SEVENTEENTH CONGRESS )
REPUBLIC OF THE PHILIPPINES )
Second Regular Session )

HOUSE OF REPRESENTATIVES,

Introduced by Representative Maximo B. Rodriguez, Jr.
House Bill No. ‘7002

EXPLANATORY NOTE

Article II, Section 13 of the Constitution states that the State recognizes the vital role
of the youth in nation-building and shall promote and protect their physical, moral, spiritual,
intellectual, and social well-being. Section 15 of Article I! also states that it is the policy to
protect and promote the right to health of the people and instill health consciousness among
them. Further, Section 11 of Article Xill states that the State shall adopt an integrated and
‘comprehensive approach to health development which shall endeavor to make essential
goods, health and other social services available to all the people at affordable cost. There
shall be priority for the needs of the underprivileged sick, elderly, disabled, women, and
children, The state shall endeavor to provide free medical care to paupers.

Statistics show that 31% and 32.9% of pre-school and grade school children,
respectively, are underweight. It only shows that these children come from families living
below poverty line,

This bill seeks to establish the Children's Health Insurance Program. Under this
program, eligible children coming from low-income families shall be entitled to a full range of
health services that include, but do not limit to, regular check-ups, immunizations,
prescription drugs, lab tests, dental care. This is in line with the Millennium Development
Goals of reducing child mortality, among others.

In view of the foregoing, early passage of this bill is eamestly sought.

< Min

MAXIMO B. RODRIGUEZ, JR.


SEVENTEENTH CONGRESS
REPUBLIC OF THE PHILIPPINES )
Second Regular Session )

HOUSE OF REPRESENTATIVES

Introduced by Representative Maximo B. Rodriguez, Jr.
House Bill No7 552

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

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

‘SECTION 1. Section 4 of Republic Act No. 7875 is hereby amended to read as follows:

“SEC. 4. Definition of Terms. - For the purposes of this Act, the following
terms shall be defined as follows:

20x
(4) CHILD HEALTH ASSISTANCE - A RANGE OF HEALTH CARE AND
SUPPORT SERVICES INCLUDING, BUT NOT LIMITED TO, PHYSICIAN
SERVICES AND ANY OTHER MEDICAL, DIAGNOSTIC, SCREENING,
PREVENTIVE, RESTORATIVE , REMEDIAL, THERAPEUTIC OR
REHABILITATIVE SERVICES;

20K
(3) Member - Any person whose premiums have been regularly paid to the
National Health insurance Program. He may be a paying member, an indigent
member, A QUALIFIED CHILD MEMBER, or a pensioner / retiree member.

2x
(dd) QUALIFIED CHILD MEMBER - ANY CHILD OF A LOW INCOME
FAMILY UNDER 6 YEARS OF AGE OR OVER BUT WHO ARE UNABLE TO
FULLY TAKE CARE OF THEMSELVES OR PROTECT THEMSELVES
FROM ABUSE, NEGLECT, CRUELTY, EXPLOITATION OR
DISCRIMINATION BECAUSE OF A PHYSICAL, MENTAL DISABILITY OR
CONDITION AND WHOSE FAMILY IS BELOW POVERTY LINE, AND
DETERMINED AS SUCH BY THE PERTINENT GOVERNMENT AGENCY.

SECTION 2. Section 5 of the same Act shall now read as follows:
“Sec, 5. Establishment and Purpose. - There is hereby created the National
Health Insurance Program which shall provide health insurance coverage and ensure
affordable, acceptable, available and accessible health care services for all citizens
of the Philippines, in accordance with the policies and specific provisions of this Act.
xxx. It shall initially consist of Programs | and Il of Medicare and be expanded
progressively to constitute one universal health insurance program for the entire
population. IT SHALL INITIATE AND EXPAND THE PROVISION OF CHILD
HEALTH ASSISTANCE TO INCLUDE A CHILD HEALTH INSURANCE PROGRAM
FOR UNINSURED, LOW-INCOME CHILDREN IN AN EFFECTIVE AND EFFICIENT
MANNER THAT IS COORDINATED WITH OTHER SOURCES OF HEALTH
BENEFITS COVERAGE FOR CHILDREN. 1x.


SECTION 3. Section 6 of the same Act shall now read as follows:

“SEC. 6. Coverage. - All citizens of the Philippines, WHETHER CHILD OR
ADULT, shall be covered by the National Health Insurance Program. In accordance
with the principles of universality and compulsory coverage enunciated in Section 2
(b) and 2 (1) hereof, implementation of the Program shall, furthermore, be gradual
and phased in over a period of not more than fifteen (15) years: Provided, That the
Program shall not be made compulsory in certain provinces and cities until the
Corporation shall be able to ensure that members in such localities shall have
reasonable access to adequate and acceptable health care services.”

SECTION 4. Section 7 of the same Act shall now read as follows:

“SEC. 7. Enrollment. - The Program shall enroll beneficiaries in order for
them to be placed under coverage that entitles them to avail of benefits with the
assistance of the financial arrangements provided by the Program. The process of
enrollment shall include the identification of beneficiaries, issuance of appropriate
documentation specifying eligibility to benefits, and indicating how membership was
obtained or is being maintained. The enrollment shall proceed in accordance with
these specific policies:

a) 100%;

b) 200%;

c) xxx; and

4) 100%.

All indigents AND QUALIFIED CHILD MEMBER not enrolled in the Program
shall have priority in the use and availment of the services and facilities of
govemment hospitals, health care personnel, and other health organizations:
Provided, however, That such government health care providers shall ensure that
said indigents AND QUALIFIED CHILD MEMBER shall subsequently be enrolled in
the Program.”

SECTION 5. Section 12 of the same Act shall now read as follows:
“SEC. 12. Entitlement to Benefits. - xx
The following need not pay the monthly contributions to be entitled to the
Program's benefits: Retirees and pensioners of the SSS and GSIS prior to the
effectivity of this Act; Members who reach the age of retirement as provided for by
law and have paid at least one hundred twenty (120) monthly contributions; [and]
Enrolled indigents; AND (D) QUALIFIED CHILD OF LOW-INCOME FAMILIES.

SECTION 6. Section 28 of the same Act is hereby amended to read as follows:
“SEC. 28. Contributions. - All members of the Program shall contribute to 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:
20
200%
20%
CONTRIBUTIONS MADE IN BEHALF OF A QUALIFIED CHILD MEMBER
SHALL NOT EXCEED THE MINIMUM CONTRIBUTIONS SET FOR EMPLOYED
MEMBERS.”

‘SECTION 7. A new Section 30 is hereby added to read as follows:
‘SEC. 30. Payment for a Child Beneficiary’s Contributions. CONTRIBUTIONS
FOR QUALIFIED CHILDREN BENEFICIARIES SHALL BE_ SUBSIDIZED
PARTIALLY BY THE LOCAL GOVERNMENT UNIT WHERE THE MEMBER
RESIDES. THE CORPORATION SHALL PROVIDE COUNTERPART FINANCING


EQUAL TO THE LGUS SUBSIDY FOR CHILDREN. THE SHARE OF THE LGUS
SHALL BE PROGRESSIVELY INCREASED UNTIL SUCH TIME THAT ITS SHARE
BECOMES EQUAL TO THAT OF THE NATIONAL GOVERNMENT.

SECTION 8. Implementing Rules and Regulations. Within thirty (30) days from the
effectivity of this Act, the Board of Directors of the Philippine Health Insurance Corporation
(PHIC) shall convene to formulate the rules and regulations for the implementation of this
Act.

SECTION 9. Separability Clause. If any part or provision of this Act shall be held
unconstitutional or invalid, other provisions which are not affected thereby shall continue to
be in full force and effect.

SECTION 10. Repealing Clause. All laws, presidential decrees, executive orders, rules and
regulations or parts thereof which are deemed inconsistent wit the provisions of this Act are
hereby repealed, amended, or modified accordingly.

SECTION 11. Effectivity Clause. This Act shall take effect fifteen (15) days following its full
and complete publication in an Official Gazette or in at least two (2) newspapers of general
circulation, whichever comes first.

Approved,