Draft HMO bill completion seen this year

The Insurance Commission (IC) is targeting to finish within the year the draft for a proposed bill which will lay out the detailed guidelines on the government’s supervision of health maintenance organizations (HMOs) in the country.

In an interview, Insurance commissioner Dennis Funa said a team from the IC is currently drafting the HMO bill, and is expecting to finish the proposal this year.

“We have a group now working on that, but they are still in the process. Probably, it will take some more months, but hopefully within this year we will have a draft bill,” Funa said.

According to the insurance chief, the proposed bill will provide rules and regulations that will govern the HMO industry in the country.

He said Executive Order (EO) 192 signed by former president Benigno Aquino III, as well as the issuances released by IC, are not enough to properly regulate the sector. “Right now, the regulation has many holes (because) we only have one rule and that is the EO issued by president Aquino. Other than that, it’s the CL (circular letters) issued by the IC,” Funa said.

Funa said there are still many issues plaguing the HMO industry that needs to be addressed via legislation.

“There are a number of issues to be tackled—capitalization, for example. How much capital should we really require for HMOs? Can we do that just by issuing an office order or CL? So to have it clarified by legislation would be the best course we can take,” he said.

Another matter that needs to be addressed through legislation, according to Funa, is the settlement of disputes involving HMOs and their planholders. As such, he said the proposed bill should include the bill of rights of HMO customers and the guidelines on how to properly settle disputes.

After drafting the proposal, the commissioner said the IC would approach the House of Representatives or the Senate and seek their help in finding a sponsor who can adopt the bill.

Despite being confident the Congress would see the need for an HMO law, Funa, however, acknowledged it may not be included in the list of priorities of the legislature as of now.

“We have to be realistic that Congress has a list of priorities and if we cannot make it, there’s nothing we can do about that. We can ask Malacañang to have it certified but even Malacañang has its list of priorities. But, whatever, we will be pushing for this bill,” the insurance chief said.

In an earlier interview, Funa said the proposed HMO bill should prescribe the specific oversight functions of the IC, as well as the requirements and responsibilities of HMOs as they were not listed in EO 192.