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(NAR) VOL. 7 NO. 2 / APRIL-JUNE 1996
[ OWWA MEMORANDUM OF INSTRUCTIONS NO. 003 SERIES OF 1996, January 31, 1996 ]
ADDENDUM TO MOI #012, SERIES OF 1995—PRESCRIBING THE POLICY GUIDELINES AND REQUIREMENTS ON AMENDING THE MEC FOR ADDITIONAL DEPENDENTS UNDER THE MEDICARE PROGRAM FOR OCWS
In the interest of the service and in order to facilitate processing of claims for reimbursement of Medicare benefits of OCW members and to minimize cancellation of Medical Eligibility Certificates (MECs) as a result of the amendments, the following guidelines shall be observed.
1. The legal dependent not listed in the MEC shall be allowed to avail of the medical benefits due him provided he submits to the service provider proof of relationship such as: Authenticated Birth Certificate for new-born child and an Authenticated Marriage Contract for wedded couple. An Affidavit of Dependency is required in addition to the Birth Certificate of the member if the member requests the inclusion of his parent/s or his legal dependent/s. This is necessary to establish the fact that the said parent/s solely depend/s on the OCW for support. The proof of relationship and other documents together with the photocopy of the MEC authenticated by the hospital, shall be attached to the claim form.
2. The Claims Processing Division (CPD), after evaluation of the claims for reimbursement by service providers, shall endorse the Authenticated MEC and proof of relationship to the Registration and Management Information Systems Division (RMISD). Upon evaluation of the submitted documents, the RMISD shall update the database. A Certificate to this effect signed by the RMISD Chief shall be forwarded to the CPD. The CPD shall photocopy the certification and attach it to the claim form. The original copy shall be forwarded to the OCW/dependent together with the Notice of Payment.
For immediate compliance.
Adopted: 31 January 1996
1. The legal dependent not listed in the MEC shall be allowed to avail of the medical benefits due him provided he submits to the service provider proof of relationship such as: Authenticated Birth Certificate for new-born child and an Authenticated Marriage Contract for wedded couple. An Affidavit of Dependency is required in addition to the Birth Certificate of the member if the member requests the inclusion of his parent/s or his legal dependent/s. This is necessary to establish the fact that the said parent/s solely depend/s on the OCW for support. The proof of relationship and other documents together with the photocopy of the MEC authenticated by the hospital, shall be attached to the claim form.
2. The Claims Processing Division (CPD), after evaluation of the claims for reimbursement by service providers, shall endorse the Authenticated MEC and proof of relationship to the Registration and Management Information Systems Division (RMISD). Upon evaluation of the submitted documents, the RMISD shall update the database. A Certificate to this effect signed by the RMISD Chief shall be forwarded to the CPD. The CPD shall photocopy the certification and attach it to the claim form. The original copy shall be forwarded to the OCW/dependent together with the Notice of Payment.
For immediate compliance.
Adopted: 31 January 1996
(SGD)WILHELM D. SORIANO
Administrator
Administrator