Restructuring The Medical Care Benefits Under The Philippine Medical Care Plan

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Restructuring The Medical Care Benefits Under The Philippine Medical Care Plan

Executive Order No. 106

December 24, 1986

Case Overview and Summary

Summary of Executive Order No. 106 on Restructuring the Medical Care Benefits under the Philippine Medical Care Plan:

Rates for Medical Care Benefits for SSS Medicare Beneficiaries (Sec. 1):
- Room and Board: Primary - P30/day, Secondary - P35/day, Tertiary - P45/day
- Medical Expenses per confinement period:
    Ordinary Cases:
        - Drugs & Medicines: Primary - P175, Secondary - P200, Tertiary - P300
        - X-ray/Laboratory/Others: Primary - P75, Secondary - P150, Tertiary - P350
    Intensive Care Cases:
        - Drugs & Medicines: Primary - P375, Secondary - P400, Tertiary - P500
        - X-ray/Laboratory/Others: Primary - P125, Secondary - P200, Tertiary - P500
    Catastrophic Cases:
        - Drugs & Medicines: Secondary - P800, Tertiary - P1,000
        - X-ray/Laboratory/Others: Secondary - P400, Tertiary - P1,000
- Medical/Dental Practitioner's Fee: P15/day, not exceeding P200 for ordinary cases and P300 for intensive care/catastrophic cases per confinement period (Sec. 1.3)
- Surgeon's Fee: In accordance with relative value scheme, not exceeding P650 (Sec. 1.4)
- Anesthesiologist's Fee: Not exceeding 30% of allowed Surgeon's fee (Sec. 1.5)
- Operating Room Fee based on Relative Unit Value:
    0 - 5: Primary - P30, Secondary - P35, Tertiary - P65
    5.1 - 10: Secondary - P120, Tertiary - P165
    10.1 - above: Secondary - P170, Tertiary - P225 (Sec. 1.6)
- Fees for surgical family planning procedures as determined by the Commission (Sec. 1.7)

Rates for Medical Care Benefits for GSIS Medicare Beneficiaries (Sec. 2):
- Room and Board: Primary - P20/day, Secondary - P24/day, Tertiary - P33/day
- Medical Expenses per confinement period:
    Ordinary Cases:
        - Drugs & Medicines: Primary - P150, Secondary - P175, Tertiary - P250
        - X-ray/Laboratory/Others: Primary - P50, Secondary - P75, Tertiary - P100
    Intensive Care Cases:
        - Drugs & Medicines: Primary - P250, Secondary - P300, Tertiary - P350
        - X-ray/Laboratory/Others: Secondary - P150, Tertiary - P300
    Catastrophic Cases:
        - Drugs & Medicines: Secondary - P400, Tertiary - P450
        - X-ray/Laboratory/Others: Secondary - P150, Tertiary - P300
- Medical/Dental Practitioner's Fee: P15/day, not exceeding P200 for ordinary cases and P300 for intensive care/catastrophic cases per confinement period (Sec. 2.3)
- Surgeon's Fee: In accordance with relative value scheme, not exceeding P650 (Sec. 2.4)
- Anesthesiologist's Fee: Not exceeding 30% of allowed Surgeon's fee (Sec. 2.5)
- Operating Room Fee based on Relative Unit Value:
    0 - 5: Primary - P30, Secondary - P35, Tertiary - P65
    5.1 - 10: Secondary - P120, Tertiary - P165
    10.1 - above: Secondary - P170, Tertiary - P265 (Sec. 2.6)
- Fees for surgical family planning procedures as determined by the Commission (Sec. 2.7)

Other Provisions:
- Repeals or modifies inconsistent laws, orders, issuances, rules and regulations (Sec. 3)
- Takes effect immediately (Sec. 4)

Amends

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Executive Issuances

Executive Orders

medical care benefits

Philippine Medical Care Plan

Medicare

Social Security System (SSS)

Government Service Insurance System (GSIS)

hospital categories

room and board rates

medical expenses

drugs and medicines

X-ray/laboratory fees

medical/dental practitioner's fees

surgeon's fees

anesthesiologist's fees

operating room fees

surgical procedures

family planning procedures

Law

Restructuring The Medical Care Benefits Under The Philippine Medical Care Plan

Executive Order No. 106

•

December 24, 1986

EXECUTIVE ORDER NO. 106 December 24, 1986 RESTRUCTURING THE MEDICAL CARE BENEFITS UNDER THE PHILIPPINE MEDICAL CARE PLAN WHEREAS, actuarial studies show that without increasing contributions, current benefits under the Philippine Medical Care Plan, otherwise known as the Medical Program can be increased for certain items only and at different rates for the two sectors of beneficiaries covered: NOW, THEREFORE, I, CORAZON C. AQUINO, President of the Philippines, do hereby order: Sec. 1. The medical care benefits to Medicare beneficiaries covered by the Social Security System (SSS) shall not exceed the rates indicated below: HOSPITAL CATEGORY BENEFIT PRIMARY SECONDARY TERTIARY 1. Room and Board P30/day P35/day 45/day 2. Medical Expense(per single period of confinement) 2.1 Ordinary Cases 2.1.1 Drugs & Medicines 175 200 300 2.1.2 X-ray/ Laboratory/ Others 75 150 350 2.2. Intensive Care Cases 2.2.1 Drugs & Medicines 375 400 500 2.2.2 X-ray/Laboratory/Others 125 200 500 2.3 Catastrophic Cases 2.3.1 Drugs & Medicines- 800 1,000 2.3.2 X-ray/Laboratory/Others 400 1,000 3. Medical/Dental Practitioner's Fee shall be P15.00 per day not to exceed: 3.1 For Ordinary...
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Restructuring The Medical Care Benefits Under The Philippine Medical Care Plan

Amends

n/a

Amended by

n/a

Tags

Executive Issuances

Executive Orders

medical care benefits

Philippine Medical Care Plan

Medicare

Social Security System (SSS)

Government Service Insurance System (GSIS)

hospital categories

room and board rates

medical expenses

drugs and medicines

X-ray/laboratory fees

medical/dental practitioner's fees

surgeon's fees

anesthesiologist's fees

operating room fees

surgical procedures

family planning procedures

EXECUTIVE ORDER NO. 106 December 24, 1986 RESTRUCTURING THE MEDICAL CARE BENEFITS UNDER THE PHILIPPINE MEDICAL CARE PLAN WHEREAS, actuarial studies show that without increasing contributions, current benefits under the Philippine Medical Care Plan, otherwise known as the Medical Program can be increased for certain items only and at different rates for the two sectors of beneficiaries covered: NOW, THEREFORE, I, CORAZON C. AQUINO, President of the Philippines, do hereby order: Sec. 1. The medical care benefits to Medicare beneficiaries covered by the Social Security System (SSS) shall not exceed the rates indicated below: HOSPITAL CATEGORY BENEFIT PRIMARY SECONDARY TERTIARY 1. Room and Board P30/day P35/day 45/day 2. Medical Expense(per single period of confinement) 2.1 Ordinary Cases 2.1.1 Drugs & Medicines 175 200 300 2.1.2 X-ray/ Laboratory/ Others 75 150 350 2.2. Intensive Care Cases 2.2.1 Drugs & Medicines 375 400 500 2.2.2 X-ray/Laboratory/Others 125 200 500 2.3 Catastrophic Cases 2.3.1 Drugs & Medicines- 800 1,000 2.3.2 X-ray/Laboratory/Others 400 1,000 3. Medical/Dental Practitioner's Fee shall be P15.00 per day not to exceed: 3.1 For Ordinary...
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Restructuring The Medical Care Benefits Under The Philippine Medical Care Plan

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