Composition of the Philippine Medical Care Commission
- Chaired by the Secretary of Health
- Members include: an Undersecretary of Health designated by the Social Security System (SSS), President and General Manager of Government Service Insurance System (GSIS), Secretary of Finance, Secretary of Local Government, Secretary of Labor and Employment
- Four other members representing beneficiaries, private employers, physicians, and hospitals
- These four members appointed by the President for six-year terms
- Ex-officio members may designate representatives with plenary powers and benefits
Functions and Powers of the Commission
- Formulate policies and administer the Medical Care Plan consistent with the National Health Plan
- Ensure provision of medical care to plan members
- Organize offices, appoint personnel, fix compensation within budget laws
- Accredit medical and dental practitioners, hospitals and facilities to participate in the Plan
- Prescribe rules and regulations to implement the Act
- Recommend contribution and benefit rates to the President using actuarial procedures
- Ensure equitable distribution of hospital accommodations and coordinate with the Department of Health for licensing
- Acquire real or personal property for Commission purposes
- Enter into contracts for efficient administration
- Adopt measures to prevent abuses of the Plan
- Conduct investigations and impose administrative fines (P5,000 to P30,000) on violators, suspend or revoke accreditation of healthcare providers, suspend beneficiary benefits for up to six months
- Decisions appealable to the Office of the President
- Issue writs of execution for enforcement
- Deputize law enforcement for order enforcement
- Submit annual report to the President
- Coordinate in developing medical manpower based on healthcare needs
- Approve rules for uniform claims evaluation
- Exercise all powers necessary to achieve the Act’s objectives
Allowances for Commission Members
- Members receive monthly commutable allowance according to applicable laws
- Members who already receive government salary do not receive additional allowances
Roles of Chairman and Vice-Chairman
- Chairman presides over meetings, implements decisions, supervises Commission operations
- Vice-Chairman acts as Chairman when the latter is unable or when vacancy occurs
- Vice-Chairman performs other functions assigned by the Chairman
Executive Director of the Commission
- Appointed by the President for a six-year term
- Must have at least ten years experience in relevant technical and administrative fields
- Holds a full-time office and removable only for cause
- Salary set by the Commission subject to compensation laws
- Responsible for general administration and operations
Coverage Choice for Members under Both SSS and GSIS
- Persons covered by both SSS and GSIS may choose either system for Medicare coverage
- Rules governing this choice prescribed by the Commission
Health Insurance Fund
- Pays medical benefits under Program I
- Composed of contributions from Medicare members collected by SSS and GSIS
- Maintained separate from other funds
- Managed and invested under applicable laws and safeguards
- Must conform to Commission policies
- SSS and GSIS may use up to 12% of total contributions and earnings for operational expenses
Contributions to the Health Insurance Fund
- Contributions are compulsory
- Rates established by the Commission and approved by the President
Collection of Contributions
- Employers deduct employees' contribution from monthly compensation
- Employers remit both employee and employer contributions to GSIS and SSS
- Employer’s contribution must not be recovered from the employee
- Failure of employer to remit contributions does not deprive employee of Medicare benefits
Records and Program Monitoring
- Commission, SSS, and GSIS to keep records of Program operations
- Commission to conduct continuous monitoring, studies and research for Program improvement
Preventive Suspension Procedure
- Hearing Committee may suspend beneficiaries or accredited practitioners/facilities preventively for up to 3 months
- Grounds: at least two prior violations and reasonable belief of current violation; or ongoing violation during inspection
- Suspension order must specify charged violation and evidence, require response within 10 days, and set hearing date
Appropriation of Funds
- Necessary funds for Commission’s operation, programs, and projects authorized to be included in the Annual Appropriations Law
Repeal and Effectivity
- All laws, orders or parts inconsistent with this Executive Order repealed or modified
- The Executive Order takes effect immediately upon issuance