EXECUTIVE ORDER NO. 501 - INCREASING THE MEDICARE BENEFITS UNDER THE PHILIPPINES 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:

Benefit Limit By Hospital Category

Items for Hospitalization   Primary Secondary Tertiary

A. Hospital Charges

1. Room and Board not P55/Day P100/Day P120/Day

exceeding 45 days per
year for each member
of program 1 and another
45 days per year to be
shared by all his dependents

(per single period of confinement)

2.1 Ordinary Cases     720   1,090   1,375

Drugs & Medicines  595 790     845
X-Ray/Lab/Other   125 300     530

Drugs & Medicines    1,125   1,350   2,430
X-Ray/Lab/Cases  270 690   1,050

Drugs & Medicines —   3,040 3,475
X-Ray/Lab/Other —     1,350 3,205

Commissions Relative Unit
value (RUV) scheme

3.1 RUV 5 & Below 140   245   390

3.2 RUV 5.1 to 10 — 420  500

3.3 RUV 10.1 & Above — 960   1,290

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 All orders, issuances, rules and regulations or parts thereof inconsistent with this Executive Order are hereby repealed or modified accordingly.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