Executive Order No. 501

December 27, 1991

EXECUTIVE ORDER NO. 501

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 Program's 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; cdtai

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:

				BENEFIT LIMIT (BY HOSPITAL CATEGORY)
	ITEMS FOR HOSPITALIZATION			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	-	1,350	3,205
	3.		Operating Room Fee based on Commissions Relative Unit Value (RUV) Scheme
		3.1	RUV 5 and Below	140	245	390
		3.2	RUV 5.1 to 10	-	420	500
		3.3	RUV 10.1 and Above	-	960	1,290

B. PROFESSIONAL FEES

1. MEDICAL/DENTAL PRACTITIONER'S 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. SURGEON'S FEE IN ACCORDANCE WITH THE RELATIVE UNIT VALUE SCHEME PRESCRIBED BY THE COMMISSION NOT TO EXCEED P7,080.

3. ANESTHESIOLOGIST'S FEE (30% OF ALLOWED SURGEON'S 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.

Published in the Official Gazette, Vol. 88 No. 6 Page 648 on February 10, 1992.