OWWA MEMORANDUM OF INSTRUCTION NO. 007-00, June 24, 2000
AMENDMENT TO MOI NO. 007, SERIES OF 1999 ON THE TABLE OF MEDICARE BENEFITS FOR OVERSEAS FILIPINO WORKERS (OFWS) AND THEIR DEPENDENTS CONFINED DUE TO CATASTROPHIC CASES
the improvement of in-patient services, particularly for OWWA Medicare
members and their legal dependents who were confined for catastrophic
illness or injury and pursuant to OWWA Board Resolution No. 2000-006
dated 30 March 2000, the following new rates of benefits ceiling shall
apply retroactive to January 1, Year 2000.
1. COVERAGE
This MOI covers confinement of OWWA members and/or their
dependents due to catastrophic cases. Catastrophic cases include cancer
cases requiring chemotherapy and/or radiotherapy, meningitis,
encephalitis, cirrhosis of the liver, myocardial infraction,
cerebrovascular attack, rheumatic heart disease, renal condition
requiring dialysis or transplant, and massive hemorrhage. Likewise,
included are surgical procedures or multiple surgical procedures done in
one sitting with a total Relative Unit Value (RUV) of 20 and above such
as coronary bypass, open heart surgery or neurosurgery.2. SCHEDULE OF BENEFITS
|
|
HOSPITAL CATEGORY |
||
|
|
|
|
|
|
|
PRIMARY |
SECONDARY |
TERTIARY |
|
|
|
|
|
|
A. Hospital Charges |
|
|
|
|
|
|
|
|
|
1. ALLOWANCE for ROOM and BOARD per day |
P360.00 |
P660.00 |
P1,035.00 |
|
|
|
|
|
|
2. DRUGS and MEDICINES per single period of confinement |
|
P19,725.00 |
P35,655.00 |
|
|
|
|
|
|
3. X-RAY, Laboratory and Others per single period of confinement |
|
P10,215.00 |
P29,430.00 |
|
|
|
|
|
|
4. OPERATING ROOM FEE (Surgical procedure with RUV of 20 and above) |
|
P6,480.00 |
P10,470.00 |
|
|
|
|
|
|
B. Professional Fees |
|
|
|
|
|
|
|
|
|
DOCTOR’S FEE (per single period confinement) |
|||
|
|
|
||
|
General Practitioner |
P315 per day but not to exceed P2,430.00 |
||
|
Specialist |
P450 per day but not to exceed P4,050.00 |
||
|
Surgeon’s Fee not exceeding |
P47,790.00 shall be paid in accordance with RUV=1,260 |
||
|
Anesthesiologist’s Fee |
(30% of Surgeon’s Fee) not to exceed P14,355.00 |
||
3. CLAIMS PAYMENT
For those who were admitted prior to January 1, 2000 but were
discharged on or after this date, the new rate will apply to the entire
confinement period. For those who will be confined starting August 2000,
their benefits shall be deducted from their hospital bill.For OWWA Medicare members or their dependents who were confined
between January 1, 2000 and July 31, 2000, the difference in what OWWA
Medicare actually paid them and their entitlement under this MOI shall
be reimbursed directly to the OWWA medicare member. The payment will be
processed upon submission of the following documents:1). Request for reimbursement (MRR Form)
2). Additional Original Official Receipts (if there are any)
3). Marriage contract or proof of relationship to OFW
The OWWA medicare member is required to submit his request for reimbursement not later than October 31, 2000.
4. INFORMATION DISSEMINATION
The Medicare Program Management Office (MPMO) is directed to
disseminate information on the upgraded benefits as widely as possible.
It shall coordinate with the Philippine Hospital Association, OFW
associations, associations of recruitment agencies and other appropriate
entities.
For immediate compliance.
24 June 2000
(SGD.) ELEUTERIO N. GARDINER
Administrator