FIFTEENTH CONGRESS OF THE REPUBLIC 
OF THE PHILIPPINES 
) 
) 
) 
First Regular Session 
SENtJ;.F. 
S. No. 
~o8 
EXPLANATORY NOTE 
The Constitution, Article 11, Section 15, provides: 
SEC. 15. The State shall protect and promote the right to health of 
the people and instill health consciousness among them. 
A fundamental part of human expenence IS fulfilling the desire to reproduce. 
Unfortunately, millions of Filipino women and men are suffering from infertility. While recent 
improvements in therapy make pregnancy possible for more couples now than in past years, the 
majority of group health plans do not provide coverage for infertility therapy; thus, making it 
impossible for low and middle income families 10 avail of the teclmology. Hence, this bill s,eeks 
to require coverage for the treatment of infertility in any group health plan or individual health 
. 
* 
lllsurance. 
* This bill was originally filed during the Thiloteenth Congress, First Regular Session. 
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FIFTEENTH CONGRESS OF THE REPUBLIC 
) 
.t,' , 
OF THE PHILIPPINES 
) 
First Regular Session 
) 
1 
AN ACT 
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REQUIRING COVERAGE FOR THE TREATMENT OF INFERTILITY IN ANY GROUP 
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HEALTH PLAN OR HEALTH INSURANCE 
Be it enacted by the Senate and the House of Representatives of the Philippines in 
Congress assembled: 
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SECTION 1. Short Title. - This Act shall be known as the "Family Building Act." 
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SECTION 2. Standards Relating to Benefits for Treatment of infertility. 
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(A) In General. - In a case in which a group health plan and a health insurance issuer, 
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offering health insurance coverage, provide coverage for obstetrical services, such plan or issuer 
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shall include coverage for treatment of infertility consistent with this Section. 
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(B) Infertility Defined. - For purposes of this section, the tenn 'infertility' means a 
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disease or condition that results in the abnonnal function of the reproductive system, which 
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results in -
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(1) The inability to conceive after (one) 1 year of unprotected intercourse, or 
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(2) The inability to carry a pregnancy to live birth. 
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(C) Required Coverage. - A group health plan and a health insurance issuer, offering 
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health insurance coverage shall provide coverage for treatment of infertility deemed appropriate 
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by a participant or beneficiary and the treating physician. Such treatment shall include ovulation 
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induction, artificial insemination, in vitro fertilization (IVF), gamete intrafallopian transfer 
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(GIFT), zygote intrafallopian transfer (ZFT), intracytoplasmic sperm injection (ICSI), and, any 
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other treatment provided it has been deemed as 'non-experimental' by the Secretary of Health 
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after consultation with appropriate professional and patient organizations such as the Philippine 
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Association of Medical Technologists, . 
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(D) Limitation on Coverage of Assisted Reproductive Technology. -
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(I) In General. - In the case of assisted reproductive technology, coverage shall 
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be provided if -
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(a) The participant or beneficiary has been unable to bring a pregnancy 
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into a live birth through less costly medically appropriate infertility 
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treatments for "{hich coverage is available under the insured's policy, 
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plan, or contract; 
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(b) The participant or beneficiary has not undergone four (4) complete 
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oocyte retrievals, except that if a live birth follows a completed oocyte 
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retrieval, then at least two (2) more completed oocyte retrievals shaH be 
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covered, with a lifetime cap of 6 retrjevals; 
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(2) Definition of Assisted Reproductive Technology. - For purposes of this 
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paragraph, the term 'assisted reproductive technology' includes all treatments or 
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procedures that involve the handling of human egg and sperm for the purpose of 
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helping a woman become pregnant. Types of Assisted Reproductive Technology 
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include in vitro fertilization, gamete intrafallopian transfer, zygote intrafallopian 
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transfer, embryo cryopreservation, egg or embryo donation, and surrogate bjrth. 
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(E) Review by the Secretary of Health. - Not later than five (5) years after the date of 
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enactment of the Family Building Act, the Secretary of Health shaH review the requirements for 
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treatment of infertility established under paragraph (D)(l). 
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(F) Limitation. - Deductibles, co-insurance, and other cost-sharing or other limitations for 
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infertility therapy may not be imposed to the extent they exceed the deductibles, co-insurance, 
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and limitations that are applied to similar services under the group health plan or health 
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insurance coverage. 
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(G) Prohibitions. - A group health plan and a health insurance issuer, offering group 
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health insurance coverage, in connection with a group health plan may not -
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(1) Deny to a participant or beneficiary eligibility, or continued eligibility, to 
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emoll or to renew coverage under the terms of the plan, solely for the purpose of 
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avoiding the requirements of this section; 
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, 
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(2) Provide incentives, either monetary or otherwise, to a participant or 
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beneficiary to encourage such participant or beneficiary not to be provided 
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infertility treatments to which they are entitled under this section or to providers 
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to induce such providers not to provide such measurements to qualified 
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participants or beneficiaries; 
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(3) Prohibit a provider from discussing with a participant or beneficiary infertility 
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treatment techniques or medical treatment options relating to this section; or 
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(4) Penalize or otherwise reduce or limit the reimbursement of a provider because 
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such provider provided infertility treatments to a qualified participant or 
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beneficiary in accordance with this section. 
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(H) Rule of Construction. - Nothing in this Section shall be construed to require a 
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participant or beneficiary to undergo infertility therapy. 
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SECTION 3. Separability Clause. - If any provision or part hereof, is held invalid or 
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unconstitutional, the remainder of the ·law or the provision not otherwise affected shall remain 
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valid and subsisting. 
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SECTION 4. Repealing Clause. - Any law, presidential decree or issuance, executive 
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order, letter of instmction, administrative order, mle or regulation contrary to or is inconsistent 
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with the provision of this Act is hereby repealed, modified, or amended accordingly. 
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SECTION 5. Effectivity Clause. - This Act shall take effect fifteen (15) days after its 
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publication in at least two (2) newspapers of general circulation. 
Approved, 
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