INCREASING THE MEDICARE BENEFITS UNDER THE PHILIPPINE MEDICAL CARE PLAN.

WHEREAS, the need arises to upgrade Medicare benefits in order to make the Program responsive to its members;

WHEREAS, the government desires to increase Medicare benefits to preserve the Program’s support level;

WHEREAS, actuarial studies show that the Health Insurance Fund administered by the SSS for medicare beneficiaries in the private sectors and by the GSIS for medicare beneficiaries in the government sector can further finance a 20% across-the-board increase in all items of hospitalization compensable under the Medicare Program;

WHEREAS, the Philippine Medical Care Commission has recommended further enhancements of the benefits under the Medicare Program;

NOW, THEREFORE, I, CORAZON C. AQUINO, President of the Philippines, by virtue of the powers vested in me by law, do hereby order:

SECTION 1. The Medicare benefits for both GSIS and SSS Medicare beneficiaries are increased as follows:

Items for Hospitalization	BENEFIT LIMIT (BY HOSPITAL CATEGORY)
	Primary	Secondary	Tertiary
A. Hospital Charges
1. Room and Board not exceeding 45 days per year for each member of program 1 and another 45days per year to be shared by all his dependents	P 55/Day	P 100/Day	P 120/Day
2. Medical Expense Benefit (per single period of confinement)
2.1 Ordinary Cases Drugs & Medicines X-Ray/Lab/Other	720 595 125	1,090 790 300	1,375 845 530
2.2 Intensive Cases Drugs & Medicines X-Ray/Lab/Cases	1,395 1,125 270	2,040 1,350 690	3,480 2,430 1,050
2.3 Catastrophic Cases Drugs & Medicines X-Ray/Lab/Other	– – –	4,390 3,040 1,350	6,680 3,475 3,205
3. Operating Room Fee based on Commissions Relative Unit value (RUV) scheme
3.1 RUV 5 & Below 3.2 RUV 5.1 to 10 3.3 RUV 10.1 & Above	140 – –	245 420 960	390 500 1,290

B. PROFESSIONAL FEES

1. Medical/Dental practitioner’s fee, per day of P55 for general practitioners and P80 for specialists, not to exceed per single period of confinement, P300 for general practitioner and P450 for specialist in ordinary cases and P450 for general practitioner and P750 for specialist in intensive care/catastrophic cases.
2. Surgeon’s fee in accordance with the relative unit value scheme prescribed by the commission not to exceed P7,080.
3. Anesthesiologists fee (30% of allowed surgeon’s fee) not to exceed P2,125.
4. Fees for surgical family planning procedures as may be determined by the commission.

SEC. 2. All orders, issuances, rules and regulations or parts thereof inconsistent with this Executive Order are hereby repealed or modified accordingly.

SEC. 3. This Executive Order shall take effect on the 1st day of January 1992.

DONE in the City of Manila, this 27th day of December, in the year of our Lord, nineteen hundred and ninety-one.

By the Philippines:

(Sgd.) FRANKLIN M. DRILON
Executive Secretary