Increasing Medicare Benefits Under the Philippine Medical Care Plan

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...

Login to see full content

This Executive Order increases the Medicare benefits for members of the Social Security System (SSS) and Government Service Insurance System (GSIS) in the Philippines.

Increased Medicare Benefits:
- Room and board: Up to 45 days per year for the member, and another 45 days shared by dependents. Rates vary by hospital category (Primary: P45/day, Secondary: P80/day, Tertiary: P100/day). (Sec. 1.A.1)
- Medical expenses benefits per single period of confinement:
    - Ordinary cases: Primary P600, Secondary P910, Tertiary P1145 (Sec. 1.A.2.1)
    - Intensive cases: Primary P1162.50, Secondary P1700, Tertiary P2900 (Sec. 1.A.2.2)
    - Catastrophic cases: Primary P3660, Secondary/Tertiary P5565 (Sec. 1.A.2.3)
- Operating room fees based on Relative Unit Value (RUV) scheme (Sec. 1.A.3)
- Professional fees for medical/dental practitioners, surgeons, anesthesiologists, and family planning procedures (Sec. 1.B)

Coverage Expansion:
- SSS death and total disability pensioners and their dependents are now entitled to Medicare benefits without additional contribution. (Sec. 2)
- Dependents of GSIS retiree-pensioners are now covered with Medicare benefits. (Sec. 3)

Effective Date:
- This Executive Order takes effect on January 1, 1991. (Sec. 5)