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Executive Orders

Restructuring The Medical Care Benefits Under The Philippine Medical Care Plan

Executive Order No. 106

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:

...
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)

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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