In view of the favorable findings of the actuarial study concerning the improvement of in-patient services, particularly for OWWA Medicare members and their legal dependents who were confined for catastrophic illness or injury and pursuant to OWWA Board Resolution No. 2000-006 dated 30 March 2000, the following new rates of benefits ceiling shall apply retroactive to January 1, Year 2000.

1.         COVERAGE

This MOI covers confinement of OWWA members and/or their dependents due to catastrophic cases. Catastrophic cases include cancer cases requiring chemotherapy and/or radiotherapy, meningitis, encephalitis, cirrhosis of the liver, myocardial infraction, cerebrovascular attack, rheumatic heart disease, renal condition requiring dialysis or transplant, and massive hemorrhage. Likewise, included are surgical procedures or multiple surgical procedures done in one sitting with a total Relative Unit Value (RUV) of 20 and above such as coronary bypass, open heart surgery or neurosurgery.

2.         SCHEDULE OF BENEFITS

	HOSPITAL CATEGORY
	PRIMARY	SECONDARY	TERTIARY
A.        Hospital Charges
1.         ALLOWANCE for ROOM and BOARD per day	P360.00	P660.00	P1,035.00
2.         DRUGS and MEDICINES per single period of confinement		P19,725.00	P35,655.00
3.         X-RAY, Laboratory and Others per single period of confinement		P10,215.00	P29,430.00
4.         OPERATING ROOM FEE (Surgical procedure with RUV of 20 and above)		P6,480.00	P10,470.00
B.        Professional Fees
DOCTOR'S FEE (per single period confinement)
General Practitioner	P315 per day but not to exceed P2,430.00
Specialist	P450 per day but not to exceed P4,050.00
Surgeon's Fee not exceeding	P47,790.00 shall be paid in accordance with RUV=1,260
Anesthesiologist's Fee	(30% of Surgeon's Fee) not to exceed P14,355.00

3.         CLAIMS PAYMENT

For those who were admitted prior to January 1, 2000 but were discharged on or after this date, the new rate will apply to the entire confinement period. For those who will be confined starting August 2000, their benefits shall be deducted from their hospital bill.

For OWWA Medicare members or their dependents who were confined between January 1, 2000 and July 31, 2000, the difference in what OWWA Medicare actually paid them and their entitlement under this MOI shall be reimbursed directly to the OWWA medicare member. The payment will be processed upon submission of the following documents:

1).   Request for reimbursement (MRR Form)

2).   Additional Original Official Receipts (if there are any)

3).   Marriage contract or proof of relationship to OFW

The OWWA medicare member is required to submit his request for reimbursement not later than October 31, 2000.

4.         INFORMATION DISSEMINATION

The Medicare Program Management Office (MPMO) is directed to disseminate information on the upgraded benefits as widely as possible. It shall coordinate with the Philippine Hospital Association, OFW associations, associations of recruitment agencies and other appropriate entities.

For immediate compliance.

24 June 2000

(SGD.) ELEUTERIO N. GARDINER
Administrator