Executive Order No. 441 (1990) — 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 an 80% across-the-board rates, and 875 increase in drugs and medicines, and a 25% increase in all other Medicare benefits which will result to a 585 overall increase and the inclusion under the medical care program of SSS death and disability pensioners and their dependents,

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Executive Order No. 441 (1990)

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 an 80% across-the-board rates, and 875 increase in drugs and medicines, and a 25% increase in all other Medicare benefits which will result to a 585 overall increase and the inclusion under the medical care program of SSS death and disability pensioners and their dependents,

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Sec. 1 Sec. 2 Sec. 3 Sec. 4 Sec. 5 · This Order shall take effect on the 1st day of January, 1991

Sec. 1

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

Items of Hospitalization

Benefit Limit

(By Hospital Category)

Hospital Charges

Primary

Secondary

Tertiary

Room and Board not exceeding 45 days per year for each member of program 1 and another 45 days per year to be shared by all his dependents

P45/Day

P80/Day

P100/Day

Medical Expenses Benefits (Per Single) Period of confinement

2.1 Ordinary Cases

P600

P910

P1145

Drugs & Medicines

495

660

705

X-Ray/Lab/Other

105

250

440

2.2 Intensive Cases

P1162.50

P1700

P2900

Drugs & Medicines

937.50

1125

2025

X-Ray/Lab/Other

225

575

875

2.3 Catastrophic Cases

3660

5565

Drugs & Medicines

2535

2895

X-Ray/Lab/Other

1125

2670

Operating Room Fee based on Commission's Relative Unit Value (RUV) Scheme

3.1 RUV 5 & Below

115

205

325

3.2 RUV 5, 1 to 10

350

415

3.3 RUV 10, 1 & Above

800

1075

B. Professional Fees

1. Medical/Dental Practitioner's Fee per day of P45 for General Practitioner's and P65 for Specialists not to exceed per single period of confinement, P250 for General Practitioner and P375 for Specialist in Ordinary Cases; and P375 for General Practitioner and P625 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 P5,900.

3. Anesthesiologist's Fee (30% of allowed Surgeon's Fee) not to exceed P1,770.

4. Fees for Surgical Family Planning Procedure as may be determined by the Commission.

Sec. 2

Sec. 2. Death and total disability pensioners of SSS, as well as their dependents shall be entitled to Medical Care benefits without need for any additional contribution.

Sec. 3

Sec. 3. Dependents of GSIS retiree-pensioners shall also be covered with Medicare benefits.

Sec. 4

Sec. 4. All orders, issuances, rules and regulations or parts, thereof inconsistent with this Executive Order are hereby repealed or modified accordingly.

Sec. 5

This Order shall take effect on the 1st day of January, 1991

Sec. 5. This Order shall take effect on the 1st day of January, 1991.

DONE in the City of Manila, this 21st of December in the year of Our Lord, nineteen hundred and ninety.