DIRECTING THE SYSTEMS TO ADOPT A SYSTEM OF PAYING EC MEDICAL BENEFIT FOR DIALYSIS OF PERSONS WITH WORK-RELATED DISABILITIES (PWRDS) TAKING INTO CONSIDERATION THEIR PHILHEALTH COVERAGE
WHEREAS, the ECC is mandated by law to safeguard the integrity of the State Insurance Fund;
WHEREAS, the ECC, GSIS and the SSS are mandated by law to provide victims of work-connected sickness and injuries with a continuing program of rehabilitation services to help them become physically independent and to restore them towards gainful employment;
WHEREAS, the PHILHEALTH is mandated under its Charter to provide comprehensive health care services to all Filipinos through a socialized health insurance program that will prioritize the healthcare needs of its covered members;
WHEREAS, the SSS and the GSIS, as the implementing agencies of the Employees’ Compensation Program (ECP) for private and public sector workers, respectively, serve persons with work-related disabilities (PWRDs) who undergo dialysis through reimbursement of the cost of dialysis sessions;
WHEREAS, the PHILHEALTH assists all its members who undergo dialysis in accordance with its prescribed case rate at a maximum of 90 sessions per year;
WHEREAS, the Systems shall reimburse the cost of dialysis after Philhealth coverage has been exhausted;
WHEREAS, the PHILHEALTH, the SSS, the GSIS and the ECC agreed to sign a Memorandum of Agreement to ensure that Philhealth benefits for dialysis provided to PWRDs are verified prior to payment of EC benefits for the same work-related medical treatment;
WHEREAS, such system of verification aims to maximize the availment by PWRDs of medical benefits from Philhealth and ECC in order to reduce their out of pocket expenses;
WHEREAS, such system also promotes the government’s objective of universal PHILHEALTH coverage through referral for Philhealth coverage of PWRDs who are non Philhealth members;
WHEREAS, PHILHEALTH maintains a “MyPhilhealth” portal containing a database of all patients who availed of Philhealth coverage for dialysis and providing a system for the efficient verification of data on Philhealth payments;
NOW THEREFORE, ON MOTION DULY MADE AND SECONDED,
This Commission RESOLVES AS IT IS HEREBY RESOLVED, to adopt a system of paying EC medical benefits taking into consideration their Philhealth coverage;
RESOLVED further that the Systems shall verify Philhealth coverage availment prior to payment of EC medical benefit for dialysis of persons with work-related disabilities (PWRDs) such that the Systems shall payor reimburse the cost of dialysis after Philhealth coverage has been exhausted;
RESOLVED further that the Systems shall refer to Philhealth all those availing of EC benefits who are non Philhealth members, for coverage under the Philhealth program;
RESOLVED further that the Systems and ECC sign an agreement with Philhealth to cooperate on the implementation of the above; .
RESOLVED FINALLY, that copies of this Resolution be duly furnished the SSS and GSIS for their compliance and PHILHEAL TH for information and proper guidance.
APPROVED in Quezon City, this 3rd day of November 2015.
(SGD.) CIRIACO A. LAGUNZAD
Chairperson-Alternate
Department of Labor and Employment
(SGD.) BRENDA P. VIOLA
Member-Designate
Social Security System
(SGD.)ROBERT G. VRGARA
Member
Government Service Insurance System
(SGD.) CARLITO P. ROBLE
Member
Employees’ Sector
(SGD.) MIGUEL B. VARELA
Member
Employers’ Sector
(SGD.) ALEXANDER A. PADILLA
Member-Designate
Philippine Health Insurance Corporation
(SGD.) STELLA ZIPAGAN-BANAWIS
Member
Employees’ Compensation Commission – Secretariat