---

EXECUTIVE ORDER NO. 441 December 21, 1990

INCREASING MEDICARE BENEFITS UNDER THE PHILIPPINE MEDICAL CARE PLAN

WHEREAS, in the light of present economic conditions with increase in prices of practically all commodities, including the cost of medicines and hospitalization, it is deemed necessary and timely to further increase and enhance the medicare benefits granted to SSS and GSIS members, to take them more meaningful and responsive to the times;

WHEREAS, under the present policy of the SSS, only active members and retiree-pensioners and their dependents enjoy medicare benefits;

WHEREAS, SSS death and total disability pensioners and their dependents must likewise be assisted in the medical care expenses similar to the old age pensioners and their dependents;

WHEREAS, under the policy of the GSIS adopted since 1974, retiree-pensioners are granted free medicare benefits;

WHEREAS, the government desires to increase medicare benefits to a meaningful level;

WHEREAS, actuarial studies show that the Health Insurance Fund administered by the SSS for medicare beneficiaries in the private sectors and by the GSIS for medicare beneficiaries in the government sector can further finance an 80% across-the-board rates, and 875 increase in drugs and medicines, and a 25% increase in all other Medicare benefits which will result to a 585 overall increase and the inclusion under the medical care program of SSS death and disability pensioners and their dependents, and dependents of GSIS pensioners without the need for increase in contributions;

WHEREAS, the Philippine Medical Care Commission has recommended further enhancement of the benefits under Medicare program;

NOW, THEREFORE, I, CORAZON C. AQUINO, President of the Philippines, by virtue of the powers vested in me by law, do hereby order:

Sec. 1. The Medicare benefits for both GSIS and SSS Medicare beneficiaries are increased as follows:

	Items of Hospitalization	Benefit Limit
		(By Hospital Category)
A.	Hospital Charges	Primary	Secondary	Tertiary
1.	Room and Board not exceeding 45 days per year for each member of program 1 and another 45 days per year to be shared by all his dependents	P45/Day	P80/Day	P100/Day
2.	Medical Expenses Benefits (Per Single) Period of confinement
	2.1 Ordinary Cases	P600	P910	P1145
	Drugs & Medicines	495	660	705
	X-Ray/Lab/Other	105	250	440
	2.2 Intensive Cases	P1162.50	P1700	P2900
	Drugs & Medicines	937.50	1125	2025
	X-Ray/Lab/Other	225	575	875
	2.3 Catastrophic Cases	3660	5565
	Drugs & Medicines	2535	2895
	X-Ray/Lab/Other	1125	2670
3.	Operating Room Fee based on Commission's Relative Unit Value (RUV) Scheme
	3.1 RUV 5 & Below	115	205	325
	3.2 RUV 5, 1 to 10	350	415
	3.3 RUV 10, 1 & Above	800	1075

B. Professional Fees

1. Medical/Dental Practitioner's Fee per day of P45 for General Practitioner's and P65 for Specialists not to exceed per single period of confinement, P250 for General Practitioner and P375 for Specialist in Ordinary Cases; and P375 for General Practitioner and P625 for Specialist in Intensive Care/Catastrophic Cases.

2. Surgeon's Fee in accordance with the Relative Unit Value Scheme prescribed by the Commission not to exceed P5,900.

3. Anesthesiologist's Fee (30% of allowed Surgeon's Fee) not to exceed P1,770.

4. Fees for Surgical Family Planning Procedure as may be determined by the Commission.

Sec. 2. Death and total disability pensioners of SSS, as well as their dependents shall be entitled to Medical Care benefits without need for any additional contribution.

Sec. 3. Dependents of GSIS retiree-pensioners shall also be covered with Medicare benefits.

Sec. 4. All orders, issuances, rules and regulations or parts, thereof inconsistent with this Executive Order are hereby repealed or modified accordingly.

Sec. 5. This Order shall take effect on the 1st day of January, 1991.

DONE in the City of Manila, this 21st of December in the year of Our Lord, nineteen hundred and ninety. lawphi1.net

The Lawphil Project - Arellano Law Foundation

---