Republic of the Philippines
HOUSE OF REPRESENTATIVES
Quezon City

SIXTEENTH CONGRESS
First Regular Session

H.B,No.__5265

Introduced by HONORABLE SCOTT DAVIES S. LANETE, M.D.

EXPLANATORY NOTE

Section II, Article XIII of the 1987 Constitution of the Republic of the Philippines
declares 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
ayailable to all the people at affordable cost. Priority of the needs of the underprivileged, sick,
elderly, disabled, women, and children shall be recognized. Likewise, it shall be the policy of
the State to provide free medical care to paupers.

In this regard, this House Bill, which expands the benefits allowed from the National
Health Insurance, seeks to:

a.) recognize that the benefits available under the current National Health Insurance Program
(NHIP) is not sufficient to perform PhilHealth’s mandate to provide health insurance
coverage to all Filipinos.

b,) provide all citizens of the Philippines with the mechanism to gain financial access to
health services;

c.) serve as the means to help the people pay for health care services; and

4d.) prioritize and accelerate the provision of health services to all Filipinos, especially that
segment of the population who cannot afford such services.

Therefore, this Bill proposes to expand the benefits under the NHIP to cover even
‘outpatient medical and surgical care, The approval of this Bill will not only aid in the
effective implementation of the NHIP but it will also make universal care a reality in our
country- Pangkalahatang Kalusugan will now become possible. Hence, the immediate
passage of this Bill is sought.

SCOTT DAVIES S. LANETE, M.D.
Representative
Third District, Province of Masbate


Republic of the Philippines
HOUSE OF REPRESENTATIVES
Quezon City

SIXTEENTH CONGRESS
First Regular Session

H. B. No. 5265

Introduced by HONORABLE SCOTT DAVIES S. LANETE, M.D.

AN ACT AMENDING REPUBLIC ACT NO. 10606 OTHERWISE KNOWN AS
THE “NATIONAL HEALTH INSURANCE ACT OF 2013”, 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 House of Representatives of the Philippines in
Congress assembled:

Section 1. Section 1 of Republic Act No. 10606, as amended, is hereby amended to
read as follows

“SECTION 1. Short Title. — This Act shall be known as the ‘National Health
Insurance Act.”

Sec. 2. Section 10 is hereby amended to read as follows:

“SEC. 10. Benefit Package —

“Members and their dependents are entitled to the following minimum services,
subject to the limitations specified in this Act and as may be determined by the
Corporation:

“(a) Inpatient hospital care:

“(1) room and board;

(2) services of health care professionals;

“(3) diagnostic, laboratory, and other medical examination services;

“(4) use of surgical or medical equipment and facilities;


“(5) prescription drugs and biologicals, subject to the limitations stated in Section 37
of this Act;

“(6) inpatient education packages; and

“(7) post-inpatient hospital care rehabilitation services

“(b) Outpatient surgical care:

“(1) services of health care professionals;

(2) diagnostic, laboratory, and other medical examination services;
“(3) personal preventive services;

“(4) prescription drugs and biologicals, subject to the limitations described in Section
37 of this Act and

“(5) post-outpatient surgical home and rehabilitation services.

“(c) Outpatient medical care:

“(1) Services of health care professionals

“(2) diagnostic, laboratory, and other medical examination services;
“(3) personal preventive services;

“(4) prescription drugs and biologicals, subject to the limitations described in Section
37 of this Act; and

“(5) post-outpatient surgical home and rehabilitation services.”
See. 3. Section 11 is hereby amended to read as follows:
“SEC. 11, Excluded Personal Health Services — The benefits granted under this Act
shall not cover expenses for the services enumerated hereunder except when the
Corporation, after actuarial studies, recommends their inclusion subject to the
approval of the Board

“(a) non-prescription drugs and devices;

“(b) out-patient psychotherapy and counseling for mental disorders,

“(c) drug and alcohol abuse or dependency treatment;

“(d) cosmetic surgery;


“(e) optometric services;
“(f) normal obstetrical delivery; and
“(g) cost-ineffective procedures which shall be defined by the Corporation.”
Sec. 4. Implementing Rules and Regulations. — Within sixty (60) days from the
effectivity of this Act, the Corporation, in coordination with the DOH, shall issue the
necessary rules and regulations for its effective implementation,”
See. 5. 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.

Sec, 6 Repealing Clause, — All laws, issuances or parts thereof inconsistent with this
Act are hereby repealed or modified accordingly.

See. 7. Effectivity. — This Act shall sake effect fifteen (15) days after its publication in
the Official Gazette or in at least two (2) newspapers of general circulation.

Approved,