OVERSEAS WORKERS WELFARE ADMINISTRATION
Memorandum Of Instructions No. 002, S. of 2010
Establishment of a Health Program for Overseas Filipino Workers
and Prescribing Its Implementing Guidelines
Adopted: 04 March 2010
In the interest of the service and as the Secretariat’s response to the medical assistance needs of Overseas Filipino Workers (OFWs) in distress, a Health Program for Overseas Filipino Workers is hereby established, subject to the following guidelines:
1.0 NATURE OF THE PROGRAM
The Health Program for Overseas Filipino Workers or HEALTHPRO is OWWA’s institutional response to address the need for subsidized medical services of migrant workers, both local and overseas whose illnesses are either classified as intensive, dreaded, and catastrophic cases.
The HEALTHPRO shall provide for in-and out-patient medical/health benefits and services as defined in this Guidelines.
2.0 GENERAL OBJECTIVE
This program is establish to ensure the provision of subsidized health services for active OWWA members and distressed OFWs who are in need of immediate medical care and services for illnesses acquired overseas.
3.0 PROGRAM COMPONENTS
To better serve the immediate and long-term medical needs of the OFW-clients, the HEALTHPRO shall have three (3) main components:
3.1 Domestic Hospitalization Services (Local confinement) – health services to be provided to OFW-patient upon arrival from abroad. It shall also include those OFWs already in the country who seek medical assistance within the prescribed period under this Guidelines.
3.2 Jobsite Hospitalization Services (Overseas confinement) – health services provided to OFW-patients on-site who need immediate confinement due to emergency and other medical reasons.
3.3 Medical Reimbursement for Emergency Cases. A reimbursement scheme for OFW patients requiring immediate medical attention/pre-evaluation of illnesses to access hospital services and initially shoulder their hospital bills.
4.0 GENERAL POLICIES
4.1 The HEALTHPRO shall cover both the active OWWA members and distressed OFWs, subject to hospitalization cap. For purposes of this program, active members and distressed workers shall be defined as follows:
4.1.1 Active Member – An OWWA-registered member who has a valid membership at the time of availment or whose membership has lapsed within the six-month period.
4.1.2 Distressed OFW – is a worker, regardless of membership status, who is in urgent need of medical assistance at post.
4.2 The health services package under this program shall include services covered by the Rehabilitation Program which maybe accessed by any qualified OFW, subject to their respective guidelines and financial cap.
4.3 All program beneficiaries shall be required to sign a pro-forma Declaration of Acceptance indicating conformity and adherence to the program’s guidelines. Said declaration shall be printed in the lower portion of the HEALTHPRO application form.
4.4 For Domestic Hospitalization Services, the HEALTHPRO shall effect payment of hospital expenses after the beneficiary’s PhilHealth allowable deductions and other HMO/similar benefits, if available, are deducted from the original bill.
4.5 For Jobsite Hospitalization Services, the HEALTHPRO shall effect payment of hospital expenses after the patient’s medical benefit (if there is any) is exhausted and/or his/her HMO benefit, if available, are deducted from the original bill.
The assistance shall complement the medical/health coverage of the workers provided under the provisions of employment contract and host country medical facilities.
Since OWWA pays the hospital bill, reimbursements from PhilHealth shall be claimed by OWWA for the OFW, through the execution of an authorization in favor of OWWA.
5.0 HEALTH SERVICE BENEFITS PACKAGE
The following types of benefits shall be provided for the following program components:
5.1 Domestic Hospitalization Services
A. In-patient hospital care
A.1 Room and board
A.2 Services of health care professionals;
A.3 Diagnostic, laboratory and other medical examination services;
A.4 Use of surgical or medical equipment and facilities;
A.5 Prescription drugs and medicines.
B. Out-patient hospital care
B.1 Services of health care professionals;
B.2 Diagnostic, laboratory and other medical examination services;
B.3 Personal preventive services
B.4 Prescription drugs and medicines
C. Referral Service to other partner institutions
5.2 Jobsite Hospitalization Services
A. In-patient hospital care.
The following are not covered by the HealthPro:
6.1 Non-prescription drugs and devices;
6.2 Alcohol abuse or dependency treatment;
6.3 Cosmetic surgery;
6.4 Optometric services;
7.0 ELIGIBILITY/ENTITLEMENT TO THE PROGRAM
7.1 Active OWWA members are entitled to the following services:
l Domestic Hospitalization
l Jobsite Hospitalization
7.2 Distressed Workers are entitled to Jobsite Hospitalization only. Those who have been medically repatriated shall, however, be covered by Domestic Hospitalization Service.
8.0 ILLNESSES TO BE COVERED
8.1 Any dreaded and/or catastrophic illnesses contracted while working abroad, including those considered under intensive cases, as defined in the International Classification of Diseases 10 Handbook.
8.2 Any of the illnesses identified above which manifested within six (6) months after the OFW had returned to the country.
9.0 HOSPITALIZATION CAP
A. Domestic (Philippines)
All expenses which will be incurred by the program beneficiaries under the hospitalization service package (in-patient and out-patient), shall be regulated by the following cap:
l One Hundred Thousand Pesos (Php100,000.00) for active member.
l Fifty Thousand Pesos (Php50,000.00) for distressed OFWs.
B. Jobsite (overseas)
For in-patient service package, the following are the maximum cap:
l Three Thousand US Dollars (US$3,000.00) for active member.
l One Thousand Five Hundred US Dollars (US$1,500.00) for distressed OFWs.
C. Scope and Conditions
C.1 Domestic Hospitalization Services
Program beneficiaries may utilize the cap to its maximum under the following conditions:
a. Out-patient and in-patient services entitlement is good only for check-up/consultation and treatment of the same illnesses originally diagnosed overseas or of illnesses contracted while working abroad;
b. Out-patient beneficiaries needing continuous treatment for dreaded/catastrophic diseases (e.g. those needing regular dialysis, chemotherapy, etc.) shall be allowed to undergo regular treatment;
c. In-patient beneficiary who developed complications after discharge from the hospital may be re-admitted to the program;
d. Beneficiaries who developed multiple illnesses, brought about by complications, may be allowed to re-avail of the program.
C.2 Jobsite Hospitalization Services
a. All program beneficiaries are entitled to confinement (in patient) services at the post;
b. Conditions for Medical Reimbursement (2.3) is covered under 10.3 of this guidelines;
c. All beneficiaries are entitled to one (1) time confinement only.
C.3 All hospitalization expenses in excess of the cap shall be shouldered by the beneficiary.
10.0 MECHANICS OF THE PROGRAM
To effectively implement the program, the following guidelines shall be strictly observed:
10.1 Domestic Hospitalization Services
a. RWOs shall forge a MOA with a reputable hospital/s in their area of jurisdiction as their partner medical institution/s (PMI).
b. All medically repatriated OFWs shall be endorsed to the PMI for treatment/or admission;
10.2 Jobsite Hospitalization Services
Beneficiaries shall be referred to government owned and government-operated medical institutions.
The services of private medical institutions shall only be availed of in emergency situation or in situation when the partner government medical institutions do not have the facilities needed by the patient.
10.3 Reimbursement of Expenses
Expenses incurred by the program beneficiaries shall be reimbursed in any of the following circumstances:
a. OFW patient, domestic and at jobsite who advanced payment of his hospitalization bill;
b. In case the beneficiary availed of the services of a non-PMI/hospital, reimbursement shall be subject to allowable cap;
c. Reimbursement shall be on a one-time basis only.
10.4 For domestic hospitalization. Referrals to hospitals shall cover both HEALTHPRO and REHABPRO cases.
a. In case a REHABPRO patient has been diagnosed to be afflicted with dreaded or catastrophic disease or classified, too, as an intensive case patient, he/she may also access the HEALTHPRO, subject to its guidelines and cap;
b. A separate billing statement for each program shall be required for appropriate program fund charging and management.
11.0 DOCUMENTARY REQUIREMENTS
11.1 Domestic Hospitalization Services
a. Duly accomplished application form
b. 1 pc. Passport size picture
c. Proof of OWWA contribution (original O.R., OEC, OFW membership verification form from OWWA-MPC), if applicable
d. Copy of passport with stamped arrival date
e. Copy of medical report/findings from overseas doctor (in English/translated in English) for those already afflicted with illness prior to arrival to the country).
11.2 Jobsite Hospitalization Services
a. Application Form
b. 1 pc. Passport size picture
c. Proof of OWWA contribution, if applicable
d. Copy of passport/any identification card
e. Copy of Doctor’s final medical report (in English)
f. Original copy of O.R and other medical bills
11.3 Reimbursement of Expenses
a. Application form with passport size picture
b. Proof of OWWA contribution, as above
c. Copy of passport/any identification card
d. Copy of Doctor’s medical report (in English)
e. Original copy of O.R. and other medical bills
12.0 PROGRAM MANAGEMENT
All Regional Welfare Offices (RWOs), and all OWWA overseas posts, shall manage the program for domestic and overseas implementation, respectively. For domestic hospitalization services, however, all RWOs are required to utilize the services of a Medical Controller/Coordinator who shall see to it that all claims for payment by the PMI are in order.
13.0 PROCESS FLOW
13.1 Domestic Hospitalization Services
a. The RWO receives and interviews OFW applicant or next-of-kin (NOK) of patient, if the former is incapable to give statement.
b. The RWO evaluates eligibility of applicant to the program, including record of contribution/s to OWWA.
l If eligible, requests applicant/NOK to fill-out application form and submit all documentary requirements.
c. The RWO registers and refers patient to PMI for medical evaluation/diagnostic test.
d. The PMI determines if patient’s illness is covered in the International Classification of Diseases 10 Handbook. Conducts evaluation and/or testing, if required.
l If patient is qualified to be admitted to be in-patient, PMI seeks approval from RWO. Otherwise, RWO refers him/her to other partner institution/s.
e. The RWO advises PMI of approval. Prepares Letter of Authorization (LOA). Brings and submits LOA to PMI.
f. The PMI admits for treatment.
g. Upon patient’s discharge, the PMI sends bill to RWO for payment together with “Medical Certificate” citing final health state or condition of patient.
13.2 Jobsite Hospitalization Service
a. The Welfare Officer or Welof receives and interviews OFW applicant or the informant, if the former is medically incapable to answer questions;
b. The Welof evaluates eligibility of applicant to the program;
c. The Welof requests applicant/informant to accomplish the required form(s);
d. The Welof determines if patient is an active member of PhilHealth/HMO;
e. The Welof registers and refers patient to a government owned/operated hospital/medical facility;
e.1 In case of an emergency admission in a private hospital, the Welof visits the patient to establish his/her eligibility;
f. The Welof monitors health condition of the patient;
g. Upon notice of discharge of patient, the Welof requests for the release of fund from the OWWA central office to settle the hospital bills.
14.0 DISAPPROVAL OF CLAIMS
All claims found to be fraudulent/fictitious shall be denied reimbursement. An OFW found to have filed fictitious claims shall be disqualified from the program and all programs of OWWA.
15.0 BUDGETARY REQUIREMENTS
The initial program fund requirement for the year 2010 to cover the hospitalization benefits of beneficiaries who will avail of the in-patient and out-patient packages is FOURTEEN MILLION PESOS (Php14,000,000.00) ONLY, subject to annual review by the Secretariat.
This MOI takes effect immediately.
(sgd.) Carmelita S. Dimzon, dpa