MALACAÑAN PALACE
MANILA
BY THE PRESIDENT OF THE PHILIPPINES
[ Executive Order No. 501, December 27, 1991 ]
INCREASING THE MEDICARE BENEFITS UNDER THE PHILIPPINE MEDICAL CARE PLAN
WHEREAS, the need arises to upgrade Medicare benefits in order to make the Program responsive to its members;
WHEREAS, the government desires to increase Medicare benefits to preserve the Programs support 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 a 20% across-the-board increase in all items of hospitalization compensable under the Medicare Program;
WHEREAS, the Philippine Medical Care Commission has recommended further enhancements of the benefits under the Medicare Program.1aшphi1
NOW, THEREFORE, I, CORAZON C. AQUINO, President of the Philippines, by virtue of the powers vested in me by law, do hereby order:
Section 1. The Medicare benefits for both GSIS and SSS Medicare beneficiaries are increased as follows:
| ITEMS FOR HOSPITALIZATION |
BENEFIT LIMIT (BY HOSPITAL CATEGORY) |
| PRIMARY |
SECONDARY |
TERTIARY |
A. Hospital Charges
| 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 |
P55/Day |
P100/Day |
P120/Day |
2. Medical Expense Benefit (per single period of confinement)
| 2.1 Ordinary Cases |
720 |
1,090 |
1,375 |
| Drugs and Medicines |
595 |
790 |
845 |
| X-Ray/Lab/Other |
125 |
300 |
530 |
| 2.2 Intensive Cases |
1,395 |
2,040 |
3,480 |
| Drugs and Medicines |
1,125 |
1,350 |
2,430 |
| X-Ray/Lab/Cases |
270 |
690 |
1,050 |
| 2.3 Catastrophic Cases |
|
4,390 |
6,680 |
| Drugs and Medicines |
|
3,040 |
3,475 |
| X-Ray/Lab/Other |
|
,350 |
3,205 |
3.Operating Room Fee based on Commissions Relative Unit Value (RUV) Scheme
| & Below |
140 |
245 |
390 |
|
|
420 |
500 |
| 3.3 1 and Above |
|
960 |
1,290 |
PROFESSIONAL FEES
1 MEDICAL/DENTAL PRACTITIONERS FEE, PER DAY OF P55 FOR GENERAL PRACTITIONERS AND P80 FOR SPECIALISTS, NOT TO EXCEED PER SINGLE PERIOD OF CONFINEMENT, P300 FOR GENERAL PRACTITIONER AND P450 FOR SPECIALIST IN ORDINARY CASES; AND P450 FOR GENERAL PRACTITIONER AND P750 FOR SPECIALIST IN INTENSIVE CARE/CATASTROPHIC CASES.
2 SURGEONS FEE IN ACCORDANCE WITH THE RELATIVE UNIT VALUE SCHEME PRESCRIBED BY THE COMMISSION NOT TO EXCEED P7,080.
3 ANESTHESIOLOGISTS FEE (30% OF ALLOWED SURGEONS FEE) NOT TO EXCEED P2,125.
4 FEES FOR SURGICAL FAMILY PLANNING PROCEDURES AS MAY BE DETERMINED BY THE COMMISSION.
Section 2. All orders, issuances, rules and regulations or parts thereof inconsistent with this Executive Order are hereby repealed or modified accordingly.
Section 3. This Executive Order shall take effect on the 1st day of January 1992.
DONE in the City of Manila, this 27th day of December, in the year of Our Lord, nineteen hundred and ninety-one.
(Sgd.) CORAZON C. AQUINO
President of the Philippines
By the President:
(Sgd.) FRANKLIN M. DRILON
Executive Secretary
The Lawphil Project - Arellano Law Foundation
