Amending R.A. No. 11223 (Universal Healthcare Act)

Senate Offite of thie ecirrtarp TWENTIETH CONGRESS OF THE REPUBLIC OF THE PHILIPPINES 25 AUG 19 P3:05 First Regular Session SENATE RECENED BY: Senate Bill No. 1218 Introduced by Senator Erwin T. Tulfo AN ACT AMENDING REPUBLIC ACT NO. 11223 OTHERWISE KNOWN AS THE 'UNIVERSAL HEALTHCARE ACT', AND FOR OTHER PURPOSES EXPLANATORY NOTE One of the general objectives of Republic Act No. 11223 or the 'Universal Health Care Act' is to ensure that all Filipinos are guaranteed equitable access to quality and affordable health care goods and services, and protected against financial risk. However, in reality, many Filipinos—particularly those in remote and underserved areas— continue to face challenges such out-of-pocket expenses preventing them from fully benefiting from the law's objective. This measure seeks to improve Republic Act No. 11223 or the 'Universal Health Care Act' by making health services more people oriented, accessible, affordable, and responsive to the needs of every Filipino people. First, it ensures that all DOH-licensed hospitals recognize the National ID as valid proof of PhilHealth membership. While its presentation remains optional, if presented, it must be accepted for admission or down payment purposes.

Second, it mandates a minimum PhilHealth coverage of 30% for members and 50% for OF Ws and their dependents in private hospitals, regardless of illness, including childbirth. This helps reduce out-of- pocket expenses and ensures more inclusive coverage. Lastly, it requires PhilHealth to submit an annual audit report and fund viability plan to the DBM, Senate, and House of Representatives, to promote transparency and ensure long-term sustainability of the program. For these reasons, the immediate passage of this bill is earnestly sought. ERWIN T. TULFO

Sentate Offite of tie Secretary TWENTIETH CONGRESS OF THE REPUBLIC OF THE PHILIPPINES 25 AUG 19 P 3:05 First Regular Session RECEIVED BY: SENATE Senate Bill No. 1218 Introduced by Senator Erwin T. Tulfo AN ACT AMENDING REPUBLIC ACT NO. 11223 OTHERWISE KNOWN AS THE 'UNIVERSAL HEALTHCARE ACT', AND FOR OTHER PURPOSES Be it enacted by the Senate and the House of Representatives of the Philippines in Congress assembled:

SECTION 1. Section 9 of Republic Act No. 11223 is hereby amended

by inserting a new section to read as follows:

SECTION 9-A. PRESENTATION OF NATIONAL

IDENTIFICATION CARD OR OTHER GOVERNMENT ISSUED IDENTIFICATION CARDS. - ALL HOSPITALS DULY LICENSED BY THE DEPARTMENT OF HEALTH (DOH) SHALL RECOGNIZE AND ACCEPT THE NATIONAL IDENTIFICATION CARD AS SUFFICIENT PROOF OF PHILHEALTH MEMBERSHIP; PROVIDED, THAT THE PRESENTATION OF THE NATIONAL IDENTIFICATION CARD SHALL NOT BE MANDATORY FOR HOSPITAL ADMISSION OR FOR THE AVAILMENT OF PHILHEALTH BENEFITS; PROVIDED, HOWEVER, THAT IN THE

ABSENCE OF THE NATIONAL IDENTIFICATION CARD, OTHER GOVERNMENT-ISSUED IDENTIFICATION CARDS AND PROOF OF MEMBERSHIP MAY BE PRESENTED. THE NATIONAL ID OR OTHER GOVERNMENT ISSUED IDENTIFICATION, IF PRESENTED, SHALL BE ACCEPTED AS A VALID FORM OF INITIAL DOWNPAYMENT FOR HOSPITAL ADMISSION OR FOR THE AVAILMENT OF PHILHEALTH BENEFITS."

SEC 2. Section 10 of Republic Act No. 11223 is hereby amended

by inserting a new section to read as follows: "SECTION 10-A. MANDATORY MINIMUM COVERAGE IN PRIVATE HOSPITALS. - NOTWITHSTANDING EXISTING POLICIES AND BENEFIT PACKAGES, PHILHEALTH SHALL BE MANDATED TO SHOULDER AT LEAST THIRTY PERCENT (30%) OF THE TOTAL HOSPITAL BILL OF ANY MEMBER OR QUALIFIED DEPENDENT ADMITTED TO ANY PRIVATE HOSPITAL, REGARDLESS OF ILLNESS OR MEDICAL CONDITION, INCLUDING BUT NOT LIMITED TO CHILDBIRTH AND RELATED MATERNAL CARE SERVICES. PHILHEALTH SHALL COVER AT LEAST FIFTY PERCENT (50%) OF THE TOTAL HOSPITAL BILL OF ANY OVERSEAS FILIPINO WORKER (OFW) OR THEIR QUALIFIED DEPENDENTS WHEN ADMITTED TO ANY PRIVATE HOSPITAL, SUBJECT TO VERIFICATION OF OFW STATUS UNDER THE DEPARTMENT OF MIGRANT WORKERS.

THE COVERAGE HEREIN PROVIDED SHALL BE IN ADDITION TO OTHER DISCOUNTS OR PRIVILEGES GRANTED UNDER EXISTING LAWS, SUCH AS THOSE FOR SENIOR CITIZENS AND PERSONS WITH DISABILITIES (PWDS). PHILAEALTH SHALL ENSURE THE IMMEDIATE IMPLEMENTATION OF THIS MINIMUM COVERAGE WHICH BE SHALL AUTOMATICALLY APPLIED AND REFLECTED IN THE BILLING PROCESS."

SEC 3. Section 37 of Republic Act No. 11223 is hereby amended

by inserting a new section to read as follows: "SEC. 37-A. SUBMISSION OF AUDIT REPORT AND FUND VIABILITY PLAN. - PHILHEALTH SHALL SUBMIT THE FOLLOWING REPORTS ANNUALLY TO THE DBM, THE SENATE, AND THE HOUSE OF REPRESENTATIVES: (A) MANAGEMENT AUDIT REPORT DETAILING POLICIES AND REFORMS TO CONTROL FRAUDULENT PRACTICES; AND (B) FUND VIABILITY PLAN, INCLUDING POLICIES AND REFORMS TO STRENGTHEN PREMIUM COLLECTION, INCREASE PROGRAM BENEFITS, AND MINIMIZE THE RISK OF DEFICITS."

SEC. 4. Separability Clause. - Should any provision or part of

this Act be declared unconstitutional or invalid, the other provisions and parts hereof, insofar as they are separable from the invalid ones, shall remain in full force and effect.

SEC. 5. Repealing Clause. - All laws, decrees, orders,

proclamations, rules and regulations, or parts thereof, which are inconsistent with this Act are hereby repealed, amended, or modified accordingly.

SEC. 6. Effectivity. - This Act shall take effect fifteen (15) days

after its publication in the Official Gazette or in at least two (2) newspapers of general circulation. Approved,