ANOTHER program implemented by the Philippine government for its estimated six million or so overseas workers, is the Medical Care (Medicare) Program for Overseas Filipino Workers (OFWs). Mandated by Executive Order No. 195, signed August 13, 1994 by then President Fidel V. Ramos, the health care scheme aims to provide medical assistance and hospitalization benefits to OFWs and their dependents. Coverage is compulsory. Any OFW leaving the country is required to register as a member and is asked to pay a yearly contribution of P900.00 (equivalent roughly to US$25). The only exception is when an OFW is an active member of either the Social Security System (SSS) or the Government Service Insurance System (GSIS), as both cover medical insurance scheme for its members.
Four major government entities – Department of Health, Department of Labor and Employment, Department of Foreign Affairs and the SSS – jointly implement the program but the main task is currently faced by the Overseas Workers Welfare Administration (OWWA), which provided the seed money to start the operations. There is a plan though that in a few years’ time, the government-owned and controlled Philippine Health Insurance Corporation (PhilHealth) will take over the full implementation of the program for OFWs. Just recently, PhilHealth took over from GSIS and SSS the Medicare coverage of over a million government employees and about five million private sector employees.
As members, OFWs are entitled to a 45-day compensable confinement in an accredited hospital in a given year. Their legal dependents are likewise provided with another 45 days to be shared among themselves within a year. Legal dependents, as defined by OWWA, are the OFW’s legitimate spouse who is not a Medicare member; the unmarried and unemployed children, including legitimated or acknowledged as appearing in the birth certificate, as well as those legally adopted or stepchildren below 21 years; minor children who are suffering from congenital disability, either physical or mental, or any disability acquired that renders them totally dependent upon the members for support; and parents who are over 60 years old whose income is less than P1,000 a month.
Once availed of by either or both the OFW and his dependents, expenses for room and board, medicines, X-rays and laboratory examinations, professional fees, operating room fees and surgical family planning procedures will be paid in part by the Medicare program. This is done once a beneficiary presents the original or a certified copy of the Medicare Eligibility Certificate (MEC) to the hospital. The MEC, which is initially issued to an OFW upon membership, is valid only for a year and once authenticated by the hospital, it will then be attached to the claim form. Before discharge, the hospital deducts the Medicare benefit from the total hospital bill before payment.
Benefits are calculated according to the category of the hospital, classified into primary, secondary or tertiary confinement. For room and board, for example, Medicare will pay P120/day, P220/day and P345/day for primary, secondary and tertiary confinement, respectively. Drugs and other medicines could be covered up to nearly P12,000, if confined in a tertiary hospital and if the case is classified as catastrophic. Medicine benefits under Intensive cases is set at P2,430 minimum and up to P7,660 maximum. Under professional fees, Medicare can pay as much as P15,930 for a surgeon’s service rendered. For a complete list of Medicare benefits and other relevant information, please refer to the ( OWWA-MEDICARE) site.
In its effort to provide more and better services to OFWs and their dependents, OWWA has recently launched its out-patient service, provided free of charge. It features free consultation, free routine and laboratory examination and free health education and counseling. This is conducted every Friday at the OWWA Center and at various Regional OWWA Units in the Philippines. The service is also now available at the Filipino Workers Resource and Development Center (FWRDC) in Tokyo, Osaka, Dubai, Abu-Dhabi, Rome, Jeddah and Bahrain. There is an on-going plan to provide the same free services to the rest of OFWs scattered all around the globe.
Author: Freda Editha O. Contreras
Published on: December 21, 1999