OFW Benefit: Medical Care Program for OFWs
Oct 27, 2005
What is the Medical Care Program for OFWs?
Medical Care Program for the Overseas Filipino Workers(OFWs) provides medical assistance and hospitalization benefits to OFWs and their dependents. Created under Executive Order No. 195 dated 13 August 1994, it is implemented by the OWWA in coordination with the POEA, DFA, and PHIC
Who can benefit under the Program?
All OFWs except those with existing coverage through the Philhealth Voluntary Membership Program, and all his legal dependents as defined below:
- The OFW’s legitimate spouse who is not a Medicare member
- The unmarried and unemployed children, including legitimated, acknowledged, legally adopted and stepchildren, below 21 years of age
- Children 21 tears old or above with disabilities acquired before age 21 which render them dependents to the members for support
- The OFW’s parents who are 60 years old and above.
Is membership to the Medicare Program compulsory?
Yes, membership is required before an OFW’s employment documents can be processed, and before he/she can be issued an Overseas Employment Certificate (OEC) (discussed in FAQ/POEA)
Who can be exempted from the Mandatory Medicare Coverage?
An OFW who has an existing coverage through his/her active status under the VMP of the PHIC is exempted from the mandatory coverage.
What are the benefits provided for the Medicare Program?
- In-Patient Services
An OFW member who gets sick or injured is entitled to compensable confinement in a PHIC-accredited hospital not exceeding forty-five (45) days in a given year and his/her legal dependents are provided with another forty-five(45) days to be shared among themselves within a year.
The Medicare Program will pay part of the expenses for room and board, medicines, x-rays, and laboratory examinations, professional fees( surgical, medical/dental, anesthesiologist fees), operating room fees and surgical family planning procedures.
EFFECTIVE 01JANUARY2000, MEDICARE BENEFITS FOR CATASTROPHIC CASES HAVE BEEN INCREASED BY 200%.
- Out-Patient Services
The out-patient services were initiated in 1998 to institute preventive/promotive measures intended to minimize the hospitalization of members and their dependents. The project offers OWWA-Medicare members and their dependents not only free consultations but also P500.00 worth of medicines and/or routine diagnostic procedure per family per year. The project is undertaken through tie-up accredited clinics/hospitals in the regions. Free check-ups are also available to members on site where there are large concentrations of OFWs.
Under what conditions can a beneficiary be entitled to benefits?
A beneficiary shall be entitled to benefits upon payment of the annual contribution if he/she meets the following:
- Operating complex on an out-patient basis or receives chemotherapy, radio therapy, or hemodialysis similarly on an out-patient basis
- The annual Medicare contribution has been paid
- The confinement date is within the period of effectivity of coverage as appearing in the member’s Medicare Eligibility Certificate (MEC)
- The forty-five (45) day room and board allowance for the calendar year has not been exhausted.
What are the requirements in the availment of Medicare benefits?
The beneficiary only needs to present the original and a true copy of the MEC to the hospital, the latter to be authenticated by the hospital and attached to the claim form. Before discharge, the hospital deducts the Medicare benefits from the total hospital bill before payment.
Can members who are abroad avail of Medicare benefits?
Yes, a member including his legal dependents abroad can avail of the same benefits under the program.
What are the conditions for the payment of Medicare benefits of members abroad?
The member must submit the following documents for the reimbursement of the Medicare benefits:
- Statement of account and/or the Official Receipts of payment from the foreign hospital where the patient was confined
- Certification by the attending physician as to the final diagnosis, medical report, period of confinement, and services rendered.
What is the amount of contribution must a member pay?
A member pays an initial premium of P900.00 to cover one year. He/She pays the same amount upon renewal of membership in the succeeding years.
How does one register for membership in the Medicare program?
OFWs enrolling for their departure should properly accomplish the OFW Medicare Information Sheet(MIS). They should pay the premium of P900.00 upon registration. OWWA shall issue a MEC which shall serve as proof of membership to be presented to the accredited hospital upon availment of service.
Those workers seeking exemption from mandatory coverage shall attach to their MIS either one of the following:
- OR of Philhealth premium payment
- Certificate of active membership in Philhealth
- Copy of MEC provided it contains at least 2 months of unexpired portion.
The Official Receipt (OR) for Medicare Premium or the Certificate of Exemption issued by the OWWA shall be an additional requirement for contract processing by POEA.
OFWs who are presently in their jobsites should submit a properly accomplished MIS to the OWWA Center or to the designated processing center nearest their jobsites. They should pay the premium P900.00 or its equivalent in the local currency. Membership to Medicare should be renewed yearly.
How do OFWs renew their Medicare memberships?
By paying their annual contribution directly to OWWA, or its designated registration centers in the country or abroad.
Source: DOLE POLO