Question & AnswerQ&A (EXECUTIVE ORDER NO. 269)
A Medical or Dental Practitioner is any doctor of Medicine or doctor of dental medicine duly licensed to practice in the Philippines and who is accredited by the Philippine Medical Care Commission in accordance with its rules and regulations.
The Philippine Medical Care Commission is composed of the Secretary of Health as Chairman; an Undersecretary of Health designated by the Social Security System; the President and General Manager of Government Service Insurance System; the Secretary of Finance; the Secretary of Local Government; the Secretary of Labor and Employment; and four other members appointed by the President representing the beneficiaries, private employers, physicians, and hospitals.
The Commission's functions include formulating policies, administering the Philippine Medical Care Plan, accrediting practitioners and facilities, promulgating necessary rules, recommending contribution and benefit rates, ensuring equitable hospital accommodations, acquiring property, entering contracts, adopting control measures to prevent abuse, imposing administrative fines, issuing decisions and enforcing them, deputizing law enforcement, submitting annual reports, coordinating manpower development, approving claim evaluation rules, and exercising all powers necessary to attain the Act's objectives.
The Commission can impose administrative fines ranging from P5,000 to P30,000. If a hospital, drugstore, or practitioner commits the violation, their accreditation may be suspended or revoked. Beneficiaries who violate may have their benefits suspended for up to six months. These administrative sanctions are without prejudice to penal provisions under Section 28 of the Act.
The appointed members serve a term of six (6) years.
The Executive Director, appointed by the President for six years, manages the general operations and administration of the Commission, holds office full-time, has at least ten years experience in relevant fields, and cannot be removed except for cause.
Contributions are compulsory and follow rates established by the Commission and approved by the President. The Health Insurance Fund consists of all contributions from Medicare members collected by SSS and GSIS, kept separate from other funds, and may be used for operational expenses (not exceeding 12%). The fund finances payments for medical care benefits under Program I.
Yes, if a person is covered by both SSS and GSIS, they may choose which system they will use for Medicare purposes under rules prescribed by the Commission.
Preventive suspension for up to three months may be imposed if a respondent has been found guilty at least twice of violations and there is reasonable ground to believe they are guilty of the present charge, or if the respondent is committing a violation at the time of inspection. The suspension order must specify the charge, evidence, require a response within 10 days, and set a hearing date.
Failure of the employer to remit contributions shall not deprive the employee of benefits under the Medicare Program.