPINE HEALTH INSURANCE
CORPORATION, AMENDING FOR THE PURPOSE REPUBLIC ACT
NO. 7875

House Bill No. 4590, introduced by Rep. Saivio B. Fortuno, entitled

AN ACT PROVIDING FOR THE MANDATORY UNIVERSAL
HEALTHCARE COVERAGE PROGRAM AND APPROPRIATING
FUNDS THEREFOR

House Bill No, 5003, introduced by Rep. Kimi S. Cojuangco, entitled:

AN ACT PROVIDING FOR THE COMPULSORY COVERAGE OF ALL
ACCREDITED BARANGAY HEALTH WORKERS IN THE NATIONAL
HEALTH INSURANCE PROGRAM, AMENDING FOR THE PURPOSE
REPUBLIC ACT NO. 7883, OTHERWISE KNOWN AS THE ‘BARANGAY
HEALTH WORKERS BENEFITS AND INCENTIVES ACT OF 1995"

House Bil! No. 5038, introduced by Rep. Anthony G. Del Rosario, entitlec:

AN ACT EXPANDING THE BENEFIT PACKAGE OF THE NATIONAL
HEALTH INSURANCE PROGRAM, AMENDING FOR THE PURPOSE
REPUBLIC ACT NO. 7875, OTHERWISE KNOWN AS THE 'NATIONAL
INSURANCE ACT OF 1995’, AS AMENDED

House Bill No. 5047, introduced by Rep. Anthony G. Del Rosario, entitled:

AN ACT PROVIDING FOR THE MANDATORY UNIVERSAL
COVERAGE OF ALL CITIZENS IN THE NATIONAL HEALTH
INSURANCE PROGRAN, AMENDING FOR THE PURPOSE REPUBLIC
ACT NO. 7875, OTHERWISE KNOWN AS THE ‘NATIONAL HEALTH
INSURANCE ACT OF 19:

House Bill No. 5177, introduced by Rep. Winston Castelo, entitled
AN ACT PROVIDING MANDATORY UNIVERSAL HEALTH CARE TO

EVERY FILIPINO CITIZEN WHO IS EIGHTEEN YEARS OLD AND
ABOVE FUNDED FROM EARNINGS OF PAGCOR AND PCSO

2 HOUSE-Bill No.-5270, introduced by Rep. Diosdade Macapagal Arroyo, entitled:



AN ACT PROVIDING FOR AFFORDABLE DRUG REHABILITATION
TREATMENT FOR PHILIPPINE HEALTH INSURANCE CORPORATION
(PHIC) BENEFICIARIES, FURTHER AMENDING FOR THE PURPOSE
RA 7875, AS AMENDED BY RA 9241

House Bill No. 5283, introduced by Rep. Carmeie F. Lazatin, entitled,

AN ACT GRANTING PHILHEALTH COVERAGE TO ALL INDIGENT
FILIPINOS, AMENDING REPUBLIC ACT NO. 7875, OTHERWISE
KNOWN AS THE NATIONAL HEALTH INSURANCE ACT OF 1995, AND.
FOR OTHER PURPOSES

and House Bill No. 5284, introduced by Rep. Carmelo F. Lazatin, entitled:

AN ACT GIVING PHILHEALTH AND GSiS COVERAGE TO ALL
BARANGAY OFFICIALS AND EMPLOYEES

has considered the same and recommends that the attached House Bill No.
, entitied,

“AN ACT
PROVIDING HEALTHCARE SERVICES TO ALL FILIPINOS, FURTHER
AMENDING FOR THE PURPOSE 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 House Bills No. . 20, 87. 102, 150, 210, 265, 367, 495, 637,
655, 937, 961, 1083, 1202, 1267, 1566, 1567, 1612, 1628, 1847, 1854, 1965, 2099, 2174,
2441, 2547, 2711, 2939, 3090, 3142, 3143, 3144, 3405, 3499, 3544, 3545, 3795, 3921,
A116, 4150, 4168, 4235, 4236, 4238, 4339, 4340, 4430, 4590, 5003, 5038, 5047, 5177,
5270, 5283, 5284 with Reps Marcelino R. Teodoro, Juan Edgardo M. Angara, Janette L.
Garin, Ben P. Evardone, Neptali M. Gonzales, Mary Mitzi L. Cajayon, Susan A. Yap,
Augusto Boboy, D. Syjuco, Bernadette R. Herrera-Dy, Rufus B. Rodriguez, Maria Milagros
—. Magsaysay, Eufranio C. Enguei, Mark A. Villar, Lorenzo R. Tafiada, Daisy Avance-
Fuentes, Ignacio T. Arroyo, Joseph Victor G. Ejercito, Imelda G. Calixto-Rubiano, Wilfrido
Mark C. Enverga, Maria Carmen. Zamora-Apsay, George P. Amaiz, Ma. Theresa B.
Bonoan-David, Mariano Michae! M. Velarde Jr, invin C. Tieng, Loreto S. Ocampos, Alfredo
D. Marafion Hil, Anthony Rolando T. Golez, Feliciano R. Belmonte, Abigail Faye C. Ferriol,
Rogelio J. Espina, Philip A. Pichay, Diosdado M. Arroyo, Romeo M. Acop, Salvio B.
Fortuno, Kimi S. Cojuanco, Anthony G. De! Rosario, Winston Castelo, Carmelo F, Lazatin,
Erico B. Aumentado, Ma. Amelita A. © ibes-Villarosa, Rachel Marguerite B. Del Mar,
Bernardo M. Vergara, Cesar V. Sarmiento, Josephine Veronique R. Lacson-Noel, Patricio
T. Antonio, Amulfo F. Go, Amei M. Cerafica, Eleanor C. Bulut-Begtang, Christopher S. Co,
Rodel M. Batocabe. Maximo B. Ro: 1e2, Rodante D. Marcoieta, Rosenda Ann Ocampo,
Irvin M. Alcala, Thelma Z. Aimario, Giorgidi B. Aggabao, Alfredo A. Garbin Jr., Tomas V.
Apacible, Jose Carlos L Cari, Neil Benedict A Montejo, Gloria A. Macapagal-Arroyo,
Catalina C. Bagasina. Monique Yazmin Q Lagdameo_ Mar-Len Abigail S. Binay, Ma.
Georgina P. De Venecia, Maria |: H. Escudero Il, Joel Roy R.
Duavity Mel Senen S. Sarmient jas B. Ramos Jr., Angelo B.



Painiones, Benhur L Salimbangon, Herminia B. Roman, Linabelle Ruth R. Villarica, Irvin
M Alcala, Lani Mercado-Revilla, Ryan Luis Singson, Salvador P. Cabaluna, Cinchona
Cruz-Gonzales, Romero Federico S. Quirnbo, David L. Kho, Emerenciana A. De Jesus,
Mohammed Hussein P. Pangandaman, Lucy Torres Gomez, Salvador H. Escudero III,
Reena Concepcion G. Obillc, Jose Carlos L. Cari, Jesus F. Celeste, Ma. Evita R. Arago,
Arthur C, Yap, Juan Miguel Macapagal-Arroyo, Bai Sandra A. Sema, Amado S. Bagatsing,
Edwin Olivarez, Alfredo Abelardo B. Benitez, Daryl Grace Abayon, Peter Unabia, Imelda
Dimaporo, Albert Garcia and Alfredo D. Marafion Ill as authors thereof.

Respectfully submitted,

HO! FREDO D. MARANON
Chairman
Committee on Health

‘THE HONORABLE SPEAKER
House of Representatives
‘Quezon Cy



wee

5,
HousEBELL NO. 6048

Introduced by Representatives Marcelino R. Teodoro, Juan Edgardo M. Angara,
Janette L. Garin, Ben P. Evardone, Neptali M. Gonzales, Mary Mitzi _. Cajayon, Susan
A. Yap, Augusto Boboy, D. Syjuco, Bernadette R. Herrera-Dy, Rufus B. Rodriguez,
Maria Milagros E. Magsaysay, Eufranio C. Eriguel, Mark A. Villar, Lorenzo R. Tafa
Daisy Avance-Fuentes, Ignacio T. Arroyo, Joseph Victor G. Ejercito, Imelda G. Calixto-
Rubiano, Wilfrido Mark C. Enverga, Maria Carmen Zamora-Apsay, George P. Arnaiz,
Ma. Theresa B. Bonoan-David, Mariano Michael M. Velarde Jr., Irwin C. Tieng, Loreto
S. Ocampos, Alfredo D. Marafion Ill, Anthony Rolando T. Golez, Feliciano R. Belmonte,
Abigael Faye C. Ferriol Rogelio J. Espina, Philip 4. Pichay, Diosdado M. Arroyo,
Romeo M. Acop, Salvio B. Fortuno, Kimi S. Cojuanco, Anthony G. Del Rosario,
Winston Castelo, Carmelo F. Lazatin, Erico B. Aumentado, Ma. Amelita A. Calimbas-
Villarosa, Rachel Marguerite B. Del Mar, Bernardo M. Vergara, Cesar V. Sarmiento,
Josephine Veronique R. Lacson-Noel, Patricio T. Antonio, Arnulfo F. Go, Arnel M.
Cerafica, Eleanor C. Bulut-Begtang, Christopher S. Co, Rode! M. Batocabe, Maximo B.
Rodriguez, Rodante D. Marcoleta, Rosenda Ann Ocampo, Irvin M. Alcala, Thelma Z.
Almario, Giorgidi B. Aggabao, Alfredo A. Garbin Jr, Tomas V. Apacible, Jose Carlos
L. Cari, Neil Benedict A. Montejo, Gloria A. Macapagal-Arroyo, Catelina C. Bagasina,
Monique Yazmin Q. Lagdameo, Mar-Len Abigail S. Binay, Ma. Georgina P. De Venecia,
Maria Isabelle G. Climaco, Salvador H. Escudero Illi, Joe! Roy R. Duavit, Mel Senen Ss.
Sarmiento, Randolph S. Ting, Deogracias B. Ramos Jr., Angelo B. Palmones, Benhur
L. Salimbangon, Herminia B. Roman, Linabelle Ruth R. Villarica, Irvin M. Alcala, Lani
Mercado-Revilla, Ryan Luis Singson, Salvador P. Cabaluna, Cinchona Cruz-
Gonzales, Romero Federico $. Quimbo, David L. Kho, Emerenciana A. De
Jesus, Mohammed Hussein P. Pangandaman, Lucy Torres Gomez, Salvador H.
Escudero ill, Reena Concepcion G. Obillo, Jose Carlos L. Cari, Jesus F.
Celeste, Ma. Evita R. Arago, Arthur C. Yap, Juan Miguel Macapagal- Arroyo,
Bai Sandra A. Sema,Amado S. Bagatsing, Edwin Olivarez, Alfredo Abelardo B.
Benitez, Daryl Grace Abayon, Peter Unabia, Imelda Dimaporo, Albert Garcia

AN ACT.
PROVIDING FOR UNIVERSAL HEALTH CARE SERVICES TO ALL FILIPINOS,
FURTHER AMENDING FOR THE PURPOSE REPUBLIC ACT NO, 7875,
OTHERWISE KNOWN AS THE ‘NATIONAL HEALTH INSURANCE ACT OF
1995’, AS AMENDED

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

SECTION 1. Sections 1 and 2 of Republic Act No. 7875, as amended, are

hereby amended to read as follow:

“SECTION 1, Short Title. ~ This Act shall be known as the
{National} PINOY Health Insurance Act {of 1995}
ARTICLE I. GUIDING PRINCIPLES
SEC. 2. Declaration of Principles and Policies. ~ {Section Uf, Article

XII of the 1987-Constitatién-of the Republic of the Philippines declares.that) “=



wv
8

IT IS HEREBY DECLARED THE POLICY OF the State [shall] TO adopt an
integrated and comprehensive approach to health development which shall

and other social services available to

endeavor to make essential goods, he:
all people at affordable cost AND TO PROVIDE FREE MEDICAL CARE
TO PAUPERS. [Priority of the needs of the underprivileged, sick, elderly,
hildren shall be recognized. Likewise, it shall be the
paupers | TOWARDS THIS

disabled women an

‘the stat
END, THE STATE SHALL
CARE SERVICES TO ALL FILIPINOS THROUGH A SOCIALIZED
HEALTH INSURANCE PROGRAM THAT WILL PRIORITIZE THE
HEALTH CARE NEEDS OF THE UNDERPRIVILEGED, SICK,
ELDERLY, DISABLED, WOMEN AND CHILDREN AND PROVIDE
FREE HEALTH CARE SERVICES TO INDIGENTS

[In the pursuit of 2 National Health Insurance Program, this Act]
PURSUANT TO THIS POLICY, THE STATE shall adopt the following
{guiding} principles

a) Allocation of Natural Resources for Health. ~ The Program
shall underscore the importance for government to give priority to health as

strategy for bringing about faster economic development and improving

quality of life

SEC. 2. Section 4 of the same Act, as amended, is hereby further amended to
read as follows
“ARTICLE IL. DEFINITION OF TERMS

SEC. 4. Definition of Terms. — For the purpose of this Act, the
following terms shall be defined as fellows:

a) Beneficiary — Any person entitled to health care benefits under
this Act

00x wx xox

| dependents of a member are

4) Dependent — The}

1 the legitimate spouse who is not a member:
Kx xxx xxx
4. the parents who are sixty (60) years old or zbove whose

monthly income is below an amount to be determined by the

ose



in accordance with the guiding principles set forth in

2 is Act: AND

3 5. PARENTS WITH PERMANENT DISABILITY THAT
4 RENDER THEM TOTALLY DEPENDENT ON THE MEMBER
3 FOR SUBSISTENCE

xxx XXX bod

0) Health care provider ~ Refers to:

8 1. a_health care institution which is duly licensed or
9 accredited devoted primarily to the maintenance and operation of
10 facilities for health promotion, prevention, diagnosis, treatment and,
W care of individuals suffering fiom illness, disease, injury, disability, or
12 deformity, drug addiction or in need of obstetrical or other medical and
13 nursing care.

“4 It shall also be construed as any institution, building, or place
15 where there are installed beds, cribs, or bassinets for twenty-four hour
16 use or longer by patients in the treatment of diseases, injuries,
7 deformities, or abnorinal physical and mental states, maternity cases or
18 sanitatial care; or infirmaries, nurseries, dispensaries, rehabilitation
19 centers and such other similar names by which they may be
20 designated, or

21 xxx wx xxx

2 4 & community-based health organization, which is an
3 association of indigenous members of the community organized for the
24 purpose of improving the health status of that community through
25 preventive, promotive and curative health services; OR

26 5. A PRACTITIONER ENGAGED IN THE PRACTICE
27 OF ALTERNATIVE HEALTH CARE SERVICE OR
28 TREATMENT WHICH INCLUDES HEALING BY TRADITIONAL
29 OR HERBAL MEDICINES AS APPROVED BY THE
30 CORPORATION.

31 xxx KX xxx

32 q) Indigent — A person who as no visible means of income, or
3 whose income is insufficient for the subsistence of his family, [as identified by

34 the Local Health Insurance Office and] as identified by the [Corporation]



1 NATIONWIDE, NOTWITHSTANDING THE EXISTENCE OF LGU-

2 BASED HEALTH INSURANCE PROGRAMS

3 SEC. 6. Coverage. — All citizens of the Philippines shall be covered
4 by the National Health Insurance Program. In accordance with the principles
5 of universality and compulsory coverage enunciated in Section 2 (b) and 2 (1)

6 hereof, implementation of the Program shall [,furthermore, be gradual and
7 phased in over a period of not more than fifteen (15) years. Provided, That the
8 Program shall not be made compulsory in certain provinces and cities until the
9 Corporation shall be able to ensure that the members in such locelities shall
10 have reasonable access to adequate and acceptable health care services)
" ENSURE SUSTAINABILITY OF THE COVERAGE AND CONTINUOUS
12 ENHANCEMENT OF THE QUALITY OF SERVICE
13 THE CORPORATION, IN COORDINATION WITH THE
14 DEPARTMENT OF HEALTH (DOH), LOCAL GOVERNMENT UNITS
15 (LGUs), OTHER NATIONAL GOVERNMENT AGENCIES INCLUDING
16 NON-GOVERNMENTAL ORGANIZATIONS (NGOs) SHALL ENSURE
W THAT ALL MEMBERS SHALL HAVE ACCESS TO QUALITY HEALTH
18 CARE SERVICES THROUGH THE PROGRAM
19 SEC. 7. Enrollmeni. ~ The [Program] CORPORATION shall enroll
20 beneficiaries in order for them [to be placed under the coverage that entitles
21 them] to avail of benefits UNDER THIS ACT with the assistance of the
22 financial arrangements provided by the [Program] CORPORATION UNDER
2B THE FOLLOWING CATEGORIES
24 A) MEMBERS IN THE FORMAL ECONOMY;
25 B) MEMBERS IN THE INFORMAL ECONOMY,
26 ©) ENROLLED INDIGENTS; AND
2 D) LIFETIME MEMBERS.
28 The process of enrollment shail include the identification of beneficiaries, issuance of

29 appropriate documentation specifying eligibility to benefits, and indicating how membership
30 was obtained or is being maintained

31 a) all persons currently eligible for benefits under Medicare Program I, including SSS
32 and GSIS members, retirees, pensioners and their dependents) ALL PERSONS
33. CURRENTLY ENROLLED AS MEMBERS shall {immediately and] BE automatically
34 ELIGIBLE [be made members of] FOR BENEFITS UNDER the National Health Insurance



1 Program UNDER THIS ACT. IT SHALL ENROLL QUALIFIED FOREIGNERS ON A

2 VOLUNTARY BASIS:

{b) all persons eligible for benefits through heaith insurance plans

4 established by local governments as part of Program Il of Medicare or in

5 accordance with the provisions of this Act, including indigent members, shall

6 also be enrolled in the Program;

7 ©) all persons cligible for benefits as members of local health —

8 insurance plans established by the Corporation in accordance with the

9 implementing rules and regulations of this Act shall also be deemed to have
10 enrolled in the Program Enrollment of persons who have no current health
MW insurance coverage shall be given priority by the Corporation; and

12 4) all. persons. eligible for benefits as members of other
3 government-initiated health insurance programs, community-based health care
“4 organizations, cooperatives, or private non-profit health insurance plans shall
15 be enrolled in the Program upon accreditation by the Corporation which shall
16 devise and provide incentives to ensure that such accredited organizations will
17 benefit from their participation in the program.

18 All indigents not enrolled in the Program shall have priority in the use
19 and availment of the services and facilities of government hospitals, health
20 care personnel, and other health organizations: Provided, however, That such
21 government health care providers shall ensure that said indigents shall
2 subsequently be enrolled in the Program]
23 SEC. 8. Health Insurance |ID) IDENTIFICATION Card. ~ in
24 conjunction with the enrollment provided above, the Corporation, through its
25 local office shall, issue a health insurance {ID} IDENTIFICATION CARD
26 (ID) TO ALL ITS MEMBERS which shall be used for purposes of
7 identification, eligibility verification, and utilization recording, The issuance
28 of this [ID] IDENTIFICATION CARD shall be accompanied by a clear
29 explanation to the enrollee of {his} THE rights, privileges and obligations as a
30 member A list of health care providers accredited by the Local Health
31 Insurance Office shall likewise be {attached thereto] PROVIDED TO THE

32 MEMBER TOGETHER WITH THE IDENTIFICATION CARD.



THE ABSENCE OF THE IDENTIFICATION CARD SHALL NOT
PREJUDICE THE RIGHT OF ANY MEMBER TO AVAIL OF BENEFITS
OR MEDICAL SERVICES UNDER THE NHIP.”

SEC. 4. Section 12 of the same Act, as amended, is hereby amended to read

as follows

“SEC. 12. Entitlement to Benefits. — A member whose premium
contributions for at least three (3) months have been paid within the six (6)
months prior to the first day of {his or his dependents’ availment]
AVAILMENT, INCLUDING THOSE OF THE DEPENDENTS, shall be
entitled to the benefits of the Program: Provided, That such member can show
that [he contributes thereto] CONTRIBUTIONS HAVE BEEN MADE with
sufficient regularity, [as evidenced in his health insurance ID card: and}
Provided, further, That {he] THE MEMBER is not currently subject to legal
penalties as provided for in Section 44 of this Act

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

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

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

©) Enrolled indigents.”

SEC. 5. Section 16 of the same Act, as amended, is hereby amended to read
as follows

“SEC. 16. Powers and Functions. ~ The Corporation shall have the
following powers and functions:

a) _ toadminister the National Health Insurance Program;

xxx 2x xx

©) TO SUPERVISE THE PROVISION OF HEALTH BENEFITS

of

AND to set standards, rules, and regulations necessary to ensure quali

care, appropriate utilization of services, fund viability, member satisfaction,
and overall accomplishment of Program objectives,
xxx 20x xxx

j) to negotiate and enter into contracts with health care

institutions, professionals, and other persons, juridical or natural, regarding the



24

pricing, payment mechanisms, design and implementation of administrative
and operating systems and procedures, financing, and delivery of health
services ON BEHALF OF ITS MEMBERS,

XxX xxx Xxx

m) [to supervise the provision of health benefits with the power] to
VISIT, ENTER AND inspect THE FACILITIES OF HEALTH CARE
PROVIDERS AND SECURE COPIES OF medical and financial records
PERTINENT TO THE APPLICATION FOR ACCREDITATION OF
HEALTH CARE PROVIDERS, OR TO THE PROCESSING OF THEIR
CLAIMS OR THAT OF THEIR PATIENTS OR TO VISIT THE
FACILITIES OF EMPLOYERS TO SECURE COPIES OF THEIR
FINANCIAL RECORDS OR DOCUMENTS PERTINENT TO THE
PREMIUM PAYMENTS OF THEIR EMPLOYEES, [of health care
providers and patients} who are [participants in or] members of the
Programf,}; {and the power to enter and inspect accredited health care
institutions, subject to the rules and regulations to be promulgated by the
Corporation;}

xx Xxx XXX

Q TO MONITOR COMPLIANCE BY THE REGULATORY
AGENCIES WITH THE REQUIREMENTS OF SECTION 28 (B) OF THIS
ACT AND TO CARRY OUT NECESSARY ACTIONS TO ENFORCE
COMPLIANCE ,

R) TO MANDATE THE NATIONAL AGENCIES AND LOCAL
GOVERNMENT UNITS TO REQUIRE PROOF OF PHILHEALTH
MEMBERSHIP BEFORE DOING BUSINESS WITH A PRI
INDIVIDUAL OR GROUP.

S) TO ESTABLISH AND MAINTAIN AN ELECTRONIC
DATA BASE OF ALL ITS MEMBERS AND ENSURE ITS SECURITY TO.
FACILITATE EFFICIENT AND EFFECTIVE SERVICES,

T) TO IMPOSE INTEREST OR SURCHARGE OF THREE
PERCENT (3%) PER MONTH IN CASE OF DELAY IN THE
REMITTANCE OF PREMIUM CONTRIBUTIONS EXCEPT UNDER
SECTION 7 OF THIS ACT,

U) TO ACCREDIT INDEPENDENT PHARMACIES AND
RETAIL DRUG OUTLETS.



Vv) TO CONDUCT A POST-AUDIT ON THE QUALITY OF
SERVICES RENDERED BY HEALTH CARE PROVIDERS; AND.

[gl W) to perform such other acts as it may deem appropriate for the
attainment of the objectives of the Corporation and for the proper enforcement
of the provisions of this Act.”

SEC. 6, Sections 18 and 19 of the same Act, as amended, are hereby further
amended to read as follows
“SEC. 18. The Board of Directors. ~

a) Composition - The Corporation shall be governed by a Board
of Directors hereinafter referred to as the Board, composed of the following
[members]

The Secretary of Health,

‘The Secretary of Labor and Employment or {his] A PERMANENT
representative,

The Secretary of the Interior and Local Government or [his] A
PERMANENT representative;

The Secretary of Social Welfare and Development or [his] A
PERPMANENT representative;

THE SECRETARY OF THE DEPARTMENT OF FINANCE OR A
PERMANENT REPRESENTATIVE,

THE CHAIRPERSON OF THE CIVIL SERVICE COMMISSION OR
A [HIS] PERMANENT REPRESENTATIVE,

The Vice Chairperson for the basic sector of the National Anti-Poverty
Commission or his PERMANENT representative;

The President AND CHIEF EXECUTIVE OFFICER (CEO) of the
Corporation;

‘A PERMANENT representative of the MEMBERS IN THE [iabor]
FORMAL ECONOMY [sector],

A PERMANENT representative of the [selemployed] MEMBERS IN
THE INFORMAL ECONOMY [sector]:

A representative of employers

[The SSS Administrator or his representative;

‘The GSIS General Manager or his representatives}

A PERMANENT representative of Filipino [overseas] MIGRANT

workers;



[A representative of health care providers to be endorsed by the national

associations of health care institutions and medical health professionals |
A PERMANENT REPRESENTATIVE OF THE ELECTED LOCAL CHIEF
EXECUTIVES TO BE ENDORSED BY THE LEAGUE OF PROVINCES,
LEAGUE OF CITIES AND LEAGUE OF MUNICIPALITIES.

The Secretary of Health shall be the ex officio Chairperson while the
President AND CEG of the Corporation shall be the Vice Chairperson of the
Board.

b) Appointment and Temure ~ {The President of the Philippines
shall appoint the Members of the Board upon the recommendation of the
Chairman of the Board and in consultation with the sectors concemed
Members of the Board shall have a term of four (4) years each, renewable for
a maximum of two (2) years, except for members whose terms shall be co-
terminus with their respective position in government. Any vacancy in the
Board shall be filled in the manner in which the original appointment was
made and the appointee shall serve only the unexpired term of his
predecessor] EXCEPT FOR EX-OFFICIO MEMBERS, THE OTHER
MEMBERS OF THE BOARD SHALL BE APPOINTED BY THE
PRESIDENT OF THE PHILIPPINES IN ACCORDANCE WITH THE
PROVISIONS OF REPUBLIC ACT (RA) NO. 10149, OTHERWISE
KNOWN AS THE “GOCC GOVERNANCE ACT OF 2011": PROVIDED,
THAT SECTORAL BOARD MEMBERS SHALL BE APPOINTED BY THE
PRESIDENT OF THE PHILIPPINES UPON THE RECOMMENDATION
OF THE CHAIRPERSON AND AFTER DUE CONSULTATIONS WITH
THE SECTORS CONCERNED.

THE TERM OF OFFICE OF THE APPOINTIVE MEMBERS OF
‘THE BOARD SHALL BE IN ACCORDANCE WITH R.A. NO. 10149.

xox Xxx 3x

SEC. 19. The President of the Corporation. ~

a) Appointment and Tenure. ~ The President of the Philippines
shall appoint {for a non renewable term of six (6) years.] the President AND
CEO of the Corporation, hereinafter referred 10 as the President, upon the
recommendation of the Board. The President shall [not be removed from
office except in accordance with existing laws] HAVE A TENURE OF ONE

YEAR IN ACCORDANCE WITH THE PROVISIONS OF RA 10149.



i se 1

we

XXX XXX Xxx.”
SEC. 7. Sections 26, 27, 28 and 29 of the same Act, as amended, are hereby
further amended to read as follows:

“SEC. 26. Financial Management. ~ The use, disposition, investment,
disbursement, administration and management of the National Health
Insurance Fund, including any subsidy, grant or donation received for program
operations shall be governed by resolution of the Board of Directors of the
Corporation, subject to the following limitations:

a) All funds under the management and control of the Corporation
shall be subject to all rules and regulations applicable to public funds

b) The Corporation is authorized to charge TO the various funds
under its control {for} the costs of administering the Program. Such costs may
inelide administration, monitoring, marketing and promotion, research and
development, audit and evaluation, information services, and other necessary
activities for the effective management of the Program. The total annual costs
for these shall not exceed [twelve (12%) of the total contributions, including

goverment contributions to the Program and not more than three percent

(3%) of the investment earnings collected during the immediately preceding
year] THE SUM TOTAL OF THE FOLLOWING
1. FOUR PERCENT (4%) OF THE TOTAL PREMIUM
CONTRIBUTIONS COLLECTED DURING THE IMMEDIATELY
PRECEEDING YEAR,
2 FOUR PERCENT (4%) OF THE TOTAL
REIMBURSEMENTS OR TOTAL COST OF HEALTH SERVICES
PAID BY THE CORPORATION IN THE IMMEDIATELY
PRECEDING YEAR; AND
3. BIVE PERCENT (5%) OF THE INVESTMENT
EARNINGS GENERATED DURING THE IMMEDIATELY
PRECEDING YEAR
THE PERIOD FOR IMPLEMENTATION OF THE COST
CEILING PROVIDED UNDER THIS SECTION SHALL NOT BE
LATER THAN FIVE (5) YEARS FROM THE EFFECTIVITY OF
THIS ACT DURING WHICH PERIOD, THE TOTAL ANNUAL
COST SHALL NOT EXCEED THE SUM TOTAL OF THE
FOLLOWING



a FIVE PERCENT (5%) OF THE TOTAL

CONTRIBUTIONS,
b FIVE PERCENT (5%) OF THE TOTAL
REIMBURSEMENTS; AND

¢ FIVE PERCENT (5%) OF THE INVESTMENT
EARNINGS GENERATED DURING THE
IMMEDIATELY PRECEDING YEAR.

SEC. 27. Reserve Funds. - The Corporation shall set aside a portion
of its accumulated revenues not needed to meet the cost of the current year’s
expenditures as reserved funds: Provided, That the total amount of reserves
shall not exceed a ceiling equivalent {to the amount actuarially estimated for
two years projected} TO THE TOTAL OF THE ACTUAL [Program]
expenditures FOR THE LAST TWO YEARS: Provided further, That
whenever actual reserves exceed the required ceiling at the end of the
Corporation's fiscal yearf, the Program’s benefits shall be increased or
member contributions decreased prospectively in order to adjust expenditures
or revenues to meet the required ceiling for reserve funds. [Such] THE
EXCESS [portions] of the CORPORATION'S reserve fund SHALL BE
USED TO INCREASE THE PROGRAM'S BENEFITS, DECREASE THE
MEMBER'S CONTRIBUTIONS, AUG! ? THE HEALTH FACILITIES
ENHANCEMENT PROGRAM OF THE DEPARTMENT OF HEALTH
AND ENHANCE THE ELECTRONIC DATA BANK OF MEMBERS.

THE REMAINING PORTION OF THE RESERVE FUND [as] THAT
are not needed to meet the current expenditure obligations OR USED FOR
THE ABOVE-MENTIONED PROGRAMS shall be [invested] PLACED in

investments to earn an average annual income at prevailing rates of interest

and shall be known as the “Investment Reserve Fund” which shall be invested
in any or all of the following

a) In interest-bearing bonds, securities or other evidences of

indebtedness of the Government of the Philippines, or in bonds,

securities, promissory notes and other evidences of indebtedness to

which full faith and credit and unconditional guarantee of the

Republic of the Philippines is pledged;



B) IN DEBT SECURITIES AND CORPORATE BONDS
PROVIDED, THAT SUCH SECURITIES AND BONDS ARE
RATED TRIPLE “A” BY AUTHORIZED ACCREDITED
DOMESTIC RATING AGENCIES, AND THE ISSUING OR
ASSUMING ENTITY OR ITS PREDECESOR SHALL NOT HAVE
DEFAULTED IN THE PAYMENT OF INTEREST ON ANY OF ITS
SECURITIES. DURING THE LAST THREE (3) FISCAL YEARS
PRECEDING THE DATE OF ACQUISITION BY THE
CORPORATION OF SUCH DEBT SECURITIES AND
CORPORATE BONDS. PROVIDED, FURTHER, THAT THE NET
EARNINGS OF THE ISSUING OR ASSUMING INSTITUTION
AVAILABLE FOR ITS RECURRING EXPENSES SUCH—AS
AMORTIZATION OF DEBT DISCOUNT AND RENTALS FOR
LEASED PROPERTIES, INCLUDING INTEREST ON FUNDED
AND UNFUNDED DEBT, SHALL NOT BE LESS THAN 1.25
TIMES OF THE TOTAL RECURRING EXPENSES FOR THE
INVESTMENT YEAR: PROVIDED, FINALLY, THAT THE
INVESTMENT ON THESE BONDS AND SECURITIES SHALL
NOT EXCEED FIFTEEN PERCENT (15%) OF THE INVESTMENT
RESERVE FUND,
XXX XXX XX

F) IN BONDS, SECURITIES, PROMISSORY NOTES OR OTHER
EVIDENCE OF INDEBTEDNESS OF ACCREDITED AND
FINANCIALLY SOUND MEDICAL INSTITUTIONS
EXCLUSIVELY TO FINANCE THE CONSTRUCTION,
IMPROVEMENT AND MAINTENANCE OF HOSPITALS AND
OTHER MEDICAL FACILITIES: PROVIDED, THAT SUCH
SECURITIES AND INSTRUMENTS ARE BACKED UP BY THE
GUARANTEE OF THE REPUBLIC OF THE PHILIPPINES (ROP)
OR THE ISSUING MEDICAL INSTITUTION AND THE ISSUED
SECURITIES AND BONDS ARE BOTH RATED TRIPLE “A” BY
AUTHORIZED ACCREDITED DOMESTIC RATING AGENCIES:
PROVIDED FURTHER. THAT SAID INVESTMENTS SHALL NOT
EXCEED TEN PERCENT (10%) OF THE TOTAL INVESTMENT



THE CORPORATION MAY, THROUGH A PUBLIC BIDDING,
HIRE LOCAL FUND OR INVESTMENT MANAGERS TO
MANAGE THE INVESTMENT RESERVE FUND.

SEC. 28. Contributions. — All members [of the program] WHO CAN
AFFORD TO PAY shal! contribute 10 the Fund, in accordance with a
reasonable, equitable and progressive contribution schedule to be determined
by the Corporation on the basis of applicable actuarial studies and in
accordance with the following guidelines:

a) | MEMBERS IN THE formal [sector employees] ECONOMY
and current Medicare members} and their employers shall continue paying the
same monthly contributions as provided for by law until such time that the
Corporation shail have determined [the] A NEW contribution schedule
{mentioned herein]: Provided, That their monthly contributions shall not
exceed [three percent (3%)} FIVE PERCENT (5%) of their respective monthly
salaries

b) Contributions from {self-employed members] MEMBERS IN
THE INFORMAL ECONOMY shall be based primarily on household
earnings and assets. {; thei total contributions for one year shall not, however,
exceed-three percent (3%) of their estimated actual net income for the
preceding, year}: THOSE FROM THE LOWEST INCOME SEGMENT WHO
DO NOT QUALIFY FOR FULL SUBSIDY UNDER THE MEANS TEST
RULE OF THE NATIONAL GOVERNMENT SHALL BE ENTIRELY
SUBSIDIZED BY THE LOCAL GOVERNMENT UNITS OR THROUGH
COST SHARING MECHANISMS BETWEEN/AMONG LOCAL
GOVERNMENT UNITS AND/OR LEGISLATIVE SPONSORS AND/OR
OTHER SPONSORS AND/OR THE ENROLEE INCLUDING THOSE FOR
BARANGAY VOLUNTEERS WHO FALL UNDER THIS CATEGORY:
PROVIDED, TUAY THE (IDENTIFICATION OF BENEFICIARIES WHO
SHALL RECEIVE SUBSIDY FROM LOCAL GOVERNMENT UNITS
SHALL BE BASED ON A LIST TO BE PROVIDED BY THE NATIONAL
GOVERNMENT THROUGH THE SAME MEANS TEST RULE OF THE
NATIONAL GOVERNMENT OR ANY OTHER APPROPRIATE
STATISTICAL METHOD THAT MAY BE ADOPTED FOR SAID
PURPOSE



THE FULL ANNUAL PREMIUM CONTRIBUTIONS OF
HOUSEHELPERS SHALL BE PAID BY THEIR EMPLOYERS

THE REQUIRED NUMBER OF MONTHLY PREMIUM
TRIBUTIONS TO QUALIFY A LIFETIME MEMBER MAY BE
INCREASED BY THE CORPORATION TO SUSTAIN THE FINANCIAL
VIABILITY OF THE PROGRAM: PROVIDED FURTHER, THAT THE
INCREASE SHALL BE BASED ON ACTUARIAL ESTIMATE AND
STUDY.

17 SHALL BE MANDATORY FOR ALL GOVERNMENT
AGENCIES TO INCLUDE THE PAYMENT OF PREMIUM
CONTRIBUTION IN THEIR RESPECTIVE ANNUAL
APPROPRIATIONS: PROVIDED FINALLY, THAT ANY INCREASE IN
THE PREMIUM CONTRIBUTION OF THE NATIONAL GOVERNMENT
AS EMPLOYER SHALL ONLY BECOME EFFECTIVE UPON
INCLUSION OF SAID AMOUNT IN THE ANNUAL GENERAL
APPROPRIATIONS ACT.

29. Payment for Indigent Contributions, ~ PREMIUM
[Contributions for indigent members AS IDENTIFIED BY THE
NATIONAL GOVERNMENT THROUGH A MEANS TEST OR ANY
OTHER APPROPRIATE STATISTICAL METHOD shall be FULLY

subsidized {partially} by the flocal government unit] NATIONAL
GOVERNMENT {where the member resides. THE AMOUNT
NECESSARY SHALL BE INCLUDED IN THE APPROPRIATIONS FOR
THE DEPARTMENT OF HEALTH UNDER THE ANNUAL GENERAL
APPROPRIATIONS ACT. [The Corporation shall provide counterpart
financing equal to the LGUs subsidy for indigents: Provided, That in the case

of fourth, fifth and sixth class municipalities, the National Government shall

provide up to ninety percent (90%) of the subsidy for indigents until such time

that they shall have been uperaded to first, second or third class municipalities
‘The share of the LGUs shall be progressively increased until such time that its
share becomes equal to that of the National Government.)

THE PREMIUM CONTRIBUTIONS OF ORPHANS, ABANDONED
AND ABUSED MINORS. OUT OF SCHOOL YOUTHS, STREET

ILDREN, PERSONS WITH DiSABILITIES, SENIOR CITIZENS AND



2 BATTERED WOMEN UNDER THE CARE OF THE DEPARTMENT OF

2 SOCIAL WELFARE AND DEVELOPMENT (DSWD), OR ANY OF ITS
3 ACCREDITED INSTITUTIONS RUN BY NON-GOVERNMENTAL
4 ORGANIZATIONS (NGOS) OR ANY NON-PROFIT PRIVATE
5 ORGANIZATIONS, SHALL BE PAID BY THE DSWD AND THE FUNDS
6 NECESSARY FOR THEIR INCLUSION IN THE PROGRAM SHALL BE
a INCLUDED IN THE ANNUAL BUDGET OF THE DSWD.”
8 SEC. 8. Section 32 of the same Act, as amended, is hereby further amended
9 to read as follows
10 “SEC. 32. Accreditation Eligibility. — All health care providers, as
mM enumerated in Sec 4 (0) hereof and operating for at least three (3) years may
12 apply for accreditation: Provided, That a health care provider which has not
13 operated for at least three (3) years may likewise apply and qualify for
14 accreditation if it complies with all the other accreditation requirements of and
15 further meets any of the following conditions:
16 a) Its managing health care professional has had a working
17 experience in another accredited health care institution for at least three (3)
18 years,
19 b) _Itoperates as a tertiary facility or its equivalent;
20 ©) It operates in a local government unit where the accredited
21 health care provider cannot adequately or fully service its population, and
2 d) Other conditions as may be determined by the Corporation.
23 A HEALTH CARE PROVIDER FOUND GUILTY OF ANY
24 VIOLATION OF THIS ACT SHALL NOT BE ELIGIBLE TO APPLY FOR
25 ‘THE RENEWAL OF ACCREDITATION.”
26 SEC. 9. Sections 34 and 35 of the same Act, as amended, are hereby
27 amended to read as follows
28 “SEC. 34. Provider Payment Mechanisms —~ The ‘ollowing
29 mechanisms for public and private providers shall be aliowed in the Program.
30 a) _Fee-for-service [based] OR PAYMENT BASED ON THE
31 COST OF SERVICES RENDERED UNDER THE mechanisms established
32 by the Corporation;
33 B) CASE-BASED PAYMENT OR PAYMENT BASED ON A
34 PRE-DETERMINED FIXED RATE FOR EACH TREATED CASE OR

DISEASE AS DETERMINED BY THE CORPORATION:



Ou aw

[b] C} Capitation of health care professionals and facilities, or
networks of the same including HMOs. medical cooperatives, and other
legally formed health service groups; AND

{c] [A combination of both, and]

d) Any or all of the above, [subject] PROVIDED, THAT IT SHALL
BE CONSIDERED AS {to} global budget.

NO OTHER FEE OR EXPENSE SHALL 8E CHARGED TO THE
INDIGENT PATIENT.

THE HEALTH CARE PROVIDER SHALL BE ALLOWED TO
CHARGE THE MEMBER ONLY FOR AMENITIES AND SERVICES NOT
INCLUDED IN THE BENEFIT PACKAGE BUT VOLUNTARILY
CHOSEN BY THE MEMBER: PROVIDED, THAT THE MEMBER HAS
PREVIOUSLY AGREED TO PAY THE COST OF SUCH SERVICES.

SUBJECT TO THE APPROVAL OF THE BOARD, THE
CORPORATION MAY ADOPT OTHER PAYMENT MECHANISMS
THAT ARE MOST BENEFICIAL TO THE MEMBERS AND TO THE
CORPORATION

Each [Office] PHILHEALTH LOCAL OFFICE shall recommend the
appropriate payment mechanism within its jurisdiction for approval by the
Corporation. Special consideration shall be given to payment for services
rendered by public and private health care providers serving remote or
medically underserved areas.”

SEC. 10. Section 35 of the same Act, as amended, is hereby amended to read
as follows

“SEC. 35. [Fee-for-service Payments and Payment in General. ~ Fee-
for-service payments may be made separately for professional fees and
hospital charges, or both, based on arrangements with health care providers
This fee shall be based on a schedule to be established by the Board which

shall be reviewed every three (3) years. Fees paid for professional services

rendered by salaried public providers shall be allowed io be retained by the
health facility in which services are rendered and be pooled and distributed
among health personnel. Charges paid to public facilities shall be allowed to
be retained by the individual facility in which services were rendered and for
which payment was made. Such revenues shall be used to defray operating

costs other than salaries, to maintain or upgrade equipment, plant or



o

28
29

31
32
33
34

aintain or improve the quality of service in the public sector]
‘O FILE CLAIMS. ~ ALL. C1AIMS FOR REIMBURSEMENT OR
PAYMENT FOR SERVICES RENDERED SHALL BE FILED WITHIN A
PERIOD OF SIXTY (60) CALENDAR DAYS FROM THE DATE OF
DISCHARGE OF THE PATIENT FROM THE HEALTH CARE
PROVIDER

THE PERIOD TO FILE THE CLAIM MAY BE EXTENDED FOR

SUCH REASONABLE CAUSES DETERMINED BY THE
CORPORATION.”

SEC, 11. Sections 41, and 42 of the same Act, as amended, are hereby
amended to read as follows:

“SEC. 41. Grievance and Appeal Procedures. — A member, {his] A
dependent, or a health care provider may file a complaint for grievance based
on any of the above grounds, in accordance with the following procedures

a) A complaint for grievance must be filed with the [Office]
CORPORATION which shali REFER SUCH COMPLAINT TO THE
GRIEVANCE AND APPEAL REVIEW COMMITTEE. THE GRIEVANCE
AND APPEAL REVIEW COMMITTEE SHALL rule on the complaint
THROUGH A NOTICE OF RESOLUTION within [ninety (90)] SIXTY (60)
calendar days from receipt thereof’

b) Appeals fiom {Office} THE DECISION OF THE
GRIEVANCE AND APPEAL REVIEW COMMITTEE must be filed with the
Board within thirty (30) CALENDAR days from receipt of THE notice of
RESOLUTION [dismissal or disallowance by the Office].

xx Xxx XXX.”

SEC. 42. Grievance and Appeal Review Committee. — The Board shall
create a Grievance and Appeal Review Committee, composed of [three (3) to]
five (5) members, hereinafter referred 10 as the Committee, which, subject to
the procedures enumerated above, shall receive and recommend appropriate
action on complaints from members and health care providers relative to this
Act and its implementing rules and regulations.

THE COMMITTEE SHALL HAVE AS ONE OF ITS MEMBERS A
REPRESENTATIVE OF ANY OF THE ACCREDITED HEALTH CARE
PROVIDERS AS ENDORSED BY THE DEPARTMENT OF HEALTH”



SEC. 12 Section 44 of the same Act, as amended, is hereby further amended
to read as follows:

“SEC. 44. Penal Provisions. ~ Any violation of the provisions of this
Act, after due notice and hearing, shall suffer the following penalties:

A) VIOLATION BY AN ACCREDITED HEALTH CARE
PROVIDER - ANY ACCREDITED HEALTH CARE PROVIDER WHO
COMMITS A VIOLATION, ABUSE, UNETHICAL PRACTICE OR
FRAUDULENT ACT WHICH TENDS TO UNDERMINE OR DEFEAT
THE OBJECTIVES OF THE PROGRAM SHALL BE PUNISHED WITH
[A] 4 fine of not less than {Ten} FIFTY id pesos {(P10,000.00)}
(50,000.00) [nor] BUT NOT more than [Fifty] ONE HUNDRED thousand
pesos [(P50,000.00)} (P100,000.00) jin case the violation is committed by the

hospital management or provider. In- addition, its accreditation shall be
suspended or revoked] OR SUSPENSION OF ACCREDITATION from three
G) menths to the whole term of accreditation, OR BOTH AT THE
DISCRETION OF THE CORPORATION: Provided, \however,] That

iecidivists may not anymore] NO LONGER be accredited as a participant of
the Program;

B) VIOLATIONS OF A MEMBER - {A fine of not less than Five
hundred pesos (P500.00) nor more than Five thousand pesos (P5,000.00) and
imprisonment of not less than six (6) months nor more than one (1) year in
case the violation is committed by the member] ANY MEMBER WHO
COMMITS ANY VIOLATION OF THIS ACT INDEPENDENTLY OR IN
CONNIVANCE WITH THE HEALTH CARE PROVIDER FOR PURPOSES
OF WRONGFULLY CLAIMING NHIP BENEFITS OR ENTITLEMENT,
SHALL BE PUNISHED WITH A FINE OF NOT LESS THAN FIVE
THOUSAND PESOS (P5,000.00) GR SUSPENSION FROM AVAILMENT
OF NHIP BENEFITS FOR NOT LESS THAN THREE (3) MONTHS BUT
NOT MORE THAN SIX (6} MONTHS, OR BOTH AT THE DISCRETION
OF THE CORPORATION

©) VIOLATIONS OF AN EMPLOYER —

1. FAILURE, REFUSAL TO REGISTER, DEDUCT, REMIT
THE CONTRIBUTIONS — {Where the violaticas consist of failure or refusal

to deduct contributions from the employee's compensation or to remit the

same to the Corporation, the penalty shall be 2 fine of not less than Five

20



hundred pesos (P500.00) but not more than One thousand pesos (P1,000.00)
multiplied by the total number of employees employed by the firm and
imprisonment of not less than six (6) months but not more than one (1) year.]
ANY EMPLOYER WHO FAILS OR REFUSES TO REGISTER
EMPLOYEES, REGARDLESS OF THEIR EMPLOYMENT STATUS. OR
TO DEDUCT CONTRIBUTIONS FROM THE EMPLOYEE'S
COMPENSATION OR REMIT THE SAME TO THE CORPORATION
SHALL BE PUNISHED WITH A FINE OF NOT LESS THAN FIVE
THOUSAND PESOS (P5,000.00) MULTIPLIED BY THE TOTAL
NUMBER OF EMPLOYEES OF THE FIRM

Any employer or any officer authorized to collect contributions under
this Act who, after collecting or deducting the monthly contributions from his
employee's compensation, fails to remit the said contributions to the
Corporation within thirty (30) days from the date they become due shall be
presumed to have misappropriated such contribution fand shall suffer the
penalties provided for in Article 315 of the Revised Penal Code}

2. UNLAWFUL DEDUCTIONS ~ Any employer or OFFICER
who shall deduct directly or indirectly from the compensation of the covered
employees or otherwise recover from them his own contribution on behalf of
such employees shall be punished [by] with a fine [not exceeding One] OF
FIVE thousand pesos {(P1,000 00)] (P5,000.00) multiplied by the total number
of AFFECTED employees [employed by the firm, or imprisonment not
exceeding one (1) year, or both fine and imprisonment, at the discretion of the

court}

If the act or omission penalized by this Act be committed by an
association, partnership, corporation or any other institution, its managing
directors or partners or president or general manager. or other persons
responsible for the commission of the said act shall be liable for the penalties
provided for in this Act [and other laws for the offense]

3. MISAPPROPRIATION OF FUNDS BY EMPLOYEES OF
THE CORPORATION ~ Any employee of the Corporation who receives or
keeps funds or property belonging, payable or deliverable to the Corporazion,
and who shall appropriate the same, or shall take or misappropriate or shall
consent, or through abandonment or negligence shall permit any other person

to take such property or funds whol! or partially, shall likewise be liable for



1 misappropriation of funds or property and shall BE PUNISHED WITH [suffer

imprisonment of not less than six (6) years and not more than twelve (12)

3 years and) a fine of not less than Ten thousand pesos (P10,000.00) nor more
4 than Twenty thousand pesos (P20,000.00). Any shortage of the funds or loss
S of the property upon audit shall be deemed prima facie evidence of the
6 offense

7 4. OTHER VIOLATIONS - OTHER VIOLATIONS OF THE
8 PROVISIONS OF THIS ACT OR OF THE RULES AND REGULATIONS
9 PROMULGATED BY THE CORPORATION SHALL BE PUNISHED
10 WITH A FINE OF NOT LESS THAN FIVE THOUSAND PESOS
n (P5,00000) BUT NOT MORE THAN TWENTY THOUSAND PESOS
1, (P20,009.00).

3 All other violations involving funds of the Corporation shall be
14 governed by the applicable provisions of the Revised Penal Code or other
15 laws, taking into consideration the rules on collection, remittances, and
16 investment of funds as may be promulgated by the Corporation

7 THE CORPORATION MAY ENUMERATE CIRCUMSTANCES
18 THAT WILL MITIGATE OR AGGRAVATE THE LIABILITY OF THE
19 OFFENDER OR ERRING HEALTH CARE PROVIDER, MEMBER OR
20 EMPLOYER
2 DESPITE THE CESSATION OF OPERATION BY A HEALTH
22 CARE PROVIDER OR TERMINATION OF PRACTICE OF AN
23 INDEPENDENT HEALTH CARE PROFESSIONAL WHILE THE
24 COMPLAINT IS BEING HEARD. THE PROCEEDING AGAINST THEM
25 SHALL CONTINUE UNTIL THE RESOLUTION OF THE CASE
26 THE DISPOSITIVE PART OF THE DECISION REQUIRING
ay PAYMENT OF FINES, REIMBURSEMENT OF PAID CLAIM OR
28 DENIAL OF PAYMENT SHALL BE IMMEDIATELY EXECUTORY~”

29 SEC. 13. Section 46 of the same Act, as amended, IS hereby FURTHER
30 amended to read as follows

ak “SEC. 46. [Subsequent Appropriations] FUNDING SOURCE. —
EPA THE AMOUNT NECESSARY FOR THE IMPLEMENTATION OF THIS
3 ACT SHALL BE SOURCED FROM THE FOLLOWING.

[Starting 1995 and thereafter, twenty-five percent (25%) of the

increment in total revene collected under Republic Act No. 7654 shall be



Wy

appropriated in the General Appropriations Act solelv for the National Health
Insurance Fund {

A) [ln addition.) {s}Starting [1996 and thereafter] 2012,] Twenty-
five percent (25%) of the incremental revenue from the increase in the
documentary stamp taxes under Republic Act No. 7660, AS AMENDED BY
REPUBLIC ACT NO. 7875 shali [likewise] be appropriated solely for the
[said] National Health Insurance [f]Fund;

B) THREE PERCENT (3%) FROM THE SALE PROCEEDS OF
MILITARY CAMPS UNDER REPUBLIC ACT NO. 7227, AS AMENDED
BY REPUBLIC ACT NO. 7917;

C) AS COUNTERPART CONTRIBUTION OF THE LOCAL
GOVERNMENT, TEN PERCENT (10%) OF THE FIFTY PERCENT (50%)
LOCAL GOVERNMENT SHARE FROM THE INCREMENTAL
REVENUE FROM VALUE-ADDED TAX UNDER REPUBLIC ACT NO
9337

IN ADDITION, ANY AMOUNT CORRESPONDING TO A
PERCENTAGE OF THE INCREMENTAL REVENUE FROM THE EXCISE
TAX ON ALCOHOL AND TOBACCO PRODUCTS AS MAY BE
PRESCRIBED UNDER APPLICABLE LAWS SHALL BE USED FOR THE
IMPLEMENTATION OF THIS ACT. THE CORPORATION MAY
LIKEWISE REQUEST CONGRESS TO APPROPRIATE SUPPLEMENTAL
FUNDING TO ACHIEVE THE OBJECTIVES OF THE UNIVERSAL
HEALTHCARE,

ALL THESE FUNDS SHALL BE APPROPRIATED UNDER THE
BUDGET OF THE DEPARTMENT OF HEALTH”

SEC. 14. Section 49 of the same Act, as amended, is hereby amended to read

as follows
“SEC. 49. implementing Rules and Regulations. ~ Within {thirty (30)
SIXTY (60) days [fom the completion of such appointments, the Board shall
convene to formulate the rules and regulations necessary for the
implementation of this Act.] FROM THE EFFECTIVITY OF THIS ACT,
THE CORPORATION, IN COORDINATION WITH THE DEPARTMENT
OF HEALTH SHALL ISSUE THE NECESSARY RULES AND
REGULATIONS FOR {1S EFFECTIVE IMPLEMENTATION.”



1 SEC. 15, Section 54 of the same Act, as amended, is hereby further amended

2 toread as follows:

Be: “SEC. 54. CONGRESSIONAI. Oversight (Provision) COMMITTEE.
4 {Congress shall conduct a regular review of the National Health Insurance
5 Program which shall entail a systematic evaluation of the Program’s
é performance, impact or accomplishments with respect to its objectives or
7 goals, Such review shall Se undertaken by the Committee of the Senate and
8 the House of Representatives which fiave legislative jurisdiction over the
9 Program.| A JOINT CONGRESSIONAL OVERSIGHT COMMITTEE 1S
10 HEREBY CREATED WHICH SHALL BE COMPOSED OF THE
ui CHAIRPERSON OF THE SENATE COMMITTEE ON HEALTH AND
12 DEMOGRAPHY AND FIVE (5) OTHER SENATORS DESIGNATED BY
13 THE SENATE PRESIDENT, AND THE CHAIRPERSON OF THE HOUSE
14 COMMITTEE ON HEALTH AND FIVE (5) OTHER MEMBERS OF THE
1s HOUSE OF REPRESENTATIVES DESIGNATED BY THE SPEAKER OF
16 THE HOUSE OF REPRESENTATIVES: PROVIDED, THAT, OF THE
7 FIVE (5) MEMBERS TO BE DESIGNATED BY EACH CHAMBER,
18 THREE (3) MEMBERS SHALL BE FROM THE MAJORITY AND THE
19 REMAINING TWO (2) MEMBERS SHALL BE FROM THE MINORITY,
20 THE JOINT CONGRESSIONAL OVERSIGHT COMMITTEE
21 SHALL HAVE THE POWER TO MONITOR AND EVALUATE THE
22 IMPLEMENTATION OF THIS ACT

23 THE OVERSIGHT COMMITTEE CREATED UNDER THIS A
24 SHALL EXIST FOR A PERIOD NOT EXCEEDING FIVE (5) YEARS
25 FROM THE EFFECTIVITY OF THIS ACT. AFTER WHICH THE
26 OVERSIGHT FUNCTIONS SHALL BE PERFORMED BY THE
OF: COMMITTEE ON HEALTH AND DEMOGRAPHY OF THE SENATE
28 AND THE COMMITTEE ON HEALTH OF THE HOUSE OF
29 REPRESENTATIVES.

30 The National Economic and Development Authority, in coordination
3t with the National Statistics Office and the National Institute of Health of the
32: University of the Philippines. INCLUDING THE PHILIPPINE INSTITUTE
33 OF TRADITIONAL AND ALTERNATIVE HEALTH CARE IN THE CASE
34 OF ALTERNATIVE CARE, TRADITIONAL MEDICINE AND HERBAL

validate the

studies

to

LTH SERVIC



accomplishments of the Program. The budget required to undertake such study
shall come from the income of the Philhealth”

SEC. 16 . New sections to be denominated as Sections 55, 56, 57 and 58
under Article XH. MISCELLANEOUS PROVISIONS, are hereby added to
read as follows

“SEC. 55. FILING OF OTHER LEGAI. ACTIONS BEFORE THE
PROPER COURIS. ~ THE FILING OF AN ADMINISTRATIVE ACTION
AGAINST ANY HEALTH CARE PROVIDER, EMPLOYER OR MEMBER
UNDER THIS ACT SHALL BE WITHOUT PREJUDICE TO THE FILING
OF ANY OTHER LEGAL ACTIONS UNDER THE REVISED PENAL
CODE OR ANY OTHER LAWS IN THE PROPER COURTS.

SEC. 56. LEGAL ASSISTANCE AND BENEFITS. - ANY OFFICER,
EMPLOYEE, OR AUTHORIZED REPRESENTATIVE OF ‘THE
CORPORATION WHO MAY BE SUED BY ANY HEALTH CARE
PROVIDER, MEMBER, STAKEHOLDER OR ANY OTHER PERSON OR
ENTITY IN CONNECTION WITH THE PERFORMANCE OF DUTIES
AND OBLIGATIONS UNDER THE NHIP MAY BE PROVIDED LEGAL
ASSISTANCE OR COUNSEL BY THE CORPORATION UPON
APPROVAL BY THE BOARD

SEC. 57. REQUISITES FOR ISSUANCE OR RENEWAL OF
LICENSE, OR PERMITS. ~ NOTWITHSTANDING ANY LAW TO THE
CONTRARY, ALL GOVERNMENT AGENCIES —_ ISSUING
PROFESSIONAL OR BUSINESS LICENSE OR PERMIT, SHALL
REQUIRE ALL APPLICANTS TO SUBMIT CERTIFICATE OR PROOF
OF PAYMENT OF PHILHEALTH PREMIUM CONTRIBUTIONS. PRIOR
TO THE ISSUANCE OR RENEWAL OF SUCH LICENSE OR PERMIT

SEC. 58. APPLICABILITY OF PROVISIONS. ~ COMPLAINTS
ALREADY FILED WITH, AND UNDER DELIBERATION BY
APPROPRIATE BODIES OF THE CORPORATION PRIOR TO THE
EFFECTIVITY OF THIS ACT SHALL BE GOVERNED IN
ACCORDANCE WITH THE PREVIOUS LAWS AND THEIR
IMPLEMENTING RULES AND REGULATIONS ”

SEC. 17. Sections 55, 56, 57, 58 and 59 of Republic Act No. 7875, as

amended, are hereby renumbered as Sections 60, 61, 62 and 63 respectively



SEC. 18. Effectivity. - This Act shall take effect fifteen (15) days after its
publication in at least two (2) newspapers of general circulation

Approved,



[s House Bills

FACT SHEET

House Bill No.__
(In substitution of House Bills No. 20, 87, 102, 150, 210, 265, 367, 495, 637,
655, 937. 961, 1083, 1202, 1267, 1566, 1567, 1612, 1628, 1847, 1854, 1965,
2099, 2174, 2441, 2547, 2711, 2939, 3090. 3142, 3143, 3144, 3405, 3499,
3544, 3545, 3795, 3921, 4116, 4150, 4168 4235, 4236, 4238, 4339, 4340,
4430, 4590, 5003, 5038, 5047, 5177, 5270, 5283, 5284)
(As approved by the Committee on May 25, 2011)

“AN ACT PROVIDING HEALTHCARE SERVICES TO ALL
FILIPINOS, FURTHER AMENDING FOR THE PURPOSE
REPUBLIC ACT NO. 7875 OTHERWISE KNOWN AS THE
‘NATIONAL HEALTH INSURANCE ACT OF 1995’ AS AMENDED,
AND FOR OTHER PURPOSES.”

Introduced by. Reps. Marcelino R. Teodoro, Juan Edgardo M. Angara, Janette L.
Garin, Ben P. Evardione, Neptall M4, Gonzales, Mary Mitzi L. Cajayon, Susan A.
Yap, Augusto Boboy, D. Syjuco, Bernadette R. Herrera-Dy, Rufus B. Rodriguez,
Maria Milagros E. Magsaysay, Eufranio C. Eriguel, Mark A. Villar, Lorenzo R.
Tafhada, Daisy Avance-Fuentes, Ignacio T. Arroyo, Joseph Victor G. Ejercito,
Imelda @. Callxto-Rublano, Witfride Mark C. Enverga, Maria Carmen. Zamora-
Apsay, George P. Araiz, Ma. Theresa 8. Bonoan-David, Mariano Michael M.
Velarde Jr, Irwin C. Tieng, Loreto S. Ocampos, Alfredo D. Marafion ill, Anthony
Rolando T. Golez, Felictano R. Belmonte, Abigail Faye C. Ferriol, Rogelio J.
Espina, Philip A. Pichay, Diosdado M. Arroyo, Romeo M. Acop, Salvio B.
Fortuno, Kimi $. Cojuanco, Anthony G. Del Rosario, Winston Castelo, Carmelo
F. Lazatin, Erico B. Aumentado, Me. Amelita A. Calimbas-Villarosa, Rachel
Marguerite B. Del Mar, Bernardo M. Vergara, Cesar V. Sarmiento, Josephine
Veronique R. Lacson-Noel, Patricio T. Antonio, Arnulfo F, Go, Arne! M.
Cerafica, Eleanor C. Bulut-Begtang, Christopher S. Co, Rodel M. Batocabe,
Maximo B. Rodriguez, Rodante D. Marcoleta, Rosenda Ann Ocampo, Irvin M.
Alcala, Thelma Z. Almario, Giorgidi B. Aggabao, Alfredo A. Garbin Jr., Tomas V.
Apacible, Jose Carlos 1. Carl, Nell Benedict A. Montojo, Gloria A. Macapagal-
Arroyo, Catalina C. Bagasins, Monique Yazmin Q. Lagdameo, Mar-Len Abigail
S. Binay, Ma. Georgina P. De Venecla, Marla Isabelle G. Climaco, Salvador H.
Escudero ili, Joel Roy R. Duavit, Me! Senen S. Sarmiento, Randolph S. Ting,
Deogracias B. Ramos Jr, Angelo B. Palmones, Benhur L. Salimbangon,
Herminia B. Roman, Linabelle Ruth R. Villarica, Irvin M. Alcala, Lani Mercado-
Revilla, Ryan Luis Singson, Salvador P. Cabaluna, Cinchona Cruz-
Gonzales, Romero Federico S. Quimbo, David L. Kho, Emerenciana A.
De Jesus, Mohammed Hussein P. Pangandaman, Lucy Torres Gomez,
Salvador H, Escudero ill, Reena Concepcion G. Obillo, Jose Carlos L.
Cari, Jesus F. Celeste, Ma. Evita R. Arago, Arthur C. Yap, Juan Miguel
Macapagal- Arroyo, Bai Sandra A. Sema,Amado S. Bagatsing, Edwin
Olivarez, Alfredo Abelardo B. Benitez, Dary Grace Abayon, Peter Unabia,
Imelda Dimaporo, Albert Garcia

Committee Referal: COMMITTEE ON HEALTH (Primary)
Committee Chairperson: HON. ALFREDO D. MARANON lil
Committee Referral: COMMITTEE ON APPROPRIATIONS (Secondary)

Committee Chairperson: HON, JOSEPH EMILIO-A-ABAYA.-~



OBJECTIVES:

* To make ail citizens of the country automatically covered by the
Philippine Health insurance Program

¢ To strengthen the Philippine Health Insurance Corporation (Philhealth)
by. granting additional powers to the Corporation

KEY PROVISIONS:

Amends Section 29 of R.A. 7875 as amended, by mandating the
national government to fully subsidize the premium contribution of
indigents as identified by the national government through a means test
or any appropriate statistical methods, The premium payment of those
who do not qualify for full government subsidy will be shouldered
entirely by the local government units through a cost sharing
mechanisms between and among LGUs, district legislators and private
sector donors and enrolees Premium payment for househelpers will be
paid by their employers;

« Mandates automatic and mandatory enroliment in the Philippine Health
Insurance Program for all citizens of the Philippines and qualified
foreigners. Mandatory coverage to the program includes the enrollees
under the following categories: a) workers in the formal economy; b)
workers in the informa! economy; c) enrolled indigents; and d) lifetime
members;

© Mandates compulsory health insurance in all Local Government Units
(LGUs) nationwide through the National Health Insurance Program,
notwithstanding the existence of an LGU-based health insurance
programs;

* Provides for payment schemes other than the fee-for-service to include,
case-based payment, capitation of health care professionals and
facilities, or a combination of payment schemes;

« Allows the Corporation to set aside a portion of its accumulated
revenues not needed to meet the cost of the current year's expenditures
as reserve fund to be used for the following: a) increase in benefit or
decrease of members’ contributions; b) augmentation of “Health
Facilities Enhancement Program” of the Department of Health; and c)
development and maintenance of electronic data bank of members,

* — Strengthens the powers of the Philippine Health Insurance Corporation
PHIC) by:

eats its visitorial power to enable the Corporation to secure
copies of medical and financial records not only of the health care
providers and employers but also of their patients and employees;
tasking the corporation to conduct post-audit on the quality of services
rendered by health care providers, among others;

empowering the Corporation to mandate the national agencies and

N

3.

cung With private individuals or aroups

local.governnsents to require proof of Phithealth membership before...


4 granting the Corporation the power to accredit independent
pharmacies and other retail outlets; and

5. imposing three percent (3%) interest and or surcharges per month on
hospitals in case of any delay in remittance of contributions which are
due within the prescribed period;

Ensures that the Corporation adequately compensates the health care
provider within sixty (60) calender days from the date of filing of claims
for reimbursements;

Penalizes any employer who fails or refuses to register its employees
regardless of employment status (contractual, casuals, etc.) or to deduct
contributions from the employee's compensation or remit the same to the
Corporation with a fine of P5,000. multiplied by the number of affected
employees of the firm;

Defines offenses and abuses against institutional health care providers,
health care professionals and members and providing penalties thereof.

RELATED LAWS

°

R.A. No. 7875 as amended by R.A. No. 9241
The Revised Penal Code