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 45 days per year to be shared by all his dependents
P55/Day
P100/Day
P120/Day
2. Medical Expense Benefit (per single period of confinement)
2.1 Ordinary Cases
720
1,090
1,375
Drugs and Medicines
595
790
845
X-Ray/Lab/Other
125
300
530
2.2 Intensive Cases
1,395
2,040
3,480
Drugs and Medicines
1,125
1,350
2,430
X-Ray/Lab/Cases
270
690
1,050
2.3 Catastrophic Cases
4,390
6,680
Drugs and Medicines
3,040
3,475
X-Ray/Lab/Other
,350
3,205
3.Operating Room Fee based on Commissions Relative Unit Value (RUV) Scheme
& Below
140
245
390
420
500
3.3 1 and Above
960
1,290
PROFESSIONAL FEES
1 MEDICAL/DENTAL PRACTITIONERS 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 SURGEONS FEE IN ACCORDANCE WITH THE RELATIVE UNIT VALUE SCHEME PRESCRIBED BY THE COMMISSION NOT TO EXCEED P7,080.
3 ANESTHESIOLOGISTS FEE (30% OF ALLOWED SURGEONS FEE) NOT TO EXCEED P2,125.
4 FEES FOR SURGICAL FAMILY PLANNING PROCEDURES AS MAY BE DETERMINED BY THE COMMISSION.