Providing A Medical Care Program To Filipino Overseas Contract Workers and Their Dependents and Prescribing the Mechanism Therefor
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Providing A Medical Care Program To Filipino Overseas Contract Workers and Their Dependents and Prescribing the Mechanism Therefor
Executive Order No. 195
August 13, 1994
Case Overview and Summary
EXECUTIVE ORDER NO. 195Providing a Medical Care Program to Filipino Overseas Contract Workers and Their Dependents
• Compulsory coverage of Filipino Overseas Contract Workers (FOCWs) and their dependents under the Philippine Medical Care Program (Sec. 1)
• Definition of terms used in the law (Rule I, Sec. 1)
• Coverage and registration requirements for FOCWs and their dependents (Rule II)
Benefits:
• Entitlement to benefits requires confinement in a hospital, payment of at least one annual contribution within the last 3 months, and unused 45-day room and board allowance for the year (Rule III, Sec. 1)
• 45-day maximum room and board allowance per year for members and dependents, with specific rates for primary, secondary, and tertiary hospitals (Rule III, Sec. 2a)
• Allowance for medical expenses like drugs, X-rays, and lab tests, with different rates for ordinary, intensive care, and catastrophic cases (Rule III, Sec. 2b)
• Professional fees for medical/dental practitioners, surgeons, and anesthesiologists, with specific rates and conditions (Rule III, Sec. 2c)
• Operating room fees based on the Relative Unit Value of the surgical procedure (Rule III, Sec. 2d)
• Surgical family planning procedures (sterilization) benefits (Rule III, Sec. 2e)
• Exclusions include cosmetic surgery, optometric services, psychiatric illness, diagnostic services, and normal obstetrical delivery (Rule III, Sec. 3)
• Requirements for availing Medicare benefits (Rule III, Sec. 4)
• Benefits for members and dependents while abroad (Rule III, Sec. 5)
Contributions:
• Annual contribution of 900 Philippine Pesos for a one-year program coverage, with options for longer periods (Rule V, Sec. 1)
• Collection of contributions during enrollment or renewal of OWWA membership and OEC processing (Rule V, Sec. 2)
Overseas Contract Workers Health Insurance Fund (OCWHIF):
• Establishment of the OCWHIF, separate from other OWWA funds (Rule VI, Sec. 1a)
• Use of the OCWHIF for claims payments and operating expenses, with a maximum of 12% for annual operating expenses (Rule VI, Sec. 1b)
• Provision of seed money by OWWA as a loan with 5% interest, payable in 2 years (Rule VII)
Effects of Termination of Overseas Employment:
• Option to continue Medicare membership by paying the annual contribution within 6 months after the last coverage period (Rule VIII, Sec. 1)
• Transfer of membership to local employment, with continued coverage for the unexpired period (Rule VIII, Sec. 2)
Accreditation:
• Power of the Philippine Medical Care Commission (PMCC) to grant accreditation to providers (Rule IX, Sec. 1)
• Prerequisites for hospital and practitioner accreditation (Rule IX, Sec. 2 & 3)
• Terms and conditions for accreditation (Rule IX, Sec. 4)
• Period of accreditation: 2 years for hospitals, 3 years for practitioners (Rule IX, Sec. 5)
• Accreditation fees imposed by the PMCC (Rule IX, Sec. 6)
• Option for the PMCC to accredit a number of beds less than the authorized capacity (Rule IX, Sec. 7)
• Denial of accreditation in case of saturation or prima facie evidence of violations (Rule IX, Sec. 8)
Supervision and Inspection:
• Authority of the PMCC and OWWA to exercise supervision and inspection (Rule X, Sec. 1 & 2)
• Access to medical records and physical plant inspection (Rule X, Sec. 2 & 3)
Fines, Suspension of Membership, Benefits, and Accreditation:
• Jurisdiction of OWWA over violations by members and dependents, with penalties of suspension and fines up to 5,000 Philippine Pesos (Rule XI, Sec. 1a)
• Jurisdiction of PMCC over violations by providers, with penalties of fines and suspension or revocation of accreditation (Rule XI, Sec. 1b)
• Grounds for filing complaints (Rule XI, Sec. 2)
• Procedures for filing complaints, summons, and answers (Rule XI, Sec. 3-6)
Hearing/Deliberation Procedures:
• Deliberation and resolution of cases by the Hearing Committee (Rule XII, Sec. 1)
• Formal hearing procedures, including subpoenas and contempt provisions (Rule XII, Sec. 2-4)
• Order of hearing and presentation of evidence (Rule XII, Sec. 5)
• Hearing Committee resolution and motion for reconsideration (Rule XII, Sec. 6 & 7)
• Finality of decision and appeal process (Rule XII, Sec. 8 & 9)
Execution/Enforcement of Decision:
• Issuance of writ of execution upon final decision (Rule XIII, Sec. 1)
• Enforcement of suspension or revocation by cessation of privileges and benefits (Rule XIII, Sec. 2)
• Voluntary payment of fines or enforcement against pending claims (Rule XIII, Sec. 3 & 4)
Preventive Suspension:
• Authority of the Hearing Committee to issue preventive suspension orders (Rule XV, Sec. 1)
• Requirements and procedures for preventive suspension orders (Rule XV, Sec. 2-5)
Penalties:
• Classification of violations according to gravity: serious, less serious, and special less serious (Rule XVI, Sec. 1)
• Exempting and aggravating circumstances affecting the gravity of violations (Rule XVI, Sec. 2)
• Rules for application of circumstances (Rule XVI, Sec. 3)
• Scale of penalties, including fines and suspension or revocation of accreditation (Rule XVI, Sec. 4 & 5)
• Specific penalties for fraudulent practices, gross negligence, breach of warranties, and violations by beneficiaries (Rule XVI, Sec. 6-9)
• Final provisions, including prescription periods for violations (Rule XVI, Sec. 10 & 11)
Implementing Rules and Regulations:
• Definition of terms used in the implementing rules (Rule I, Sec. 1)
• Applicability of provisions of the Rules of Court (Rule XIV)
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Tags
Executive Issuances
Executive Orders
Filipino Overseas Contract Workers
Medical Care Program
Medicare Benefits
Contributions
Accreditation
Violations
Penalties
Overseas Workers Welfare Administration
Philippine Medical Care Commission
Law
Providing A Medical Care Program To Filipino Overseas Contract Workers and Their Dependents and Prescribing the Mechanism Therefor
Executive Order No. 195
•August 13, 1994
EXECUTIVE ORDER NO. 195 August 13, 1994
PROVIDING A MEDICAL CARE PROGRAM TO FILIPINO OVERSEAS CONTRACT WORKERS AND THEIR DEPENDENTS AND PRESCRIBING THE MECHANISM THEREFOR
WHEREAS, it is the avowed policy of the government to provide adequate medical care services to the people;
WHEREAS, under the present policy, among the private working sector, only members of the Social Security System who are employed within the Philippines are compulsorily covered by the Philippine Medical Care Program (Law);
WHEREAS, studies show that a large number of overseas contract workers and their dependents, which comprise a significant portion of the Filipino population, are not assured of any medical care, in view of the lack of a program with a compulsory coverage;
WHEREAS, Filipino Overseas Contract Workers and their dependents must likewise be assisted in their medical care expenses consistent with the policy for their counterpart local workers and their dependents;
WHEREAS, the Philippine Medical Care Commission, the Department of Labor and Employment thru the Overseas Workers Welfare Administration and the Philippine Overseas Employment Administration, the Department of Foreign...
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