Amending Universal Health Care Act (Philhealth Premium Contribution)

He tike TWENTIETH CONGRESS OF THE REPUBLIC OF THE PHILIPPINES First Regular Session 25 JUL -2 P4:08 SENATE RECH S. No. 3 INTRODUCED BY SENATOR JV EJERCITO AN ACT AMENDING REPUBLIC ACT NO. 11223, OTHERWISE KNOWN AS THE "UNIVERSAL HEALTH CARE ACT EXPLANATORY NOTE The Universal Health Care Act (UHC) is the embodiment of government care. It was a bill crafted and passed into law for its effects to be beneficial and directly felt by all Filipinos. However, more than a piece of legislation, the UHC was meant to serve as a guiding light for our government in times of health care crises and emergencies; but perhaps most importantly, a relief for our less fortunate country men in dire need of medical attention. Every single day, our people who struggle to make ends meet, are given a tough choice between undergoing treatment or focusing on survival. The high cost of medical care instantly drives away a patient from seeking not only hospitalization but a mere basic medical checkup. Even though it is already more or less five years since the COVID-19 pandemic ravaged our people's lives physically and economically, the truth of the matter is that we are still in the period of recovery. Soaring inflation and war in the Middle East have affected the rise of fuel prices and consequently, basic commodities. All of which have very much contributed to the economic hardships of families making our people care less about their health and wellbeing.

This bill aims to lighten the financial burden of every Filipino by amending the UHC Act to further address their current health needs. The PhilHealth premium contribution shall be lowered to a more reasonable amount while ensuring that more health benefit packages shall be formulated, developed; and existing packages improved. In lowering premiums, we uplift the lives of our people. Recently, outrage sparked when Philippine Health Insurance Corporation (Philhealth) was ordered to return to the Bureau of Treasury an alleged excess funds. This happened despite the provision in the UHC that no portion of the reserve fund shall accrue to the general fund of the National Government. In order to ensure that this will not be repeated, the proposed bill requires the Department of Health and Philhealth to establish a mechanism for lowering premium contributions. The mechanism will be used whenever there is an excess of the Philhealth reserve funds that will not be used to increase benefit packages. Lastly, the proposed bill mandates the Philhealth Board to submit annual audit reports and a fund viability plan to Congress. It further requires Philhealth to engage an independent, reputable, and accredited third-party auditor to review Philhealth's actuarial projections. The objective is for Philhealth to improve public confidence through strengthened audit mechanisms and actuarial transparency. To reiterate, the proposed amendments in this measure aims to further our goals of having a healthy nation. We stand firm of our vision: Filipinos taking care of fellow Filipinos. It is then with a deeper sense of duty that we refile this measure in the Twentieth Congress. In view of the foregoing, the passage of this measure is earnestly sought. JV EJERCITO

TWENTIETH CONGRESS OF THE REPUBLIC OF THE PHILIPPINES First Regular Session 25 JUL -2 P4:08 SENATE RECI S. No. _ INTRODUCED BY SENATOR IV EJERCITO AN ACT AMENDING REPUBLIC ACT NO. 11223, OTHERWISE KNOWN AS THE "UNIVERSAL HEALTH CARE ACT" 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 to read as

follows:

Sec. 9. Entitlement to Benefits. - Every member shall be granted

immediate eligibility for health benefit package under the NHIP: Provided, That PhilHealth Identification Card shall not be required in the availment of any health services: Provided further, That no co-payments shall be charged for services rendered in basic accommodation: Provided furthermore, That co-payments and co-insurance for amenities in public hospitals shall be regulated by the DOH and PhilHealth: PROVIDED, FURTHERMORE, THAT THE PHILHEALTH BOARD, IN CONSULTATION WITH THE HEALTH TECHNOLOGY ASSESSMENT COUNCIL, SHALL CONDUCT PERIODIC REVIEW AND AJUSTMENT OF BENEFIT PACKAGES EVERY THREE YEARS AFTER THE EFFECTIVITY OF THIS ACT: Provided, finally, That the current PhilHealth package for members shall not be reduced.

PhilHealth shall provide additional NHIP benefits for direct contributors, where applicable: Provided, That failure to pay premiums shall not prevent the enjoyment of any NHIP benefits: Provided further, That employers [and self employed direct contributers] shall be required to pay all missed contributions with an interest, compounded monthly, of at least three percent (3%) for employers [and not exceeding 1.5% for self earning, professional practitioners, and migrant workers].

Sec. 2. Section 10 of Republic Act No. 11223 is hereby amended to read as

follows:

SEC. 10. Premium Contributions. - For direct contributors,

premium rates shall be in accordance with the following schedule, and monthly income floor and ceiling: Year Premium Income Floor Income Ceiling Rate 2019 2.75% P10,000.00 $50,000.00 2020 3.00% P10,000.00 P60,000.00 2021 3.50% P10,000.00 P70,000.00 202₴ 4.00% P10,000.00 P80,000.00 2023 4.50% P90,000.00 P10,000.00 2024 5.00% P10,000.00 P100,000.00 2025 5.00% P10,000.00 P100,000.007 YEAR PREMIUM INCOME INCOME RATE FLOOR CEILING 2026 - 2028 3.5% P100,000.00 P10,000.00 2029 - 2031 4.5% P10,000.00 P100,000.00 2032 - 2035 P100,000.00 5% P10,000.00 FOR MIGRANT WORKERS, PREMIUM CONTRIBUTIONS SHALL BE BASED ON THE INCOME FLOOR: PROVIDED, THAT FIFTY PERCENT (50%) OF THE PREMIUM CONTRIBUTION OF MIGRANT WORKERS SHALL BE SHOULDERED BY THE NATIONAL

GOVERNMENT : PROVIDED FURTHER, THAT EMPLOYERS OF SEAFARERS, THROUGH THE LOCAL MANNING AGENCIES, SHALL CONTINUE TO SHOULDER FIFTY PERCENT (50%) OF THE PREMIUM CONTRIBUTION OF THE SEADARERS: PROVIDED FURTHERMORE, THAT UNPAID PREMIUM CONTRIBUTIONS OF MIGRANT WORKERS IN DISTRESS UNDER REPUBLIC ACT NO. 8042, OR THE 'MIGRANT WORKERS AND OVERSEAS FILIPINOS ACT OF 1995', AS AMENDED BY REPUBLIC ACT NO. 10022 SHALL NOT BE COLLECTED UPON THEIR ARRIVAL IN THE COUNTRY: PROVIDED FINALLY, THAT FAILURE TO PAY PHILHEALTH CONTRIBUTION SHALL NOT BE A GROUND FOR NON-ISSUANCE OF OVERSEAS EMPLOYMENT CERTIFICATE OF A MIGRANT WORKER. [Provided, That f]For indirect contributors, premium subsidy shall be gradually adjusted and included annually in the General Appropriations Act (GAA): Provided, [further,] That the funds shall be released to Philhealth: Provided further[fore]: That the DOH, in coordination with Philhealth, may request Congress to appropriate supplemental funding to meet targeted milestones of this Act: Provided finally, That for every increase in the rate of contribution of direct contributors and premium subsidy of indirect contributors, Philhealth shall provide for a corresponding increase in benefits. IN THE EVENT OF A STATE OF NATIONAL EMERGENCY, PUBLIC HEALTH EMERGENCY, OR STATE OF CALAMITY, THE PRESIDENT OF THE PHILIPPINES, UPON RECOMMENDATION OF THE PHILHEALTH BOARD AFTER CONSULTATION WITH STAKEHOLDERS, MAY SUSPEND THE INCREASE IN PREMIUM CONTRIBUTION RATES PROVIDED UNDER THIS SECTION. THE MANDATED INCREASE SHALL BE IMPLEMENTED UPON LIFTING OF THE STATE OF NATIONAL EMERGENCY, PUBLIC HEALTH EMERGENCY, OR STATE OF CALAMITY. IN THE EVENT OF SUSPENSION, ALL SUBSEQUENT SCHEDULED INCREASES IN

CONTRIBUTION RATES SHALL BE IMPLEMENTED IN THE SUCCEEDING YEARS ACCORDINGLY.

Sec 3. Section 11 of Republic Act 11223 is hereby amended to read as follows:

Sec 11. Program Reserve Funds - Philhealth shall set aside a

portion of its accumulated revenues AS MENTIONED IN SECTION 37 OF THIS ACT AND ANY OTHER INCOME FROM ANY SOURCE not needed to meet the cost of the current year's expenditures as reserve funds: Provided, That the total amount of reserves shall not exceed a ceiling equivalent to the amount actuarially estimated for two (2) years' projected Program expenditures: Provided, further, That whenever actual reserves exceed the required ceiling at the end of the fiscal year, the excess of the Philhealth reserve fund shall be used to increase the Program's benefits and to the decrease the [amount of members' contributions] PREMIUM CONTRIBUTION RATES OF MEMBERS: PROVIDED, FINALLY, THAT THE DOH AND PHILHEALTH SHALL INCLUDE A MECHANISM FOR LOWERING PREMIUM CONTRIBUTION RATES IN THE IMPLEMENTING RULES AND REGULATIONS OF THIS ACT.

Sec 4. Republic Act 11223 is hereby amended by inserting a new section to

read as follows: "SEC. 37-A. SUBMISSION OF AUDIT REPORT AND FUND VIABILITY PLAN. - THE 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 5. Republic Act 11223 is hereby amended by inserting a new section to

read as follows: "SEC. 37-B. THIRD-PARTY AUDITOR. - THE PHILHEALTH SHALL ENGAGE A THIRD-PARTY AUDITOR TO REVIEWITS ACTUARIAL PROJECTIONS AND BENEFIT PACKAGES ANNUALLY TO ENSURE THE EFFECTIVE IMPLEMENTATION OF ITS MANDATE: PROVIDED, THAT THE THIRD-PARTY AUDITOR SHALL BE INDEPENDENT, REPUTABLE, AND DULY ACCREDITED AS SUCH BY AN ACCREDITING OR SIMILAR AGENCY RECOGNIZED BY INDUSTRY EXPERTS: PROVIDED, FURTHER, THAT NOTHING HEREIN SHALL PREVENT THE BUREAU OF INTERNAL REVENUE AND THE COMMISSION ON AUDIT FROM UNDERTAKING A POST- AUDIT INDEPENDENT VERIFICATION OF THE GROSS REVENUE OF PHILHEALTH AS DETERMINED BY THE THIRD-PARTY AUDITOR."

Sec 6. Continuity of Benefits - Nothing in this Act shall be construed to eliminate

or diminish any benefits or entitlements already granted to members of Philhealth.

Sec 7. Separability Clause. If any provision of this Act is declared invalid or

unconstitutional, the remainder thereof not otherwise affected shall remain in full force and effect.

Sec 8. Repealing Clause. - All laws, presidential decrees, executive orders,

letters of instruction, proclamations, and administrative regulations that are 23 inconsistent with the provisions of this Act are hereby repealed, amended or modified accordingly.

Sec 9. Effectivity Clause - This act shall take effect after fifteen (15) days

following the completion of its publication in the Official Gazette or in any newspaper of general circulation. Approved,