(NAR) VOL. 21 NO.1/ JANUARY - MARCH 2010
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.
4.1 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.4.2 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.
4.1.2 Distressed OFW - is a worker, regardless of membership status, who is in urgent need of medical assistance at post.
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.
5.1 Domestic Hospitalization Services
A. In-patient hospital careA.1 Room and boardB. Out-patient hospital care
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.1 Services of health care professionals;C. Referral Service to other partner institutions
B.2 Diagnostic, laboratory and other medical examination services;
B.3 Personal preventive services
B.4 Prescription drugs and medicines
5.2 Jobsite Hospitalization Services
A. In-patient hospital care.
6.1 Non-prescription drugs and devices;7.0 ELIGIBILITY/ENTITLEMENT TO THE PROGRAM
6.2 Alcohol abuse or dependency treatment;
6.3 Cosmetic surgery;
6.4 Optometric services;
7.1 Active OWWA members are entitled to the following services:7.2 Distressed Workers are entitled to Jobsite Hospitalization only. Those who have been medically repatriated shall, however, be covered by Domestic Hospitalization Service.
- Domestic Hospitalization
- Jobsite Hospitalization
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.
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.
10.1 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.
11.1 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
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.c. The RWO registers and refers patient to PMI for medical evaluation/diagnostic test.
- If eligible, requests applicant/NOK to fill-out application form and submit all documentary requirements.
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.e. The RWO advises PMI of approval. Prepares Letter of Authorization (LOA). Brings and submits LOA to PMI.
- 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.
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.