Amending R.A. No. 11223 (Universal Health Care Act)

CNA20 sOfice of the Societary TWENTIETH CONGRESS OF THE REPUBLIC OF THE PHILIPPINES 25 AUG -4 P5:48 First Regular Session SENATE RECEIVED BY: S. No. 864 Introduced by Senator Jinggoy Ejercito Estrada AN ACT AMENDING REPUBLIC ACT NO. 11223, OTHERWISE KNOWN AS THE "UNIVERSAL HEALTH CARE ACT" EXPLANATORY NOTE Republic Act No. 11223, or the Universal Health Care (UHC) Act, marked a major milestone in the government's commitment to deliver equitable and quality health care to all Filipinos. Since its enactment, the law has initiated critical reforms to broaden access and improve service delivery through the National Health Insurance Program. However, implementation has revealed several areas requiring immediate legislative intervention to ensure the program's effectiveness, sustainability, and responsiveness to our people's needs. This measure proposes to strengthen the UHC Act by expanding the benefit package to include dental services and clarifying the definition of legal dependents to ensure wider family coverage. It reinforces the principle of immediate eligibility, regardless of identification or premium payment status, and mandates a periodic review of benefit packages every three years to align with changing health needs and economic conditions. To ease financial burdens, particularly for Overseas Filipino Workers, the bill revises the premium rate schedule starting in 2025, ensures a 50% government subsidy for OFWs, and exempts distressed migrant workers from premium collections

upon their return. It also authorizes the President to suspend scheduled premium hikes during national emergencies or calamities. The measure safeguards PhilHealth's reserve funds by prohibiting their diversion to the general fund or any government entity and by requiring that excess reserves be used to reduce contributions or expand benefits. A mechanism for lowering premiums must also be included in the law's implementing rules and regulations. Governance reforms include expanding the PhilHealth Board from 13 to 15 members with broader sectoral representation, including medical professionals, dentists, and local executives. Gender representation is institutionalized, and the Secretary of Health is designated as the ex officio Chairperson of the Board. To promote transparency, PhilHealth will be required to submit annual audit reports and a fund viability plan to Congress and the Department of Budget and Management. A third-party auditor will independently review the institution's actuarial projections and benefit designs, subject to oversight by the Commission on Audit and Bureau of Internal Revenue. Lastly, the proposed bill calls for the reorientation of medical and allied heaith education toward public health and primary care, ensuring that health professionals are better equipped to meet the objectives of universal health care. This proposed legislation strengthens the foundations of the UHC Act and advances its core vision: that every Filipino, regardless of status, can access essential health services without suffering financial hardship.

In view of the foregoing, the immediate passage of this measure is earnestly sought. JINGGOY EJERCITO ESTRADA

tie of the ting purr TWENTIETH CONGRESS OF THE REPUBLIC OF THE PHILIPPINES First Regular Session 25 AUG -4 P5:49 SENATE постов. S. No. 864 Introduced by Senator Jinggoy Ejercito Estrada 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 4 of Republic Act No. 11223 is hereby amended to read as

2 follows: "SEC. 4. Definition of Terms. - As used in this Act: "XXX "(i) Essential health benefit package refers to a set of individual-based entitlements covered by the National Health Insurance Program (NHIP) which includes primary care; medicines, diagnostics and laboratory; and preventive, curative, [and] rehabilitative services; AND DENTAL SERVICES; "xxx "(V) DEPENDENTS OF A MEMBER REFER TO: (1) THE LEGITIMATE SPOUSE WHO IS NOT A MEMBER; (2) THE UNMARRIED AND UNEMPLOYED LEGITIMATE, LEGITIMATED, ILLEGITIMATE, LEGALLY ADOPTED, OR

STEPCHILDREN TWENTY-THREE (23) YEARS OF AGE AND BELOW."

Sec 2. 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 Program: Provided, That PhilHealth • Identification Card shall not be required in the availment of any health service: Provided, further, That no co-payment shall be charged for services rendered in basic or ward 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 INSURANCE COMMISSION, SHALL CONDUCT PERIODIC REVIEW AND ADJUSTMENT OF BENEFIT PACKAGES NOT LATER THAN THREE (3) YEARS FROM THE EFFECTIVITY OF THIS ACT AND EVERY THREE (3) YEARS THEREAFTER: Provided, finally, That the current PhilHealth package for members shall not be reduced. "PhilHealth shall provide additional Program benefits for direct contributors, where applicable: Provided, That failure to pay premiums shall not prevent the enjoyment of any Program benefits: Provided, further, That employers [and self employed direct contributors] 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 3. 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: Premium Rate Income Floor [Year Income Ceiling 2019 2.75% P10,000.00 P50,000.00 2020 3.00% P10,000.00 P60,000.00 2021 3.50% P10,000.00 P70,000.00 2022 4.00% P10,000.00 P80,000.00 2023 4.50% P10,000.00 P90,000.00 2024 5.00% P100,000.00 P10,000.00 2025 5.00% P10,000.00 P100,000.00] YEAR PREMIUM RATE INCOME FLOOR INCOME CEILING 2026 5.00% P10,000.00 P100,000.00 2027 3.25% P10,000.00 P100,000.00 2028 3.50% P10,000.00 P100,000.00 2029 3.75% P10,000.00 P100,000.00 2030 4.00% P10,000.00 P100,000.00 "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 SEAFARERS: 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 CONTRIBUTIONS SHALL NOT BE A GROUND FOR THE NON- ISSUANCE OF AN OVERSEAS EMPLOYMENT CERTIFICATE OF A MIGRANT WORKER. FOR THIS PURPOSE, 'OVERSEAS FILIPINO IN DISTRESS' REFERS TO AN OVERSEAS FILIPINO WHO HAS A MEDICAL, PSYCHO-SOCIAL, OR LEGAL ASSISTANCE PROBLEM REQUIRING TREATMENT, HOSPITALIZATION, COUNSELING, LEGAL REPRESENTATION, OR ANY OTHER KIND OF INTERVENTION BY THE AUTHORITIES IN THE COUNTRY WHERE HE OR SHE IS FOUND. FILIPINOS WITH DUAL CITIZENSHIP (FDC), OR THOSE WHO HAVE RETAINED AND RE- ACQUIRED FILIPINO CITIZENSHIP BY VIRTUE OF REPUBLIC ACT NO. 9225, OR THE 'CITIZENSHIP RETENTION AND REACQUISITION ACT OF 2003', MAY ENJOY THE BENEFITS PROVIDED BY THE STATE HEALTH INSURER: PROVIDED, THAT FAILURE TO PAY PREMIUMS SHALL NOT PREVENT THE FDC AND

THEIR LEGAL DEPENDENTS FROM ENJOYING ANY PROGRAM BENEFIT. "[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[more]: 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 EMERGENCY, PUBLIC HEALTH EMERGENCY, OR CALAMITY. IN THE EVENT OF SUSPENSION, ALL SUBSEQUENT SCHEDULED INCREASES IN CONTRIBUTION BE RATES SHALL IMPLEMENTED ACCORDINGLY IN THE SUCCEEDING YEARS."

Sec. 4. Section 11 of Republic Act No. 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 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. "XXX "a) xxx "b) xxx "c) xXX "d) xxx "e) xxx "f) XXX "g) In debt instruments and other securities traded in the secondary markets with the same intrinsic quality as those enumerated in paragraphs (a) to (e) hereof, subject to the approval of the PhilHealth Board.

"INo portion of the reserve fund or income thereof shall accrue to the general fund of the National Government or to any of its agencies of instrumentalities including government owned or controlled corporations.] "As part of its investments operations, PhilHealth may hire institutions with valid trust licenses as its external local fund managers to manage the reserve fund, as it may deem appropriate, through public bidding. The fund manager shall submit an annual report on investment performance to PhilHealth. "XXX "The PhilHealth shall manage the supplemental benefits fund to the minimum required to ensure that the supplemental benefit payments are secure. "NOTWITHSTANDING ANY LAW TO THE CONTRARY, NO PORTION OF ANY FUND OR INCOME OF PHILHEALTH, INCLUDING THE PROVIDENT FUND UNDER SECTION 16(C) AND THE SPECIAL HEALTH FUND UNDER SECTION 20 OF THIS ACT, SHALL ACCRUE TO THE GENERAL FUND OF THE NATIONAL GOVERNMENT OR TO ANY OF ITS AGENCIES OR INSTRUMENTALITIES, INCLUDING GOVERNMENT-OWNED OR-CONTROLLED CORPORATIONS."

Sec. 5. Section 13 of Republic Act No. 11223 is hereby amended to read as

follows: "SEC. 13. PhilHealth Board of Directors- (a) The PhilHealth Board of Directors, hereinafter referred to as the Board, is hereby reconstituted to have a

maximum of [thirteen (13)] FIFTEEN (15) members, consisting of the following: (1) five (5) ex officio members, namely: the Secretary of Health, Secretary of Social Welfare and Development, Secretary of Budget and Management, Secretary of Finance, AND Secretary of Labor and Employment; (2) three (3) expert panel members with expertise in public health, management, finance, and health economics; and (3) [five (5)] SEVEN (7) sectoral panel members REPRESENTING THE FOLLOWING SECTORS: [representing the] (A) direct contributors, (B) indirect contributors WHERE THE REPRESENTATIVE IS HIMSELF/HERSELF AN INDIRECT CONTRIBUTOR, (C) employers group, (D) MEDICAL DOCTORS ENDORSED BY THEIR PROFESSIONAL ASSOCIATIONS, (E) HEALTH CARE PROFESSIONALS, OTHER THAN MEDICAL DOCTORS, ENDORSED BY THEIR NATIONAL ASSOCIATIONS OF HEALTH CARE PROFESSIONALS, (F) DENTISTS ENDORSED BY THEIR PROFESSIONAL ASSOCIATIONS, AND [health care providers to be endorsed by their nationat associations of health care institutions and health care professionals, and] (G) [representative of the ] elected local chief executives to be endorsed by the League of Provinces of the Philippines, League of Cities of the Philippines and League of Municipalities of the Philippines: Provided, That at least one (1) of the expert panel members and at least two (2) of the sectoral panel members are women. "XXX

"(b) The Secretary of Health shall be an ex officio [nonvoting] Chairperson of the Board "(c) × xx "XXX."

Sec. 6. Section 25 of Republic Act No. 11223 is hereby amended to read as

follows: "Sec. 25. Scholarship and Training Program. -XXX "xXX "(d) The CHED, PRC, and DOH, in coordination with duly-registered medical and allied professional societies, shall reorient medical and allied medical professional education, and health professional certification and regulation towards producing health workers with competencies in the provision of primary care services AND PUBLIC HEALTH."

Sec. 7. Republic Act No. 11223 is hereby amended by inserting a new section

18 after Section 37 which shall 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. 8. Republic Act No. 11223 is hereby amended by inserting a new section

2 after the Section 37 which shall read as follows: "SEC. 37-B. THIRD-PARTY AUDITOR. - THE PHILHEALTH SHALL ENGAGE A THIRD- PARTY AUDITOR TO REVIEW ITS 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. 9. 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 10. 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 11. Repealing Clause. - All laws, presidential decrees, executive orders,

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

Sec 12. Effectivity Clause. - This Act shall take effect after fifteen (15) days

2 following the completion of its publication in the Official Gazette or in any newspaper 3 of general circulation. Approved,