Law Summary
Philippine Medical Care Commission Composition
- Commission composed of nine members from government, medical associations, and private sector.
- Key members include Chairman, Administrator, SSS and GSIS Administrators, representatives from medical and hospital associations, DoH Secretary or designee, and private sector representatives.
- Chairman and certain members appointed by the President with Commission on Appointments' consent.
- Terms last six years.
Commission's Powers and Duties
- Formulate policies and implement Medical Care Plan.
- Organizational authority including personnel management and compensation.
- Establish provincial, city, and municipal Medical Care Councils.
- Authorize actuarial studies to adjust contributions and benefits.
- Regulate beneficiary registration and prevent abuse.
- Fund allocation to local councils.
- Enforce contribution payments by withholding benefits when necessary.
- Issue supplementary rules/regulations.
- Annual reporting to President and Congress.
Commission Meetings and Compensation
- Regular weekly meetings; special meetings allowed.
- Quorum is five members.
- Compensation: Government officials serve without additional pay but may receive expense reimbursements; private members receive per diem.
- Commission appoints secretary and fixes compensation.
Chairman and Administrator Qualifications and Roles
- Chairman: Experienced reputable medical professional with executive skills; full-time with defined compensation.
- Administrator: Chief Executive Officer; full-time; registered physician with executive experience; appointed by President with confirmation.
The Philippine Medical Care Plan Structure
- Two programs: Program I for SSS and GSIS members; Program II for others.
- Program I benefits specified; Program II implementation planned within 3 years, with Congress to determine coverage and contributions.
Program I Benefits and Implementation
- SSS and GSIS to establish medical care funds and administer under Commission policies.
- Supplementary plans for dependents to be adopted within 5 years.
- Compulsory coverage for employees under relevant laws.
- Separation from employment may allow continuation of contributions within 60 days.
Specific Medical Benefits under Program I
- Hospitalization: up to 45 days/year; daily room and board and special charges capped.
- Surgical benefits: limited by operation size (minor, medium, major).
- Medical expense benefits for daily professional treatment visits with maximum limits.
- Freedom to choose hospital and medical practitioner.
- Notification and supervision procedures by SSS/GSIS during hospitalization.
- Direct payment to hospitals, practitioners, and drug stores; excess charges borne by employee.
Limitations and Exclusions of Benefits
- Minimum contribution requirements before benefits apply.
- Penalty for failure to notify SSS/GSIS by hospitals.
- Grounds for denial or reduction of benefits including noncompliance, falsification, negligence.
- Exclusions: cosmetic, most dental and optometric services, psychiatric and purely diagnostic services.
Contributions and Collection
- Monthly contribution rates based on salary brackets with equal employer-employee shares.
- Employer responsible for deduction and remittance within prescribed time.
- Employers may not recover their share from employees.
- Nonremittance by employer does not deprive employees of benefits.
Health Insurance Fund and Fund Management
- Separate Health Insurance Funds for SSS and GSIS from contributions.
- Fund administration aligned with existing laws but subject to Commission's policies.
- Timely deposit of contributions in government banks.
- Maintenance of accounting, actuarial records, and reports.
Program II Provisions and Local Medical Care Councils
- Private hospitals to allocate a minimum bed capacity as "service beds" with government subsidy.
- Priority government loans for hospital development.
- Out-patient and domiciliary care by government facilities initially.
- Registration of residents and payment of annual assessments managed by local treasurers.
Local Medical Care Councils Composition and Functions
- Provincial, City, and Municipal Councils established with membership from health officers, treasurers, government, medical and hospital associations, and private citizens.
- Councils have terms arranged on staggered basis.
- Functions include supervision, fund management, adjudication, distribution of funds and oversight of services.
- City Councils may create Community Medical Care Councils.
- Councils administer Community Mutual Health Funds.
Community Mutual Health Fund
- Fund comprised of resident contributions plus equal government counterpart.
- Held in trust by local treasurers and managed by Medical Care Councils.
Revolving Funds for Government Hospitals
- Hospital gross income to be used for upgrading, expansion, maintenance and operation subject to DoH approval.
Reparations Allocation
- Annual $1.5 million allocation for machineries, equipment, and instruments for government and private hospitals recommended by Commission.
Definitions of Key Terms
- Clarification of terms including SSS, GSIS, employee, employer, benefits, hospital, medical practitioner, confinement, single period of confinement, Commission, service beds, mutual health funds, and Administrator.
Actuarial Studies and Legislative Recommendations
- Commission tasked to conduct studies on contributions and benefits.
- Findings and recommendations to be submitted to Congress.
Penal Provisions
- Fraud, collusion, falsification, and misrepresentation punishable by fines and/or imprisonment.
- Misuse of collected contributions subject to imprisonment and fines.
Separability and Repealing Clauses
- Invalid provisions do not affect the validity of remaining provisions.
- Repealing inconsistent laws or regulations but preserving existing agency powers.
Appropriations and Effectivity
- Initial appropriation of one million pesos for organizational expenses.
- Subsequent funding part of General Appropriations Act.
- Immediate implementation of Program I.
- Program II implementation timing to be determined by Congress upon Commission's recommendation.