EXECUTIVE ORDER NO. 269 July 25, 1987
AMENDING PRESIDENTIAL DECREE NO. 1519, ENTITLED "REVISING THE PHILIPPINE MEDICARE ACT OF NINETEEN HUNDRED AND SIXTY NINE"
WHEREAS, to make the Philippine Medical Care Plan more responsive to its objectives, in view of the reorientation and structuring of health policies, programs and organizations, and to have a more effective administration of the Medicare Program, there is a need to amend further the Revised Philippine Medical Care Act.
NOW, THEREFORE, I, CORAZON C. AQUINO, President of the Philippines, by virtue of the powers vested in me by the Constitution, do hereby order:
Sec. 1. Section 4 (k) of Presidential Decree No. 1519 is hereby amended to read as follows:
"(k) Medical or Dental Practitioner. Any doctor of medicine or doctor of dental medicine duly licensed to practice in the Philippines and who is accredited by the Commission in accordance with its rules and regulations."
Sec. 2. Section 5 of Presidential Decree No. 1519 is hereby amended to read as follows:
"Sec. 5. Philippine Medical Care Commission....
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Executive Orders
Amending Presidential Decree No. 1519, Entitled "Revising the Philippine Medicare Act of Nineteen Hundred and Sixty Nine"
Executive Order No. 269
EXECUTIVE ORDER NO. 269
Amending Presidential Decree No. 1519, entitled "Revising the Philippine Medicare Act of Nineteen Hundred and Sixty Nine"
• Definitions (Sec. 1):
- Medical or Dental Practitioner: Any doctor of medicine or doctor of dental medicine duly licensed to practice in the Philippines and accredited by the Commission.
• Philippine Medical Care Commission (Sec. 2, 5, 6, 8):
- Composition: Secretary of Health (Chairman), Undersecretary of Health (Vice-Chairman), heads of SSS, GSIS, DOF, DILG, DOLE, and four members representing beneficiaries, private employers, physicians, and hospitals.
- Functions and Powers:
- Formulate policies, administer and implement the Philippine Medical Care Plan.
- Ensure medical care is provided to members.
- Organize offices, appoint personnel, and fix compensation.
- Accredit medical/dental practitioners, hospitals, and facilities.
- Promulgate rules and regulations.
- Recommend contributions and benefits to the President.
- Ensure adequate hospital accommodations and coordinate with DOH.
- Acquire property for the Commission.
- Enter into agreements or contracts.
- Adopt control measures to prevent abuses.
- Conduct investigations, impose fines (P5,000 - P30,000), suspend or revoke accreditation, and suspend benefits (up to 6 months).
- Issue writs of execution and deputize law enforcement agencies.
- Submit annual report to the President.
- Coordinate with agencies for medical manpower development.
- Approve rules for uniform evaluation of claims.
- Chairman and Vice-Chairman: Preside over meetings, implement decisions, exercise supervision and control, and perform assigned functions.
- Executive Director: Appointed by the President for 6 years, with at least 10 years of relevant experience, responsible for general conduct of operations and administration.
• Coverage (Sec. 7, 11):
- Members covered by both SSS and GSIS can choose which system to be covered under for Medicare purposes.
• Health Insurance Fund (Sec. 17):
- Consists of contributions from Medicare members and accruals, kept separate from other funds.
- Deposited, invested, administered, and disbursed by SSS and GSIS under Commission policies.
- SSS and GSIS can disburse up to 12% of total contributions and investment earnings for operational expenses.
• Contributions (Sec. 18, 19):
- Compulsory contributions by members according to rates established by the Commission and approved by the President.
- Employers deduct employee contributions from monthly compensation and remit to SSS/GSIS along with employer counterpart.
- Failure to remit contributions does not deprive employee of benefits.
• Records, Monitoring, and Research (Sec. 24, 25):
- Commission, SSS, and GSIS to keep records of operations.
- Commission to undertake continuous monitoring, study, and research to improve the Program.
• Preventive Suspension (Sec. 27):
- Hearing Committee may preventively suspend beneficiary, practitioner, hospital, or facility for up to 3 months if:
1. Found guilty of violation at least twice and reasonable ground to believe guilty of present charge.
2. Committing a violation at the time of inspection.
• Appropriations (Sec. 29):
- Funds necessary to finance the Commission's operations, programs, and projects to be included in the Annual Appropriations Law.
Amending Presidential Decree No. 1519, entitled "Revising the Philippine Medicare Act of Nineteen Hundred and Sixty Nine"
• Definitions (Sec. 1):
- Medical or Dental Practitioner: Any doctor of medicine or doctor of dental medicine duly licensed to practice in the Philippines and accredited by the Commission.
• Philippine Medical Care Commission (Sec. 2, 5, 6, 8):
- Composition: Secretary of Health (Chairman), Undersecretary of Health (Vice-Chairman), heads of SSS, GSIS, DOF, DILG, DOLE, and four members representing beneficiaries, private employers, physicians, and hospitals.
- Functions and Powers:
- Formulate policies, administer and implement the Philippine Medical Care Plan.
- Ensure medical care is provided to members.
- Organize offices, appoint personnel, and fix compensation.
- Accredit medical/dental practitioners, hospitals, and facilities.
- Promulgate rules and regulations.
- Recommend contributions and benefits to the President.
- Ensure adequate hospital accommodations and coordinate with DOH.
- Acquire property for the Commission.
- Enter into agreements or contracts.
- Adopt control measures to prevent abuses.
- Conduct investigations, impose fines (P5,000 - P30,000), suspend or revoke accreditation, and suspend benefits (up to 6 months).
- Issue writs of execution and deputize law enforcement agencies.
- Submit annual report to the President.
- Coordinate with agencies for medical manpower development.
- Approve rules for uniform evaluation of claims.
- Chairman and Vice-Chairman: Preside over meetings, implement decisions, exercise supervision and control, and perform assigned functions.
- Executive Director: Appointed by the President for 6 years, with at least 10 years of relevant experience, responsible for general conduct of operations and administration.
• Coverage (Sec. 7, 11):
- Members covered by both SSS and GSIS can choose which system to be covered under for Medicare purposes.
• Health Insurance Fund (Sec. 17):
- Consists of contributions from Medicare members and accruals, kept separate from other funds.
- Deposited, invested, administered, and disbursed by SSS and GSIS under Commission policies.
- SSS and GSIS can disburse up to 12% of total contributions and investment earnings for operational expenses.
• Contributions (Sec. 18, 19):
- Compulsory contributions by members according to rates established by the Commission and approved by the President.
- Employers deduct employee contributions from monthly compensation and remit to SSS/GSIS along with employer counterpart.
- Failure to remit contributions does not deprive employee of benefits.
• Records, Monitoring, and Research (Sec. 24, 25):
- Commission, SSS, and GSIS to keep records of operations.
- Commission to undertake continuous monitoring, study, and research to improve the Program.
• Preventive Suspension (Sec. 27):
- Hearing Committee may preventively suspend beneficiary, practitioner, hospital, or facility for up to 3 months if:
1. Found guilty of violation at least twice and reasonable ground to believe guilty of present charge.
2. Committing a violation at the time of inspection.
• Appropriations (Sec. 29):
- Funds necessary to finance the Commission's operations, programs, and projects to be included in the Annual Appropriations Law.