law 3 republic act no. 7875 national health insurance act of 1995

8/16/2019 Law 3 Republic Act No. 7875 National Health Insurance Act of 1995

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NATIONAL HEALTH INSURANCE ACT OF 1995

[REPUBLIC ACT NO. 7875]

AN ACT INSTITUTING A NATIONAL HEALTH INSURANCE PROGRAM

FOR ALL FILIPINOS AND ESTABLISHING THE PHILIPPINE HEALTHINSURANCE CORPORATION FOR THE PURPOSE.

SECTION 1. Short Title. - This Act shall be known as the "National Health

Insurance Act of 1995."

ARTICLE I

GUIDING PRINCIPLES

SECTION 2.cha!"#$%& '(!)*a$ $a+ $(#!a!,Declaration of Principles and Policies. - Section 11, Article

XIII of the 1987 Constitution of the Republic of the hilippines !eclares that

the State shall a!opt an inte"rate! an! co#prehensi$e approach to health

!e$elop#ent which shall en!ea$or to #ake essential "oo!s, health an! othersocial ser$ices a$ailable to all the people at affor!able cost% riorit& for the

nee!s of the un!erpri$ile"e!, sick, el!erl&, !isable!, wo#en, an! chil!ren

shall be reco"ni'e!% (ikewise, it shall be the polic& of the State to pro$i!e

free #e!ical care to paupers% cralaw

In the pursuit of a )ational *ealth Insurance ro"ra#, this Act shall a!opt

the followin" "ui!in" principles+

a Allocation of National Resources for Health - The ro"ra# shall

un!erscore the i#portance for "o$ern#ent to "i$e priorit& to health as a

strate"& for brin"in" about faster econo#ic !e$elop#ent an! i#pro$in"

ualit& of life.b ni!ersalit - The ro"ra# shall pro$i!e all citi'ens with the #echanis#

to "ain financial access to health ser$ices, in co#bination with other

"o$ern#ent health pro"ra#s% The )ational *ealth Insurance ro"ra# shall

"i$e the hi"hest priorit& to achie$in" co$era"e of the entire population with

at least a basic #ini#u# packa"e of health insurance benefits.

c #$uit - The ro"ra# shall pro$i!e for unifor# basic benefits% Access to

care #ust be a function of a person/s health nee!s rather than his abilit& to

pa&.

! Responsi!eness - The ro"ra# shall a!euatel& #eet the nee!s for

personal health ser$ices at $arious sta"es of a #e#ber/s life.e Social Solidarit - The ro"ra# shall be "ui!e! b& co##unit& spirit% It

#ust enhance risk-sharin" a#on" inco#e "roups, a"e "roups, an! persons

of !ifferin" health status, an! resi!in" in !ifferent "eo"raphic areas.

f #ffecti!eness - The ro"ra# shall balance econo#ical use of resources

with ualit& of care.

" Inno!ation - The ro"ra# shall a!opt to chan"es in #e!ical technolo"&,

health ser$ice or"ani'ations, health care pro$i!er paents s&ste#s, scopes


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of professional practice, an! other tren!s in the health sector% It #ust be

co"ni'ant of the appropriate roles an! respecti$e stren"ths of the public an!

pri$ate sectors in health care, inclu!in" people/s or"ani'ations an!

co##unit&-base! health care or"ani'ations.

h De!olution - The ro"ra# shall be i#ple#ente! in consultation with the

local "o$ern#ent units 0(2s, sub3ect to the o$er-all polic& !irections setb& the )ational o$ern#ent.

i %iduciar Responsi&ilit - The ro"ra# shall pro$i!e effecti$e stewar!ship,

fun!s #ana"e#ent, an! #aintenance of reser$es.

3 Infor'ed (hoice - The ro"ra# shall encoura"e #e#bers to choose fro#

a#on" accre!ite! health care pro$i!ers% The Corporation/s local offices shall

ob3ecti$el& apprise its #e#bers of the full ran"e of pro$i!ers in$ol$e! in the

ro"ra# an! of the ser$ices an! pri$ile"es to which the& are entitle! as

#e#bers% This e4planation, which the #e#ber #a& use as a "ui!e in

selectin" the appropriate an! #ost suitable pro$i!er, shall be "i$en in clear

an! si#ple 5ilipino an! in the local lan"ua"e that is co#prehensible to the#e#bers.

k )a*i'u' (o''unit Participation - The ro"ra# shall buil! on e4istin"

co##unit& initiati$es for its or"ani'ation an! hu#an resource reuire#ents% cralaw

l (o'pulsor (o!era+e - All citi'ens of the hilippines shall be reuire! to

enroll in the )ational *ealth Insurance ro"ra# in or!er to a$oi! a!$erse

selection an! social ineuit&.

# (ost Sharin+ - The ro"ra# shall continuousl& e$aluate its cost-sharin"

sche!ule to ensure that the costs borne b& the #e#bers are fair an!

euitable an! that the char"es b& health care pro$i!ers are reasonable.

n Professional Responsi&ilit of Health (are Pro!iders - The ro"ra# shallassure that all participatin" health care pro$i!ers are responsible an!

accountable in all their !ealin"s with the Corporation an! its #e#bers.

o Pu&lic Health Ser!ices - The o$ern#ent shall be responsible for

pro$i!in" public health ser$ices for all "roups such as wo#en, chil!ren,

in!i"enous people, !isplace! co##unities in en$iron#entall& en!an"ere!

areas, while the ro"ra# shall focus on the pro$ision of personal health

ser$ices% re$enti$e an! pro#oti$e public health ser$ices are essential for

re!ucin" the nee! an! spen!in" for personal health ser$ices.

p ,ualit of Ser!ices - The ro"ra# shall pro#ote the i#pro$e#ent in the

ualit& of health ser$ices pro$i!e! throu"h the institutionali'ation of pro"ra#s of ualit& assurance at all le$els of the health ser$ice !eli$er&

s&ste#% The satisfaction of the co##unit&, as well as in!i$i!ual

beneficiaries, shall be a !eter#inant of the ualit& of ser$ice !eli$er&.

(ost (ontain'ent - The ro"ra# shall incorporate features of cost

contain#ent in its !esi"n an! operations an! pro$i!e a $iable #eans of

helpin" the people pa& for health care ser$ices. an!


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r (are for the Indi+ent - The "o$ern#ent shall be responsible for pro$i!in"

a basic packa"e of nee!e! personal health ser$ices to in!i"ents throu"h

pre#iu# subsi!&, or throu"h !irect ser$ice pro$ision until such ti#e that the

pro"ra# is full& i#ple#ente!% cralaw

SECTION -. eneral &/ecti!es. - This Act seeks to+

a pro$i!e all citi'ens of the hilippines with the #echanis# to "ain financialaccess to health ser$ices.

b create the )ational *ealth Insurance ro"ra#, hereinafter referre! to as

the ro"ra#, to ser$e as the #eans to help the people pa& for health care

ser$ices.

c prioriti'e an! accelerate the pro$isions of health ser$ices to all 5ilipinos,

especiall& that se"#ent of the population who cannot affor! such ser$ices.

an!

! establish the hilippine *ealth Insurance Corporation, hereinafter referre!

to as the Corporation, that will a!#inister the ro"ra# at central an! local

le$els%

ARTICLE II

DEFINITION OF TERMS

SECTION . Definition of Ter's. - 5or the purpose of this Act, the followin"

ter#s shall be !efine! as follows+

a 0eneficiar - An& person entitle! to health care benefits un!er this Act% cralaw

b 0enefit Paca+e - Ser$ices that the ro"ra# offers to its #e#bers% cralaw

c (apitation - A paent #echanis# where a fi4e! rate, whether per

person, fa#il&, househol!, or "roup, is ne"otiate! with the health care

pro$i!er who shall be responsible for !eli$erin" or arran"in" for the !eli$er&of health ser$ices reuire! b& the co$ere! person un!er the con!itions of a

health pro$i!er contract% cralaw

! (ontri&ution - The a#ount pai! b& or in behalf of a #e#ber to the

ro"ra# for co$era"e, base! on salaries or wa"es in the case of for#al

sector e#plo&ees, an! on househol! earnin"s an! assets, in the case of the

self-e#plo&e!, or on other criteria as #a& be !efine! b& the Corporation in

accor!ance with the "ui!in" principles set forth in Article I of this Act% cralaw

e (o!era+e - The entitle#ent of an in!i$i!ual, as a #e#ber or as a

!epen!ent, to the benefits of the ro"ra#%cralaw

f Dependent - The le"al !epen!ents of a #e#ber are+ 1 the le"iti#ate

spouse who is not a #e#ber. 6 the un#arrie! an! une#plo&e! le"iti#ate,

le"iti#ate!, ille"iti#ate, acknowle!"e! chil!ren as appearin" in the birth

certificate. le"all& a!opte! or stepchil!ren below twent&-one 061 &ears of

a"e. chil!ren who are twent&-one 061 &ears ol! or abo$e but sufferin"

fro# con"enital !isabilit&, either ph&sical or #ental, or an& !isabilit&

acuire! that ren!ers the# totall& !epen!ent on the #e#ber for support.

the parents who are si4t& 0: &ears ol! or abo$e whose #onthl& inco#e is


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below an a#ount to be !eter#ine! b& the Corporation in accor!ance with

the "ui!in" principles set forth in Article I of this Act% cralaw

" Dia+nostic Procedure - An& proce!ure to i!entif& a !isease or con!ition

throu"h anal&sis an! e4a#ination% cralaw

h #'er+enc - An unforeseen co#bination of circu#stances which calls for

i##e!iate action to preser$e the life of a person or to preser$e the si"ht of one or both e&es. the hearin" of one or both ears. or one or two li#bs at or

abo$e the ankle or wrist% cralaw

i #'ploee - An& person who perfor#s ser$ices for an e#plo&er in which

either or both #ental an! ph&sical efforts are use! an! who recei$es

co#pensation for such ser$ices, where there is an e#plo&er-e#plo&ee

relationship%cralaw

3 #'ploer - A natural or 3uri!ical person who e#plo&s the ser$ices of an

e#plo&ee%cralaw

k #nroll'ent - The process to be !eter#ine! b& the Corporation in or!er to

enlist in!i$i!uals as #e#bers or !epen!ents co$ere! b& the ro"ra#% cralaw

l %ee for Ser!ice - A reasonable an! euitable health care paent s&ste#

un!er which ph&sicians an! other health care pro$i!ers recei$e a paent

that !oes not e4cee! their bille! char"e for each unit of ser$ice pro$i!e!% cralaw

# lo&al 0ud+et - An approach to the purchase of #e!ical ser$ices b&

which health care pro$i!er ne"otiation concernin" the costs of pro$i!in" a

specific packa"e of #e!ical benefits is base! solel& on a pre!eter#ine! an!

fi4e! bu!"et%cralaw

n o!ern'ent Ser!ice Insurance Sste' - The o$ern#ent Ser$ice

Insurance S&ste# create! un!er Co##onwealth Act )o% 18, as a#en!e!% cralaw

o Health (are Pro!ider - Refers to+1 a health care institution, which is !ul& license! an! accre!ite!

an! !e$ote! pri#aril& to the #aintenance an! operation of

facilities for health pro#otion, pre$ention, !ia"nosis, treat#ent,

an! care of in!i$i!uals sufferin" fro# illness, !isease, in3ur&,

!isabilit& or !efor#it&, or in nee! of obstretical or other #e!ical

an! nursin" care% It shall also be construe! as an& institution,

buil!in", or place where there are installe! be!s, cribs, or

bassinets for twent&-four hour use or lon"er b& patients in the

treat#ent of !iseases, in3uries, !efor#ities, or abnor#al ph&sical

an! #ental states, #aternit& cases or sanitarial care. orinfir#aries, nurseries, !ispensaries, an! such other si#ilar

na#es b& which the& #a& be !esi"nate!. or

6 a health care professional, who is an& !octor of #e!icine,

nurse, #i!wife, !entist, or other health care professional or

practitioner !ul& license! to practice in the hilippines an!

accre!ite! b& the Corporation. or


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a health #aintenance or"ani'ation, which is an entit& that

pro$i!es, offers, or arran"es for co$era"e of !esi"nate! health

ser$ices nee!e! b& plan #e#bers for a fi4e! prepai! pre#iu#.

or

a co##unit&-base! health care or"ani'ation, which is an

association of in!i"enous #e#bers of the co##unit& or"ani'e!for the purpose of i#pro$in" the health status of that co##unit&

throu"h pre$enti$e, pro#oti$e an! curati$e health ser$ices%

p Health Insurance Identification 2ID3 (ard - The !ocu#ent issue! b& the

Corporation to #e#bers an! !epen!ents upon their enroll#ent to ser$e as

the instru#ent for proper i!entification, eli"ibilit& $erification, an! utili'ation

recor!in"%

Indi+ent - A person who has no $isible #eans of inco#e, or whose inco#e

is insufficient for the subsistence of his fa#il&, as i!entifie! b& the (ocal

*ealth Insurance ;ffice an! base! on specific criteria set b& the Corporation

in accor!ance with the "ui!in" principles set forth in Article I of this Act% cralaw

r Inpatient #ducation Paca+e - A set of infor#ational ser$ices #a!e

a$ailable to an in!i$i!ual who is confine! in a hospital to affor! hi# with

knowle!"e about his illness an! its treat#ent, an! of the #eans a$ailable,

particularl& lifest&le chan"es, to pre$ent the recurrence or a""ra$ation of

such illness an! to pro#ote his health in "eneral%cralaw

s )e'&er - An& person whose pre#iu#s ha$e been re"ularl& pai! to the

)ational *ealth Insurance ro"ra#% *e #a& be a pa&in" #e#ber, an

in!i"ent #e#ber, or a pensioner


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4 Personal Health Ser!ices - *ealth ser$ices in which benefits accrue to the

in!i$i!ual person% These are cate"ori'e! into in-patient an! out-patient

ser$ices%cralaw

& Philippine )edical (are (o''ission - The hilippine =e!ical Care

Co##ission create! un!er Republic Act )o% 111, as a#en!e!% cralaw

' Philippine National Dru+ %or'ular - The essential !ru"s list for thehilippines which is prepare! b& the )ational >ru" Co##ittee of the

>epart#ent of *ealth in consultations with e4perts an! specialists fro#

or"ani'e! professional #e!ical societies, #e!ical aca!e#e an!

phar#aceutical in!ustr&, an! which is up!ate! e$er& &ear%cralaw

aa Porta&ilit - The enable#ent of a #e#ber to a$ail of ro"ra# benefits in

an area outsi!e the 3uris!iction of his (ocal *ealth Insurance ;ffice%cralaw

bb Prescription Dru+ - A !ru" which has been appro$e! b& the ?ureau of

5oo! an! >ru"s an! which can be !ispense! onl& pursuant to a prescription

or!er fro# a ph&sician who is !ul& license! to !o so% cralaw

cc Pu&lic Health Ser!ices - Ser$ices that stren"then pre$enti$e an!pro#oti$e health care throu"h i#pro$in" con!itions in partnership with the

co##unit& at lar"e% These inclu!e control of co##unicable an! non-

co##unicable !iseases, health pro#otion, public infor#ation an! e!ucation,

water an! sanitation, en$iron#ental protection, an! health relate! !ata

collection, sur$eillance, an! outco#e #onitorin"% cralaw

!! ,ualit Assurance - A for#al set of acti$ities to re$iew an! ensure the

ualit& of ser$ices pro$i!e!% @ualit& assurance inclu!es ualit& assess#ent

an! correcti$e actions to re#e!& an& beneficiaries i!entifie! in the ualit& of

!irect patient, a!#inistrati$e, an! support ser$ices% cralaw

ee Residence - The place where the #e#ber actuall& li$es%cralaw

ff Retiree - A #e#ber of the ro"ra# who has reache! the a"e of

retire#ent or who has retire! on account of !isabilit&%cralaw

"" Self-e'ploed - a person who works for hi#self an! is, therefore, both

e#plo&ee an! e#plo&er at the sa#e ti#e% cralaw

hh Social Securit Sste' - The Social Securit& S&ste# create! un!er

Republic Act )o% 111, as a#en!e!% cralaw

ii Treat'ent Procedure - An& #etho! use! to re#o$e the spto#s an!

cause of a !isease% cralaw

33 tili4ation Re!ie - A for#al re$iew of patient utili'ation or of the

appropriateness of health care ser$ices, on a prospecti$e, concurrent orretrospecti$e basis%

ARTICLE III

THE NATIONAL HEALTH INSURANCE PROGRAM

SEC. 5. #sta&lish'ent and Purpose. - There is hereb& create! the )ational

*ealth Insurance ro"ra# which shall pro$i!e health insurance co$era"e an!

ensure affor!able, acceptable, a$ailable an! accessible health care ser$ices


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for all citi'ens of the hilippines, in accor!ance with policies an! specific

pro$isions of this Act% This social insurance pro"ra# shall ser$e as the

#eans for the health& to help pa& for the care of the sick an! for those who

can affor! #e!ical care to subsi!i'e those who cannot% It shall initiall&

consist of ro"ra#s I an! II of =e!icare an! be e4pan!e! pro"ressi$el& to

constitute one uni$ersal health insurance pro"ra# for the entire population%The ro"ra# shall inclu!e a sustainable s&ste# of fun!s constitution,

collection, #ana"e#ent an! !isburse#ent for financin" the a$ail#ent of a

basic #ini#u# packa"e an! supple#entar& packa"es of health insurance

benefits b& a pro"ressi$el& e4pan!in" proportion of the population% The

ro"ra# shall be li#ite! to pa&in" for the utili'ation of health ser$ices b&

co$ere! beneficiaries or to purchasin" health ser$ices in behalf of such

beneficiaries% It shall be prohibite! fro# pro$i!in" health care !irectl&, fro#

bu&in" an! !ispensin" !ru"s an! phar#aceuticals, fro# e#plo&in"

ph&sicians an! other professionals for the purpose of !irectl& ren!erin" care,

an! fro# ownin" or in$estin" in health care facilities% cralaw

SEC. /. (o!era+e. - All citi'ens of the hilippines shall be co$ere! b& the

)ational *ealth Insurance ro"ra#% In accor!ance with the principles of

uni$ersalit& an! co#pulsor& co$era"e enunciate! in Section 6 0b an! 6 01

hereof, i#ple#entation of the ro"ra# shall, further#ore, be "ra!ual an!

phase! in o$er a perio! of not #ore than fifteen 01 &ears+ Pro!ided6 That

the ro"ra# shall not be #a!e co#pulsor& in certain pro$inces an! cities

until the Corporation shall be able to ensure that #e#bers in such localities

shall ha$e reasonable access to a!euate an! acceptable health care

ser$ices%cralaw

SEC. 7. #nroll'ent. - The ro"ra# shall enroll beneficiaries in or!er forthe# to be place! un!er co$era"e that entitles the# to a$ail of benefits with

the assistance of the financial arran"e#ents pro$i!e! b& the ro"ra#% The

process of enroll#ent shall inclu!e the i!entification of beneficiaries,

issuance of appropriate !ocu#entation specif&in" eli"ibilit& to benefits, an!

in!icatin" how #e#bership was obtaine! or is bein" #aintaine!% The

enroll#ent shall procee! in accor!ance with these specific policies+

a all persons currentl& eli"ible fro benefits un!er =e!icare ro"ra# I,

inclu!in" SSS an! SIS #e#bers, retirees, pensioners an! their

!epen!ents, shall i##e!iatel& an! auto#aticall& be #a!e #e#bers of the

)ational *ealth Insurance ro"ra#.b all persons eli"ible for benefits throu"h health insurance plans establishe!

b& local "o$ern#ents as part of ro"ra# II of =e!icare or in accor!ance with

the pro$isions of this Act, inclu!in" in!i"ent #e#bers, shall also be enrolle!

in the ro"ra#.

c all persons eli"ible for benefits as #e#bers of local health insurance plans

establishe! b& the Corporation in accor!ance with the i#ple#entin" rules

an! re"ulations of this Act shall also be !ee#e! to ha$e enrolle! in the


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ro"ra#% Bnroll#ent of persons who ha$e no current health insurance

co$era"e shall be "i$en priorit& b& the Corporation. an!

! all persons eli"ible for benefits as #e#bers of other "o$ern#ent-initiate!

health insurance pro"ra#s, co##unit&-base! health care or"ani'ations,

cooperati$es, or pri$ate non-profit health insurance plans shall be enrolle! in

the ro"ra# upon accre!itation b& the Corporation which shall !e$ise an!pro$i!e incenti$es to ensure that such accre!ite! or"ani'ations will benefit

fro# their participation in the pro"ra#% cralaw

All in!i"ents not enrolle! in the ro"ra# shall ha$e priorit& in the use an!

a$ail#ent of the ser$ices an! facilities of "o$ern#ent hospitals, health care

personnel, an! other health or"ani'ations+ Pro!ided6 howe$er, That such

"o$ern#ent health care pro$i!ers shall ensure that sai! in!i"ents shall

subseuentl& be enrolle! in the ro"ra#% cralaw

SEC. 8. Health Insurance ID (ard - In con3unction with the enroll#ent

pro$i!e! abo$e, the Corporation throu"h its local office shall issue a health

insurance I> which shall be use! for purposes of i!entification, eli"ibilit&$erification, an! utili'ation recor!in"% The issuance of this I> car! shall be

acco#panie! b& a clear e4planation to the enrollee of his ri"hts, pri$ile"es

an! obli"ations as a #e#ber% A list of health care pro$i!ers accre!ite! b&

the (ocal *ealth Insurance ;ffice shall likewise be attache! thereto% cralaw

SEC. 9. (han+e of Residence. - A citi'en can be un!er onl& one (ocal *ealth

Insurance ;ffice which shall be locate! in the pro$ince or cit& of his place of

resi!ence% A person who chan"es resi!ence, beco#es te#poraril& e#plo&e!,

or for other 3ustifiable reasons, is transferre! to another localit&, shoul!

infor# sai! ;ffice of such transfer an! subseuentl& transfer his ro"ra#

#e#bership%cralaw

SEC. 10. 0enefit Paca+e. - Sub3ect to the li#itations specifie! in this Act

an! as #a& be !eter#ine! b& the Corporation, the followin" cate"ories of

personal health ser$ices "rante! to the #e#ber or his !epen!ents as

#e!icall& necessar& or appropriate, shall inclu!e+

a Inpatient hospital care7

1 roo# an! boar!.

6 ser$ices of health care professionals.

!ia"nostic, laborator&, an! other #e!ical e4a#ination ser$ices.

use of sur"ical or #e!ical euip#ent an! facilities.

prescription !ru"s an! biolo"icals. sub3ect to the li#itations state!in Section 7 of this Act.

inpatient e!ucation packa"es.

b utpatient care7

1 ser$ices of health care professionals.

6 !ia"nostic, laborator&, an! other #e!ical e4a#ination ser$ices.

personal pre$enti$e ser$ices. an!


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prescription !ru"s an! biolo"icals, sub3ect to the li#itations

!escribe! in Section 7 of this Act.

c #'er+enc and transfer ser!ices. an!

! Such other health care ser$ices that the Corporation shall !eter#ine to be

appropriate an! cost-effecti$e+ Pro!ided6 That the ro"ra#, !urin" its initial

phase of i#ple#entation, which shall not be #ore than fi$e 0 &ears, shallpro$i!e a basic #ini#u# packa"e of benefits which shall be !efine!

accor!in" to the followin" "ui!elines+

1 the cost of pro$i!in" sai! packa"es is such that the a$ailable national an!

local "o$ern#ent subsi!ies for pre#iu# paents of in!i"ents are sufficient

to e4ten! co$era"e to the wi!est possible population% cralaw

6 the initial set of ser$ices shall not be less than half of those pro$i!e!

un!er the current =e!icare ro"ra# I in ter#s of o$erall a$era"e cost of

clai#s pai! per beneficiar& househol! per &ear%cralaw

the ser$ices inclu!e! are prioriti'e!, first6 accor!in" to its cost-

effecti$eness an!, second6 accor!in" to its potential of pro$i!in" #a4i#u#relief fro# the financial bur!en on the beneficiar&+ Pro!ided6 That, in

a!!ition to the basic #ini#u# packa"e, the ro"ra# shall pro$i!e

supple#ental health benefit co$era"e to beneficiaries of contributor& fun!s,

takin" into consi!eration the a$ailabilit& of fun!s for the purpose fro# sai!

contributor& fun!s+ Pro!ided6 further6 That the ro"ra# pro"ressi$el&

e4pan! the basic #ini#u# benefit packa"e as the proportion of the

population co$ere! reaches tar"ete! #ilestone so that the sa#e benefits are

e4ten!e! to all #e#bers of the ro"ra# within fi$e 0 &ears after the

i#ple#entation of this Act% Such e4pansion will pro$i!e for the "ra!ual

incorporation of supple#entar& health benefits pre$iousl& e4ten!e! onl& toso#e beneficiaries into the basic #ini#u# packa"e e4ten!e! to all

beneficiaries+ an! Pro!ided6 finall6 That in the phase! i#ple#entation of

this Act, there shoul! be no re!uction or interruption in the benefits

currentl& en3o&e! b& present #e#bers of =e!icare% cralaw

SEC. 11. #*cluded Personal Health Ser!ice. - The benefits "rante! un!er

this Act shall not co$er e4penses for the ser$ices enu#erate! hereun!er

e4cept when the Corporation, after actuarial stu!ies, reco##en! their

inclusion sub3ect to the appro$al of the ?oar!+

a non-prescription !ru"s an! !e$ices.

b out-patient ps&chotherap& an! counselin" for #ental!isor!ers.

c !ru" an! alcohol abuse or !epen!enc& treat#ent.

! cos#etic sur"er&.

e ho#e an! rehabilitation ser$ices.

f opto#etric ser$ices.

" nor#al obstetrical !eli$er&. an!


10/29


11/29

! to for#ulate an! i#ple#ent "ui!elines on contributions an!

benefits. portabilit& of benefits, cost contain#ent an! ualit&

assurance. an! health care pro$i!er arran"e#ents, paent

#etho!s, an! referral s&ste#s.

e to establish branch offices as #an!ate! in Article of this

Act.f to recei$e an! #ana"e "rants, !onations, an! other for#s of

assistance.

" to sue an! be sue! in court.

h to acuire propert&, real an! personal, which #a& be

necessar& or e4pe!ient for the attain#ent of the purposes of this

Act.

i to collect, !eposit, in$est, a!#inister, an! !isburse the

)ational *ealth Insurance 5un! in accor!ance with the pro$isions

of this Act.

3 to ne"otiate an! enter into contracts with health careinstitutions, professionals, an! other persons, 3uri!ical or

natural, re"ar!in" pricin", paent #echanis#s, !esi"n an!

i#ple#entation of a!#inistrati$e an! operatin" s&ste#s an!

proce!ures, financin", an! !eli$er& of health ser$ices.

k to authori'e (ocal *ealth Insurance ;ffices to ne"otiate an!

enter into contracts in the na#e an! on behalf of the Corporation

with an& accre!ite! "o$ern#ent or pri$ate sector health

#aintenance or"ani'ations, cooperati$es an! #e!ical

foun!ations, for the pro$ision of at least the #ini#u# packa"e

of personal health ser$ices prescribe! b& the Corporation.l to !eter#ine reuire#ents an! issue "ui!elines for the

accre!itation of health care pro$i!ers for the ro"ra# in

accor!ance with this Act%.

# to super$ise the pro$ision of health benefits with the power

to inspect #e!ical an! financial recor!s of health care pro$i!ers

an! patients who are participants in or #e#bers of the ro"ra#,

the power to enter an! inspect accre!ite! health care

institutions, sub3ect to the rules an! re"ulations to be

pro#ul"ate! b& the Corporation.

n to or"ani'e its office, fi4 the co#pensation of an! appointpersonnel as #a& be !ee#e! necessar& an! upon the

reco##en!ation of the presi!ent of the Corporation.

o to sub#it to the resi!ent of the hilippines an! to both

*ouses of Con"ress its Annual Report which shall contain the

status of the )ational *ealth Insurance 5un!, its total

!isburse#ents, reser$es, a$era"e costin"s to beneficiaries, an&

reuest for a!!itional appropriation, an! other !ata pertinent to


12/29

the i#ple#entation of the ro"ra# an! publish a s&nopsis of

such report in two 06 newspapers of "eneral circulation.

p to keep recor!s of the operation of the Corporation an!

in$est#ents of the )ational *ealth Insurance 5un!. an!

to perfor# such other acts as it #a& !ee# appropriate for the

attain#ent of the ob3ecti$es of the Corporation an! for theproper enforce#ent of the pro$isions of this Act%

SEC. 17. ,uasi-8udicial Poers.- The Corporation, to carr& out its tasks

#ore effecti$el&, shall be $este! with the followin" powers+

a to con!uct in$esti"ations for the !eter#ination of a uestion, contro$ers&,

co#plaint, or unresol$e! "rie$ance brou"ht to its attention, an! ren!er

!ecisions, or!ers, or resolutions thereon% It shall procee! to hear an!

!eter#ine the case e$en in the absence of an& part& who has been properl&

ser$e! with notice to appear% It shall con!uct its procee!in"s or an& part

thereof in public or in e4ecuti$e session. a!3ourn its hearin"s to an& ti#e

an! place. refer technical #atters or accounts to an e4pert an! to accept hisreports as e$i!ence. !irect parties to be 3oine! in or e4clu!e! fro# the

procee!in"s. an! "i$e all such !irections as it #a& !ee# necessar& or

e4pe!ient in the !eter#ination of the !ispute before it.

b to su##on the parties to a contro$ers&, issue subpoenas reuirin" the

atten!ance an! testi#on& of witnesses or the pro!uction of !ocu#ents an!

other #aterials necessar& to a 3ust !eter#ination of the case un!er

in$esti"ation.

c to suspen! te#poraril&, re$oke per#anentl&, or restore the accre!itation

of a health care pro$i!er or the ri"ht to benefits of a #e#ber an!irectors hereinafter referre! to as the ?oar!,co#pose! of ele$en #e#bers as follows+

The Secretar& of *ealth.

The Secretar& of (abor an! B#ploent or his representati$e.

The Secretar& of Interior an! (ocal o$ern#ent or his representati$e.

The Secretar& of Social Delfare an! >e$elop#ent or his representati$e.

The resi!ent of the Corporation.

A representati$e of the labor sector.


13/29

A representati$e of e#plo&ers.

The SSS A!#inistrator or his representati$e.

The SIS eneral =ana"er or his representati$e.

A representati$e of the self-e#plo&e! sector. an!

A representati$e of health care pro$i!ers% cralaw

The Secretar& of *ealth shall be the e*-officio Chairperson while theresi!ent of the Corporation shall be the ice-Chairperson of the ?oar!% cralaw

0b Appoint'ent and Tenure - The resi!ent of the hilippines shall appoint

the =e#bers of the ?oar! upon the reco##en!ation of the Chair#an of the

?oar! an! in consultation with the sectors concerne!% =e#bers of the ?oar!

shall ha$e a ter# of four 0 &ears each, renewable for a #a4i#u# of two

06 &ears, e4cept for #e#bers whose ter#s shall be co-ter#inous with their

respecti$e positions in "o$ern#ent% An& $acanc& in the ?oar! shall be fille!

in the #anner in which the ori"inal appoint#ent was #a!e an! the

appointee shall ser$e onl& the une4pire! ter# of his pre!ecessor%cralaw

0c )eetin+s and ,uoru' - The ?oar! shall hol! re"ular #eetin"s at leastonce a #onth% Special #eetin"s #a& be con$ene! at the call of the

Chairperson or b& a #a3orit& of the #e#bers of the ?oar!% The presence of

si4 0 $otin" #e#bers shall constitute a uoru#% In the absence of the

Chairperson an! ice-Chairperson, a te#porar& presi!in" officer shall be

!esi"nate! b& the #a3orit& of the uoru#% cralaw

0! Alloance and Per Die's - The #e#bers of the ?oar! shall recei$e a per

die' for e$er& #eetin" actuall& atten!e! sub3ect to the pertinent bu!"etar&

laws, rules an! re"ulations on co#pensation, honoraria an! allowances% cralaw

SEC. 19. The President of the (orporation. - 0a Appoint'ent and Tenure -

The resi!ent of the hilippines shall appoint for non-renewable ter# of si40 &ears, the resi!ent of the Corporation, hereinafter referre! to as the

resi!ent, upon the reco##en!ation of the ?oar!% The resi!ent shall not

be re#o$e! fro# office e4cept in accor!ance with e4istin" laws% cralaw

0b Duties and %unctions - The resi!ent shall ha$e the !ut& of a!$isin" the

?oar! an! carr&in" into effect its policies an! !ecisions% *is functions are as

follows+

1 to act as the chief e4ecuti$e officer of the Corporation. an!

6 to be responsible for the "eneral con!uct of the operations

an! #ana"e#ent functions of the Corporation an! for other

!uties assi"ne! to hi# b& the ?oar!%0c ,ualifications - The resi!ent #ust be a 5ilipino citi'en an! #ust possess

a!euate an! appropriate trainin" an! at least fi$e 0 &ears e4perience in

the fiel! of health care financin" an! corporate #ana"e#ent%

0! Salar - The resi!ent shall recei$e a salar& to be fi4e! b& the ?oar!,

with the appro$al of the resi!ent of the hilippines, pa&able fro# the fun!s

of the Corporation% cralaw


14/29

0e Prohi&ition - To a$oi! conflict of interest, the resi!ent #ust not be

in$ol$e! in an& health care institution as owner or #e#ber of its boar!% cralaw

SEC. 20. Health %inance Polic Research. - A#on" the staff !epart#ents

that will be establishe! b& the Corporation shall be the *ealth 5inance olic&

Research >epart#ent, which shall ha$e the followin" !uties an! functions+

a !e$elop#ent of broa! conceptual fra#ework for i#ple#entation of thero"ra# throu"h a national health finance #aster plan to ensure sustaine!

in$est#ents in health care, an! to pro$i!e "ui!ance for a!!itional

appropriations fro# the )ational o$ern#ent.

b con!uct of researches an! stu!ies towar! the !e$elop#ent of

policies necessar& to ensure the $iabilit&, a!euac& an!

responsi$eness of the ro"ra#.

c re$iew, e$aluation, an! assess#ent of the ro"ra#/s i#pact

on the access to, as well as the ualit& an! cost of, health care in

the countr&.

! perio!ic re$iew of fees, char"es, co#pensation rates,capitation rates, #e!ical stan!ar!s, health outco#es an!

satisfaction of #e#bers, benefits, an! other #atters pertinent to

the operations of the ro"ra#.

e co#parison in the !eli$er&, ualit&, use, an! cost of health

care ser$ices of the !ifferent ;ffices.

f sub#ission for consi!eration of pro"ra# of ualit& assurance,

utili'ation re$iew, an! technolo"& assess#ent. an!

" sub#ission of reco##en!ations on polic& an! operational

issues that will help the Corporation #eet the ob3ecti$es of this

Act%SEC. 21. Actuar of the (orporation. - An ;ffice of Actuar& shall be create!

within the Corporation to con!uct the necessar& actuarial stu!ies an!

present reco##en!ations on insurance pre#iu#, in$est#ents an! other

relate! #atters%

ARTICLE

LOCAL HEALTH INSURANCE OFFICE

SEC. 22. #sta&lish'ent. - The Corporation shall establish a (ocal *ealth

Insurance ;ffice, hereinafter referre! to as the ;ffice, in e$er& pro$ince or

chartere! cit&, or where$er it is !ee#e! practicable, to brin" its ser$ices

closer to #e#bers of the ro"ra#% *owe$er, one office #a& ser$e the nee!s

of #ore than one pro$ince or cit& when the #er"e! operations will result in

lower a!#inistrati$e cost an! "reater cross-subsi!& between rich an! poor

localities%cralaw

ro$inces an! cities where prospecti$e #e#bers are or"ani'e! shall recei$e

priorit& in the establish#ent of local health insurance offices% cralaw


15/29

SEC. 2-. %unctions. - Bach ;ffice shall ha$e the followin" powers an!

functions+

a to consult an! coor!inate, as nee!e!, with the local

"o$ern#ent units within its 3uris!iction in the i#ple#entation of

the ro"ra#.

b to recruit an! re"ister #e#bers of the ro"ra# fro# all areaswithin its 3uris!iction.

c to collect an! recei$e pre#iu#s an! other paent

contributions to the ro"ra#.

! to #aintain an! up!ate the #e#bership eli"ibilit& list at

co##unit& le$els.

e to super$ise the con!uct of #eans testin" which shall be

base! on the criteria set b& the Corporation an! un!ertaken b&

the ?aran"a& Captain in coor!ination with the social welfare

officer an! co##unit&-base! health care or"ani'ations to

!eter#ine the econo#ic status of all househol!s an! in!i$i!uals,inclu!in" those who are in!i"ent.

f to issue health insurance I> car!s to persons whose pre#iu#s

ha$e been pai! accor!in" to the reuire#ents of the ;ffice an!

the "ui!elines issue! b& the ?oar!.

" to reco##en! to the ?oar! pre#iu# sche!ules that pro$i!e

for lower rates to be pai! b& the #e#bers whose !epen!ents

inclu!e those with re!uce! probabilit& of utili'ation, as in full&

i##uni'e! chil!ren.

h to reco##en! to the ?oar! a contribution sche!ule which

specifies contribution le$els b& the in!i$i!uals an! househol!s,an! a correspon!in" unifor# packa"e of personal health ser$ice

benefits which is at least eual to the #ini#u# packa"e of such

benefits prescribe! b& the ?oar! as appl&in" to the nation.

i to "rant an! !en& accre!itation to health care pro$i!ers in

their area of 3uris!iction, sub3ect to the rules an! re"ulations to

be issue! b& the ?oar!.

3 to process, re$iew an! pa& the clai#s of pro$i!ers, within a

perio! not e4cee!in" si4t& 0: !a&s, whene$er applicable in

accor!ance with the rules an! "ui!elines of the Corporation.

k to pa& fees, as necessar&, for clai#s re$iew an! processin"when such are con!ucte! b& the central office of the Corporation

or b& an& of its contractors.

l to establish referral s&ste#s an! network arran"e#ents with

other ;ffices, as #a& be necessar&, an! followin" the "ui!elines

set b& the Corporation.


16/29

# to establish #echanis#s b& which pri$ate an! public sector

health facilities an! hu#an resources #a& be share! in the

interest of opti#i'in" the use of health resources.

n to support the #ana"e#ent infor#ation s&ste# reuire#ents

of the Corporation.

o to ser$e as the first le$el for appeals an! "rie$ance cases.p to tap co##unit&-base! $olunteer health workers an!

baran"a& officials, if necessar&, for #e#ber recruit#ent,

pre#iu# collection an! si#ilar acti$ities, an! to "rant such

workers incenti$es accor!in" to the "ui!elines set b& the

Corporation an! in accor!ance with the applicable laws%

*owe$er, the incenti$es for the baran"a& officials shall accrue to

the baran"a& an! not to the sai! officials.

to participate in infor#ation an! e!ucation acti$ities that are

consistent with the "o$ern#ent/s priorit& pro"ra#s on !isease

pre$ention an! health pro#otion. an!r to prepare an annual report accor!in" to the "ui!elines set b&

the ?oar! an! to sub#it the sa#e to the central office of the

Corporation%

ARTICLE I

THE NATIONAL HEALTH INSURANCE FUND

SEC. 2. (reation of the National Health Insurance %und. - There is hereb&

create! a )ational *ealth Insurance 5un!, hereinafter referre! to as the

5un!, that shall consist of+

a contributions fro# ro"ra# #e#bers.b current balances of the *ealth Insurance 5un! of the SSS an!

SIS collecte! un!er the hilippine =e!ical Care Act of 199, as

a#en!e!, inclu!in" arreara"es of the o$ern#ent of the

hilippines with the SIS for the sai! 5un!.

c other appropriations ear#arke! b& the national an! local

"o$ern#ents purposel& for the i#ple#entation of the ro"ra#.

! subseuent appropriations pro$i!e! for un!er Sections an!

7 of this Act.

e !onations an! "rants-in-ai!. an!

f all accruals thereof%SEC. 25. (o'ponents of the National Health Insurance %und. - The )ational

*ealth Insurance 5un! shall ha$e the followin" co#ponents+

a The 0asic 0enefit %und. - This 5un! shall finance the a$ail#ent of the

basic #ini#u# benefit packa"e b& eli"ible beneficiaries% All liabilities

associate! with the e4tension of entitle#ent to the basic #ini#u# benefit

packa"e to the enrolle! population shall be borne b& the basic benefit fun!%

It shall be constitute! an! #aintaine! throu"h the followin" process+


17/29

1 upon the !eter#ination of the a#ount of "o$ern#ent

subsi!ies an! !onations a$ailable for pa&in" full& or partiall& the

pre#iu# of in!i"ent beneficiaries, a basic #ini#u# packa"e

affor!able for enrollin" as #an& of the in!i"ent beneficiaries as

possible shall be !efine!% The "o$ern#ent subsi!ies will then be

constitute! as pre#iu# paents for enrolle! in!i"ents an!contribute! into the basic benefit fun!%

6 for e4ten!in" co$era"e of this sa#e #ini#u# benefit packa"e

to non-in!i"ents who are not #e#bers of =e!icare, pre#iu#

prices for specific population shall be actuariall& !eter#ine!

base! on $ariations in risk, capacit& to pa&, an! pro3ecte! costs

of ser$ices utili'e!% The a#ounts correspon!in" to the pre#iu#

reuire!, inclu!in" costs of !irect benefit paents, all costs of

a!#inistration, an! pro$ision of a!euate reser$es, for

e4ten!in" the co$era"e of the basic #ini#u# benefit packa"e

for such population "roups shall be contribute! into the basicbenefit fun!%

for the population enrolle! throu"h =e!icare ro"ra# I un!er

SSS, the correspon!in" pre#iu# for the basic #ini#u# benefit

packa"e, inclu!in" costs of !irect benefit paents, all costs of

a!#inistration, an! pro$ision of a!euate reser$es, shall be

char"e! to the health insurance fun! of the SSS an! pai! into

the basic benefit fun!%

for the population enrolle! throu"h =e!icare ro"ra# I un!er

SIS, the correspon!in" pre#iu# for the basic #ini#u# benefit

packa"e, inclu!in" costs of !irect benefit paents, all costs of a!#inistration, an! pro$ision of a!euate reser$es, shall be

char"e! to the health insurance fun! of the SIS an! pai! into

the basic benefit fun!%

for "roups enrolle! throu"h an& of the e4istin" or future

health insurance sche#es an! plans, inclu!in" those create!

un!er =e!icare ro"ra# II an! those or"ani'e! b& local

"o$ern#ent units, national a"encies, cooperati$es, an! other

si#ilar or"ani'ations, the correspon!in" pre#iu#, inclu!in"

costs of !irect benefit paents, all costs of a!#inistration, an!

pro$ision of a!euate reser$es, for e4ten!in" the basic #ini#u#benefit packa"e to their respecti$e enrollees will be char"e! to

their respecti$e fun!s an! pai! into the basic benefit fun!%

b Supple'entar 0enefit %unds. These are separate an! !istinct

supple#entar& benefit fun!s create! b& the Corporation as eli"ible for use to

pro$i!e supple#entar& co$era"e to $arious "roups of the population

en3o&in" the basic benefit co$era"e as are affor!able b& their respecti$e

fun!in" sources% Bach supple#entar& benefit fun! shall finance the


18/29

e4tension an! a$ail#ent of a!!itional benefits not inclu!e! in the basic

#ini#u# benefit packa"e but appro$e! b& the ?oar!% Such supple#entar&

benefits shall be finance! b& whate$er a#ounts are a$ailable after !e!uctin"

the costs of pro$i!in" the basic #ini#u# benefit packa"e, inclu!in" costs of

!irect benefit paents, all costs of a!#inistration, an! pro$ision of

a!euate reser$es% All liabilities associate! with the e4tension of supple#entar& benefits to the !efine! "roup of enrollees shall be borne

e4clusi$el& b& the respecti$e supple#entar& benefit fun!s% 2pon the

i#ple#entation of this Act, the followin" supple#entar& benefit fun!s shall

be establishe!+

1 supple#entar& benefit fun! for SSS-=e!icare #e#bers an!

beneficiaries% After !e!uctin" the a#ount correspon!in" to the

pre#iu# of the basic #ini#u# benefit packa"e, the balance of

the SSS-*ealth Insurance 5un! 0*I5 shall be constitute! into a

supple#entar& benefit fun! to finance the e4tension of benefits

in a!!ition to the #ini#u# basic packa"e to SSS #e#bers an!beneficiaries. an!

6 supple#entar& benefit fun! for SIS-=e!icare #e#bers an!

beneficiaries% After !e!uctin" the a#ount correspon!in" to the

pre#iu# for the basic #ini#u# benefit packa"e, the balance of

the SIS-*I5 plus the arreara"es of the o$ern#ent of the

hilippines with the SIS for the sai! *I5 shall be constitute!

into a supple#entar& benefit fun! to finance the e4tension of

benefits in a!!ition to the #ini#u# basic packa"e to SIS

#e#bers an! beneficiaries%

In accor!ance with the principles of euit& an! social soli!arit&, asenunciate! in Section 6 of this Act, the abo$e supple#entar& benefit fun!s

shall be #aintaine! for not #ore than fi$e 0 &ears, after which, such fun!s

shall be #er"e! into the basic benefit fun!%

SEC. 2/. %inancial )ana+e'ent. - The use, !isposition, in$est#ent,

!isburse#ent, a!#inistration an! #ana"e#ent of the )ational *ealth

Insurance 5un!, inclu!in" an& subsi!&, "rant or !onation recei$e! for

pro"ra# operations shall be "o$erne! b& resolution of the ?oar! of >irectors

of the Corporation, sub3ect to the followin" li#itations+

a All fun!s un!er the #ana"e#ent an! control of the Corporation shall be

sub3ect to all rules an! re"ulations applicable to public fun!s%cralaw

b The Corporation is authori'e! to char"e the $arious fun!s un!er its

control for the costs of a!#inisterin" the ro"ra#% Such costs #a& inclu!e

a!#inistration, #onitorin", #arketin" an! pro#otion, research an!

!e$elop#ent, au!it an! e$aluation, infor#ation ser$ices, an! other

necessar& acti$ities for the effecti$e #ana"e#ent of the ro"ra#% The total

annual costs for these shall not e4cee! twel$e percent 016E of the total

contributions, inclu!in" "o$ern#ent contributions to the ro"ra# an! not


19/29

#ore than three percent 0E of the in$est#ent earnin"s collecte! !urin"

the i##e!iatel& prece!in" &ear%cralaw

SEC. 27.cha!"#$%& '(!)*a$ $a+ $(#!a!,Reser!e %unds. - The Corporation shall set asi!e a portion of its

accu#ulate! re$enues not nee!e! to #eet the cost of the current &ear/s

e4pen!itures as reser$e fun!s+ Pro!ided6 That the total a#ount of reser$es

shall not e4cee! a ceilin" eui$alent to the a#ount actuariall& esti#ate! fortwo &ears/ pro3ecte! ro"ra# e4pen!itures+ Pro!ided6 further6 That

whene$er actual reser$es e4cee! the reuire! ceilin" at the en! of the

Corporation/s fiscal &ear, the ro"ra#/s benefits shall be increase! or

#e#ber-contributions !ecrease! prospecti$el& in or!er to a!3ust

e4pen!itures or re$enues to #eet the reuire! ceilin" for reser$e fun!s%

Such portions of the reser$e fun! as are not nee!e! to #eet the current

e4pen!iture obli"ations shall be in$este! in short-ter# in$est#ents to earn

an a$era"e annual inco#e at pre$ailin" rates of interest an! shall be known

as the "In!est'ent Reser!e %und" which shall be in$este! in an& or all of the

followin"+a In interest-bearin" bon!s, securities or other e$i!ences of

in!ebte!ness of the o$ern#ent of the hilippines, or in bon!s,

securities, pro#issor& notes an! other e$i!ences of in!ebte!ness

to which full faith an! cre!it an! uncon!itional "uarantee of the

Republic of the hilippines is ple!"e!.

b In interest-bearin" !eposits an! loans to or securities in an&

!o#estic bank !oin" business in the hilippines+ Pro!ided6 That

in the case of such !eposits, this shall not e4cee! at an& ti#e

the uni#paire! capital an! surplus or total pri$ate !eposits of

the !epositor& bank, whiche$er is s#aller+ Pro!ided6further6 That sai! bank shall first ha$e been !esi"nate! as a

!epositor& for this purpose b& the =onetar& ?oar! of the ?an"ko

Sentral n" ilipinas. an!

c In preferre! stocks of an& sol$ent corporation or institution

create! or e4istin" un!er the laws of the

hilippines+ Pro!ided6 That the issuin", assu#in", or

"uaranteein" entit& or its pre!ecessor has pai! re"ular !i$i!en!s

upon its preferre! or "uarantee! stocks for a perio! of at least

three 0 &ears i##e!iatel& prece!in" the !ate of in$est#ent in

such preferre! "uarantee! stocks+ Pro!ided6 further6That if thecorporation or institution has not pai! !i$i!en!s upon its

preferre! stocks, the corporation or institution has sufficient

retaine! earnin"s to !eclare !i$i!en!s for at least two 06 &ears

on such preferre! stocks an! in co##on stocks option or

warrants to co##on stocks of an& sol$ent corporation or

institution create! or e4istin" un!er the laws of the hilippines in

the stock e4chan"e with pro$en track recor! of profitabilit& an!


20/29

paent of !i$i!en!s o$er the last three 0 &ears or in co##on

stocks of a newl& or"ani'e! corporation about to be liste! in the

stock e4chan"e+ Pro!ided6 finall6 That such !ul& or"ani'e!

corporations shall ha$e been rate! "A" , !ouble "As" or

triple "As" b& authori'e! accre!ite! !o#estic ratin" a"encies or

b& the Corporation or in #utual fun!s inclu!in" allie!in$est#ents%

ARTICLE II

FINANCING

SEC. 28. (ontri&utions. - All #e#bers of the ro"ra# shall contribute to the

5un!, in accor!ance with a reasonable, euitable an! pro"ressi$e

contribution sche!ule to be !eter#ine! b& the Corporation on the basis of

applicable actuarial stu!ies an! in accor!ance with the followin" "ui!elines+

a 5or#al sector e#plo&ees an! current =e!icare #e#bers an!

their e#plo&ers shall continue pa&in" the sa#e #onthl&contributions as pro$i!e! for b& law until such ti#e that the

Corporation shall ha$e !eter#ine! the contribution sche!ule

#entione! herein+ Pro!ided6That their #onthl& contribution shall

not e4cee! three percent of their respecti$e #onthl& salaries%

b Contributions fro# self-e#plo&e! #e#bers shall be base!

pri#aril& on househol! earnin"s an! assets. their total

contributions for one &ear shall not, howe$er, e4cee! three

percent 0E of their esti#ate! actual net inco#e for the

prece!in" &ear%

c Contributions #a!e in behalf of in!i"ent #e#bers shall note4cee! the #ini#u# contributions set for e#plo&e! #e#bers%

SEC. 29. Pa'ent for Indi+ent (ontri&utions. - Contributions for in!i"ent

#e#bers shall be subsi!i'e! partiall& b& the local "o$ern#ent unit where

the #e#ber resi!es% The Corporation shall pro$i!e counterpart financin"

eual to the (2/s subsi!& for in!i"ents+ Pro!ided6 That in the case of

fourth, fifth an! si4th class (2/s, the )ational o$ern#ent shall pro$i!e up

to ninet& percent 09:E of the subsi!& for in!i"ents for a perio! not

e4cee!in" fi$e 0 &ears% The share of the (2/s shall be pro"ressi$el&

increase! until such ti#e that its share beco#es eual to that of the )ational

o$ern#ent%

ARTICLE III

HEALTH CARE PROIDERS

SEC. -0. %ree (hoice of Health %acilit6 )edical or Dental Practitioner.

-?eneficiaries reuirin" treat#ent or confine#ent shall be free to choose


21/29

fro# accre!ite! health care pro$i!ers% Such choice shall, howe$er, be sub3ect

to li#itations base! on the area of 3uris!iction of the concerne! ;ffice an!

on the appropriateness of treat#ent in the facilit& chosen or b& the !esire!

pro$i!er%cralaw

SEC. -1. Authorit to rant Accreditation. - The Corporation shall ha$e the

authorit& to "rant to health care pro$i!ers accre!itation which confers thepri$ile"e of participatin" in the ro"ra#% cralaw

SEC. -2. Accreditation #li+i&ilit. - All health care pro$i!ers, as enu#erate!

in Sec% 0o hereof an! operatin" for at least three 0 &ears, #a& appl& for

accre!itation%cralaw

SEC. --. )ini'u' Re$uire'ents for Accreditation. - The #ini#u#

accre!itation reuire#ents for health care pro$i!ers are as follows+

a hu#an resource, euip#ent an! ph&sical structure in

confor#it& with the stan!ar!s of the rele$ant facilit&, as

!eter#ine! b& the >epart#ent of *ealth.

b acceptance of for#al pro"ra# of ualit& assurance an!utili'ation re$iew.

c acceptance of the paent #echanis#s specifie! in the

followin" section.

! a!option of referral protocols an! health resources sharin"

arran"e#ents.

e reco"nition of the ri"hts of the patients. an!

f acceptance of infor#ation s&ste# reuire#ents an! re"ular

transfer of infor#ation%

SEC. -. Pro!ider Pa'ent )echanis's. - The followin" #echanis#s for

public an! pri$ate pro$i!ers shall be allowe! in the ro"ra#+a 5ee-for-ser$ice base! on #echanis#s establishe! b& the

Corporation.

b Capitation of health care professionals an! facilities, or

network of the sa#e, inclu!in" *=;s, #e!ical cooperati$es, an!

other le"all& for#e! health ser$ice "roups.

c A co#bination of both. an!

! An& or all of the abo$e, sub3ect to "lobal bu!"et%

Bach ;ffice shall reco##en! the appropriate paent #echanis# within its

3uris!iction for appro$al b& the Corporation% Special consi!eration shall be

"i$en to paent for ser$ices ren!ere! b& public an! pri$ate health carepro$i!ers ser$in" re#ote or #e!icall& un!erser$e! areas%

SEC. -5. %ee-for-ser!ice Pa'ents and Pa'ents in eneral. - 5ee-for-

ser$ice paents #a& be #a!e separatel& for professional fees an! hospital

char"es, or both, base! on arran"e#ents with health care pro$i!ers% This

fee shall be base! on a sche!ule to be establishe! b& the ?oar! which shall

be re$iewe! e$er& three 0 &ears% 5ees pai! for professional ser$ices

ren!ere! b& salarie! public pro$i!ers shall be allowe! an! be poole! an!


22/29

!istribute! a#on" health personnel% Char"es pai! to public facilities shall be

allowe! to be retaine! b& the in!i$i!ual facilit& in which ser$ices were

ren!ere! an! for which paent was #a!e% Such re$enues shall be use! to

!efra& operatin" costs other than salaries, to #aintain or up"ra!e

euip#ent, plant or facilit&, an! to #aintain or i#pro$e the ualit& of ser$ice

in the public sector%cralaw

SEC. -/. (apitation Pa'ents. - Capitation paents #a& be pai! to public

or pri$ate pro$i!ers accor!in" to rates of capitation paents base! on

annual capitation rate "ui!elines to be issue! b& the Corporation% cralaw

SEC. -7. ,ualit Assurance. - 2n!er the "ui!elines pro$i!e! b& the

Corporation an! in collaboration with their respecti$e ;ffices, health care

pro$i!ers shall take part in pro"ra#s of ualit& assurance, utili'ation re$iew,

an! technolo"& assess#ent that ha$e the followin" ob3ecti$es+

a to ensure that the ualit& of personal health ser$ices

!eli$ere!, #easure! in ter#s of inputs, process, an! outco#es,

are of reasonable ualit& in the conte4t of the hilippines o$erti#e.

b to ensure that the health care stan!ar!s are unifor# within

the ;ffice/s 3uris!iction an! e$entuall& throu"hout the nation.

an!

c to see to it that the acuisition an! use of scarce an!

e4pensi$e #e!ical technolo"ies an! euip#ent are consistent

with actual nee!s an! stan!ar!s of #e!ical practice, an! that+

1 the perfor#ance of #e!ical proce!ures an! the a!#inistration

of !ru"s are appropriate, necessar& an! unuestionabl&

consistent with accepte! stan!ar!s of #e!ical practice an!ethics% >ru"s for which paents will be #a!e shall be those

inclu!e! in the hilippine )ational >ru" 5or#ular&, unless e4plicit

e4ception is "rante! b& the Corporation%

6 the perfor#ance of #e!ical proce!ures an! the a!#inistration

of !ru"s are appropriate, consistent with accepte! stan!ar!s of

#e!ical practice an! ethics, an! respectful of the local culture%

SEC. -8. Safe+uards A+ainst !er and nder tili4ation. - It is incu#bent

upon the Corporation to set up a #onitorin" #echanis# to be

operationali'e! throu"h a contract with health care pro$i!ers to ensure that

there are safe"uar!s a"ainst+a o$er-utili'ation of ser$ices.

b unnecessar& !ia"nostic an! therapeutic proce!ures an!

inter$ention.

c irrational #e!ication an! prescriptions.

! un!er-utili'ation of ser$ices. an!

e inappropriate referral practices%


23/29

The Corporation #a& !en& or re!uce the paent for clai#s when such

clai#s are atten!e! b& false or incorrect infor#ation an! when the clai#ant

fails, without 3ustifiable cause, to co#pl& with the rules an! re"ulations of

this Act%

ARTICLE I

GRIEANCE AND APPEAL

SEC. -9. rie!ance Sste'. - A s&ste# of "rie$ance is hereb& establishe!,

wherein #e#bers, !epen!ents, or health care pro$i!ers of the ro"ra# who

belie$e the& ha$e been a""rie$e! b& an& !ecision of the i#ple#entors of the

ro"ra#, #a& seek re!ress of the "rie$ance in accor!ance with the

pro$isions of this Article% cralaw

SEC. 0.cha !"#$% & '(!)*a $ $a + $ (#!a !,rounds for rie!ances. - The followin" acts shall constitute

$ali! "roun!s for "rie$ance action+a an& $iolation of the ri"hts of the patients.

b a willful ne"lect of !uties of ro"ra# i#ple#entors that

results in the loss or non-en3oent of benefits of #e#bers or

their !epen!ents.

c un3ustifiable !ela& in actions on clai#s.

! !ela& in processin" of clai#s that e4ten!s be&on! the perio!

a"ree! upon. an!

e an& other act or ne"lect that ten!s to un!er#ine or !efeat the

purposes of this Act%

SEC. 1. rie!ance and Appeal Procedures. - A #e#ber, his !epen!ent, or ahealth care pro$i!er, #a& file a co#plaint for "rie$ance base! on an& of the

abo$e "roun!s, in accor!ance with the followin" proce!ures+

a A co#plaint for "rie$ance #ust be file! with the ;ffice which

shall rule on the co#plaint within ninet& 09: calen!ar !a&s fro#

receipt thereof%

b Appeals fro# ;ffice !ecisions #ust be file! with the ?oar!

within thirt& 0: !a&s fro# receipt of notice of !is#issal or

!isallowance b& the ;ffice%

c The ;ffices shall ha$e no 3uris!iction o$er an& issue in$ol$in"

the suspension or re$ocation of accre!itation, the i#position of

fines, or the i#position of char"es on #e#bers or their

!epen!ents in case of re$ocation of their entitle#ent%

! All !ecisions b& the ?oar! as to entitle#ent to benefits of

#e#bers or to paents of health care pro$i!ers shall be

consi!ere! final an! e4ecutor&%

SEC. 2. rie!ance and Appeal Re!ie (o''ittee. - The ?oar! shall create

a rie$ance Appeal Re$iew Co##ittee, co#pose! of three 0 to fi$e 0


24/29

#e#bers, hereinafter referre! to as the Co##ittee, which, sub3ect to the

proce!ures enu#erate! abo$e, shall recei$e an! reco##en! appropriate

action on co#plaints fro# #e#bers an! health care pro$i!ers relati$e to this

Act an! its i#ple#entin" rules an! re"ulations%

SEC. -. Hearin+ Procedures of the (o''ittee. - 2pon the filin" of the

co#plaint, the rie$ance an! Appeal Re$iew Co##ittee, fro# aconsi!eration of the alle"ations thereof, #a& !is#iss the case outri"ht !ue to

lack of $erification, failure to state the cause of action, or an& $ali! "roun!

for the !is#issal of the co#plaint after consultation with the ?oar!. or

reuire the respon!ent to file a $erifie! answer within fi$e 0 !a&s fro#

ser$ice of su##ons% cralaw

Shoul! the !efen!ant fail to answer the co#plaint within the re"le#entar&

-!a& perio! herein pro$i!e!, the Co##ittee, 'otu proprio or upon #otion

of the co#plainant, shall ren!er 3u!"#ent as #a& be warrante! b& the facts

alle"e! in the co#plaint an! li#ite! to what is pra&e! for therein%cralaw

After an answer is file! an! the issues are 3oine!, the Co##ittee shallreuire the parties to sub#it, within ten 01: !a&s fro# receipt of the or!er,

the affi!a$its of witnesses an! other e$i!ence on the factual issues !efine!

therein, to"ether with a brief state#ent of their positions settin" forth the

law an! the facts relie! upon b& the#% In the e$ent the Co##ittee fin!s,

upon consi!eration of the plea!in"s, the affi!a$its an! other e$i!ence, an!

position state#ents sub#itte! b& the parties, that a 3u!"#ent #a& be

ren!ere! thereon without nee! of for#al hearin", it #a& procee! to ren!er

3u!"#ent not later than ten 01: !a&s fro# the sub#ission of the position

state#ents of the parties% cralaw

In cases where the Co##ittee !ee#s it necessar& to hol! a hearin" toclarif& specific factual #atters before ren!erin" 3u!"#ent, it shall set the

case for hearin" for the purpose% At such hearin", witnesses whose affi!a$its

were pre$iousl& sub#itte! #a& be aske! clarificator& uestions b& the

proponent an! b& the Co##ittee an! #a& be cross-e4a#ine! b& the

a!$erse part&% The or!er settin" the case for hearin" shall specif& the

witnesses who will be calle! to testif&, an! the #atters on which their

e4a#ination will !eal% The hearin" shall be ter#inate! within fifteen 01

!a&s, an! the case !eci!e! b& the Co##ittee within fifteen 01 !a&s fro#

such ter#ination%cralaw

The !ecision of the Co##ittee shall beco#e final an! e4ecutor& fifteen 01!a&s after notice thereof+ Pro!ided6 hoe!er6 That it is appealable to the

?oar! b& filin" the appellant/s #e#oran!u# of appeal within fifteen 01

!a&s fro# receipt of the cop& of the 3u!"#ent appeale! fro#% The appellee

shall be "i$en fifteen 01 !a&s fro# notice to file the appellee/s

#e#oran!u# after which the ?oar! shall !eci!e the appeal within thirt&

0: !a&s fro# the sub#ittal of the sai! plea!in"s% cralaw


25/29

The !ecision of the ?oar! shall also beco#e final an! e4ecutor& fifteen 01

!a&s after notice thereof+ Pro!ided6 hoe!er , That it is re$iewable b& the

Supre#e Court on purel& uestions of law in accor!ance with the Rules of

Court%cralaw

The Co##ittee an! the ?oar!, in the e4ercise of their uasi-3u!icial function,

as specifie! in Section 17 hereof, can a!#inister oaths, certif& to official actsan! issue su&poena to co#pel the atten!ance an! testi#on& of the

witnesses, an!su&poena duces tecu' ad testificandu' to en3oin the

pro!uction of books, papers an! other recor!s an! to testif& therein on an&

uestion arisin" out of this Act% An& case of contu#ac& shall be !ealt with in

accor!ance with the pro$isions of the Re$ise! A!#inistrati$e Co!e an! the

Rules of Court% The ?oar! or the Co##ittee, as the case #a& be, shall

prescribe the necessar& a!#inistrati$e sanctions such as fines, warnin"s,

suspension or re$ocation of the ri"ht to participate in the ro"ra#% cralaw

In all its procee!in"s, the Co##ittee an! the ?oar! shall not be boun! b&

the technical rules of e$i!ence+ Pro!ided6 hoe!er , That the Rules of Courtshall appl& with suppletor& effect%

ARTICLE

PENALTIES

SEC. . Penal Pro!isions. - An& $iolation of the pro$isions of this Act, after

!ue notice an! hearin", shall suffer the followin" penalties+

A fine of not less than Ten thousan! pesos 01:,::: nor #ore than 5ift&

thousan! pesos 0:,::: in case the $iolation is co##itte! b& the hospital#ana"e#ent or pro$i!er% In a!!ition, its accre!itation shall be suspen!e! or

re$oke! fro# three #onths to the whole ter# of the accre!itation+ Pro!ided6

hoe!er , That reci!i$ists #a& not anore be accre!ite! as a participant of

the ro"ra#.

A fine of not less than 5i$e hun!re! pesos 0:: nor #ore than 5i$e

thousan! pesos 0,::: an! i#prison#ent of not less than si4 0 #onths

nor #ore than one 01 &ear in case the $iolation is co##itte! b& the

#e#ber%cralaw

Dhere the $iolations consist of failure or refusal to !e!uct contributions fro#

the e#plo&ee/s co#pensation or to re#it the sa#e to the Corporation, the

penalt& shall be a fine of not less than 5i$e hun!re! pesos 0:: but not

#ore than ;ne thousan! pesos 01,::: #ultiplie! b& the total nu#ber of

e#plo&ees e#plo&e! b& the fir# an! i#prison#ent of not less than si4 0

#onths but not #ore than one 01 &ear+ Pro!ided6 further6 That in the case

of self-e#plo&e! #e#bers, failure to re#it one/s own contribution shall be

penali'e! with a fine of not less than 5i$e hun!re! pesos 0:: but not

#ore than ;ne thousan! pesos 01,:::% cralaw


26/29

An& e#plo&er or an& officer authori'e! to collect contributions un!er this Act

who, after collectin" or !e!uctin" the #onthl& contributions fro# his

e#plo&ee/s co#pensation, fails to re#it the sai! contributions to the

Corporation within thirt& 0: !a&s fro# the !ate the& beco#e !ue shall be

presu#e! to ha$e #isappropriate! such contributions an! shall suffer the

penalties pro$i!e! for in Article 1 of the Re$ise! enal Co!e% cralaw

An& e#plo&er who shall !e!uct !irectl& or in!irectl& fro# the co#pensation

of the co$ere! e#plo&ees or otherwise reco$er fro# the# his own

contribution on behalf of such e#plo&ees shall be punishe! b& a fine not

e4cee!in" ;ne thousan! pesos 01,::: #ultiplie! b& the total nu#ber of

e#plo&ees e#plo&e! b& the fir#, or i#prison#ent not e4cee!in" one 01

&ear, or both fine an! i#prison#ent, at the !iscretion of the Court% cralaw

If the act or o#ission penali'e! b& this Act be co##itte! b& an association,

partnership, corporation or an& other institution, its #ana"in" !irectors or

partners or presi!ent or "eneral #ana"er, or other persons responsible for

the co##ission of the sai! act shall be liable for the penalties pro$i!e! for inthis Act an! other laws for the offense% cralaw

An& e#plo&ee of the Corporation who recei$es or keeps fun!s or propert&

belon"in", pa&able or !eli$erable to the Corporation, an! who shall

appropriate the sa#e, or shall take or #isappropriate or shall consent, or

throu"h aban!on#ent or ne"li"ence, shall per#it an& other person to take

such propert& or fun!s wholl& or partiall&, shall likewise be liable for

#isappropriation of fun!s or propert& an! shall suffer i#prison#ent of not

less than si4 0 &ears an! not #ore than twel$e 016 &ears an! a fine of not

less than Ten thousan! pesos 01:,::: nor #ore than Twent& thousan!

pesos 06:,:::% An& shorta"e of the fun!s or loss of the propert& uponau!it shall be !ee#e! pri'a facie e$i!ence of the offense% cralaw

All other $iolations in$ol$in" fun!s of the Corporation shall be "o$erne! b&

the applicable pro$isions of the Re$ise! enal Co!e or other laws, takin" into

consi!eration the rules on collection, re#ittances, an! in$est#ent of fun!s

as #a& be pro#ul"ate! b& the Corporation%

ARTICLE I

APPROPRIATIONS

SEC. 5. Initial Appropriation. - The une4pen!e! portion of the bu!"et of

the hilippine =e!ical Care Co##ission 0=CC for the &ear !urin" which

this Act was appro$e! shall be utili'e! for establishin" the Corporation an!

initiatin" its operations, inclu!in" the for#ulation of the rules an! re"ulation

necessar& for the i#ple#entation of this Act% In a!!ition, initial fun!in" shall

co#e fro# an& unappropriate! but a$ailable fun! of the o$ern#ent%cralaw


27/29

SEC. /. Su&se$uent Appropriations. - Startin" 199 an! thereafter, twent&-

fi$e percent 06E of the incre#ent in total re$enue collecte! un!er

Republic Act )o% 7 shall be appropriate! in the eneral Appropriations

Act solel& for the )ational *ealth Insurance 5un!% cralaw

In a!!ition, startin" 199 an! thereafter, twent&-fi$e percent 06E of the

incre#ental re$enue fro# the increase in the !ocu#entar& sta#p ta4esun!er Republic Act )o% 7: shall likewise be appropriate! solel& for the sai!

fun!%cralaw

SEC. 7. Additional Appropriations. - The Corporation #a& reuest Con"ress

to appropriate supple#ental fun!in" to #eet tar"ette! #ilestones of the

ro"ra# in accor!ance with Section 1:0! of this Act%

ARTICLE II

TRANSITOR3 PROISIONSSEC. 8. Appoint'ent of 0oard )e'&ers.- Dithin thirt& 0: !a&s fro# the

!ate of effecti$it& of this Act, the resi!ent of the hilippines shall appoint

the #e#bers of the ?oar! an! the resi!ent of the Corporation% cralaw

SEC. 9. I'ple'entin+ Rules and Re+ulations. - Dithin thirt& 0: !a&s

fro# the co#pletion of such appoint#ents, the ?oar! shall con$ene to

for#ulate the rules an! re"ulations necessar& for the i#ple#entation of this

Act%cralaw

SEC. 50. Pro'ul+ation. - Dithin one &ear fro# its initial #eetin", the ?oar!

shall pro#ul"ate the afore#entione! rules an! re"ulations in at least two 06

national newspapers of "eneral circulation% ?ut until such ti#e that theCorporation shall ha$e pro#ul"ate! sai! rules an! re"ulations, the e4istin"

rules an! re"ulations of the =CC shall be followe!% The present =e!icare

ro"ra# shall continue to be so a!#inistere!, until the Corporation/s ?oar!

!ee#s the new s&ste# as rea!& for i#ple#entation in accor!ance with the

pro$isions of this Act% cralaw

SEC. 51. )er+er. - Dithin si4t& 0: !a&s fro# the pro#ul"ation of the

i#ple#entin" rules an! re"ulations, all functions an! assets of the hilippine

=e!ical Care Co##ission shall be #er"e! with those of the Corporation

without nee! of con$e&ance, transfer or assi"n#ent% The =CC shall

thereafter cease to e4ist%cralaw

The liabilities of the =CC shall be treate! in accor!ance with the e4istin"

laws an! pertinent rules an! re"ulations% cralaw

To the "reatest e4tent possible an! in accor!ance with e4istin" laws, all

e#plo&ees of the =CC shall be absorbe! b& the Corporation% cralaw

SEC. 52. Transfer of the Health Insurance %unds of the SSS and SIS. - The

*ealth Insurance 5un!s bein" a!#inistere! b& the SSS an! SIS shall be

transferre! to the Corporation within si4t& 0: !a&s fro# the pro#ul"ation


28/29

of the i#ple#entin" rules an! re"ulations% The SSS an! SIS shall, howe$er,

continue to perfor# =e!icare functions un!er contract with the Corporation

until such ti#e that such functions are assu#e! b& the Corporation, in

accor!ance with the followin" Section% cralaw

SEC. 5-. Transfer of the )edicare %unctions of the SSS and SIS. - Dithin

fi$e 0 &ears fro# the pro#ul"ation of the i#ple#entin" rules an!re"ulations, the functions, assets, euip#ent, recor!s, operatin" s&ste#,

an! liabilities, if an&, of the =e!icare operations of the SSS an! SIS shall

be transferre! to the Corporation+ Pro!ided6 hoe!er6 That the SSS an!

SIS shall continue perfor#in" its =e!icare functions be&on! the stipulate!

fi$e-&ear perio! if such e4tension will benefit ro"ra# #e#bers, as

!eter#ine! b& the Corporation% cralaw

ersonnel of the =e!icare !epart#ents of the SSS an! SIS shall be "i$en

priorit& in the hirin" of the Corporation/s e#plo&ees%

ARTICLE III

MISCELLANEOUS PROISIONS

SEC. 5. !ersi+ht Pro!ision. - Con"ress shall con!uct a re"ular re$iew of

the )ational *ealth Insurance ro"ra# which shall entail a s&ste#atic

e$aluation of the ro"ra#/s perfor#ance, i#pact or acco#plish#ents with

respect to its ob3ecti$es or "oals% Such re$iew shall be un!ertaken b& the

Co##ittee of the Senate an! the *ouse of Representati$es which ha$e

le"islati$e 3uris!iction o$er the ro"ra#% cralaw

SEC. 55. Infor'ation (a'pai+n. - There shall be pro$i!e! a substantial

perio! of ti#e to un!ertake an intensi$e public infor#ation ca#pai"n prior tothe i#ple#entation of the rules an! re"ulations of this Act% cralaw

SEC. 5/. Separa&ilit (lause. - In the e$ent an& pro$ision of this Act or the

application of such pro$ision to an& person or circu#stances is !eclare!

in$ali!, the re#ain!er of this Act or the application of sai! pro$isions to

other persons or circu#stances shall not be affecte! b& such !eclaration% cralaw

SEC. 57. Repealin+ (lause. - B4ecuti$e ;r!er 119, resi!ential >ecree 119

an! other laws currentl& appl&in" to the a!#inistration of =e!icare are

hereb& repeale!% All other laws, e4ecuti$e or!ers, a!#inistrati$e rules an!

re"ulations or parts thereof which are inconsistent with the pro$isions of this

Act are also hereb& a#en!e!, #o!ifie!, or repeale! accor!in"l&%cralaw

SEC. 58. o!ern'ent uarantee. - The o$ern#ent of the hilippines

"uarantees the financial $iabilit& of the ro"ra#%

SEC. 59. #ffecti!it. - This Act shall take effect fifteen 01 !a&s after its

publication in at least three 0 national newspaper of "eneral circulation%

Appro$e! + February 14, 1995


29/29

2S+d.3 5I>B( % RA=;S

President of the Philippines

law 3 republic act no. 7875 national health insurance act of 1995

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