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Republic of the Philippines

'

Department of Health

OFFICE OF THE SECRETARY

NOV 10 2011

DEPARTMENT ORDER
No. 2011- 0~55"

SUBJECT: Guidelines for the Medical, Dental and Hospitalization Benefit

of the Department of Health Employees.

I. BACKGROUND AND RATIONALE

Republic Act No. 7305, otherwise known as the Magna Carta of Public Health
Workers of 1992 and its Implementing Rules and Regulations (IRR) mandates
medical, dental and hospitalization benefits and privileges to all public health workers.
Rule XV, Number 7.7.2 (Compensation, Benefits and Privileges) of the IRR stipulates
the provision of a compulsory and free medical examination to public health workers.

Administrative Order No. 32-E, s. 1994 defines the guidelines for the
implementation of medical examination, hospitalization and treatment of public health
workers as provided for by RA No. 7305 and directs all concerned agencies in the
health sector to include the funds for this in their annual budgets.

Civil Service Commission's Resolution No. 97-4684 dated December 18, 1997 and
Memorandum Circular No. 33, s. 1997 on the "Policy on Working Conditions at the
Workplace" stipulates that all government offices shall provide health programs for
employees which includes hospitalization services and annual mental, medical-
physical examinations and enjoin all heads of department/agencies to appropriate
funds for the institutionalization of these policies/programs.

The Department of Health have yet to fulfill the foregoing provisions for its
employees. This is compounded by the fact that the rising cost of medical,
hospitalization and dental services, including rehabilitative care are beyond the reach
of DOH employees. This Order shall provide the necessary guidelines to support a
comprehensive medical, dental, hospitalization and rehabilitation benefit package for
all DOH employees.

II. DEFINITION OF TERMS

1. Hospitalization Expenses- refers to the expenses incurred by reason of an

employee's illness, injury, treatment and rehabilitation.

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 2. Dental Service -refers to services including dental emergencies, extraction of
unsavable tooth, restoration of savable tooth through temporary and permanent
fillings, oral prophylaxis and denture construction.
3. Smoking Cessation Service - refers to services that include counseling and
pharmacologic intervention and provision for Nicotine Replacement Therapy
(NRT).
4. Adult Vaccination - refers to the provision of immunization to persons twenty
one (21) years old and above as recommended by the Health Secretary as part
of policy covering DOH.
5. Out-Patient care- refers to medical services availed without confinement.
6. In-Patient care -refers to medical services availed with confinement
7. Maintenance Medicines - refer to drugs and medicines prescribed by the
Attending Physician to be taken regularly for long periods of time.
8. Send Bill- refers to the hospital's submission of the Original Billing Statement
including the Doctor's Billing Statement for Professional Service/Fee, and
Clinical Abstract of the patient to his/her agency/office/unit for payment.
9. NCPAM-MAP -refers to National Center for Pharmaceutical Access
Management's Medicines Access Program that provides health care access
particularly for essential medicines to patients, addressing priority diseases in
the country.
10. CO -refers to Central Office as defined under DO No.O 188-0rganizational
Chart.
11. CHDs- refer to Centers for Health Development (Regional Offices).
12. Specialty/Special Hospitals - refer to DOH hospitals that provide specific
clinical care and management as defined in AO No. 2005-0029, Subsection
7.2.2.
13. Hospitals- refer to DOH retained general hospitals that provide services for all
types of deformity, diseases, illness or injury as defined in AO No. 2005-0029,
Subsection 7.2.1.
14. Other DOH Health Facilities - refer to DOH retained facilities that include
Birthing Homes and Psychiatric Care Facilities including Treatment and
Rehabilitation Centers, as defined in AO No. 2005-0029, subsection 7.3.2.
15. DOH Employees- refer to all officers and employees of Central Office, Bureau
of Quarantine, Food and Drug Administration, Centers for Health
Development, Specialty/Special Hospitals, DOH Retained Hospitals, Attached
Agencies and Other DOH Health Facilities.
16. Medical, Dental and Hospitalization Fund (MDHF) - refers to the allotted
budget requirements of DOH employees for this benefit to be sourced from
their respective office/agency concerned.

III. OBJECTIVES

This Order sets the guidelines for:

1. The availment by DOH employees of all mandated Medical, Dental and

Hospitalization Benefits as provided in RA 7305, the Civil Service Resolution
on Working Conditions at the Workplace, and other pertinent laws and
Issuances;

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2. The rational and fair implementation of the Medical, Dental and

Hospitalization Benefits in the Department of Health and all offices or health
facilities as defined in this Order.

IV. SCOPE AND COVERAGE

This Order applies to all officers and employees of the DOH Central Office,
Bureau of Quarantine, Food and Drug Administration, Centers for Health
Development, Specialty/Special Hospitals, DOH Retained Hospitals, Attached
Agencies and Other DOH Health Facilities.

V. GENERAL GUIDELINES

I. DOH employees are entitled to medical and dental care as well as treatment and/or
hospitalization in all DOH hospitals.
2. The aforementioned benefit shall be made available to all DOH employees at all
times for the duration of their tenure of employment and after availing of the
regular medical benefits/privileges such as: NCPAM-MAP for DOH Employees,
Senior Citizen Privilege Discount, and/or Persons with Disabilities Discount and
PhilHealth.
3. All DOH offices/agencies/facilities covered by this Order shall allot funds in the
amount of Ten Thousand Pesos (PhplO,OOO.OO) for the annual medical
examination for each employee, and a maximum aggregate amount of Fifty
Thousand Pesos (Php50,000.00) for dental service, out-patient and in-patient care,
rehabilitative care and maintenance medicines for the employees annually to cover
the full medical and dental benefits.
4. All concerned DOH offices/agencies/facilities are authorized to create their
respective Hospitalization and Medical Benefit Committee (HMBC) and shall
oversee the implementation of this Order.
5. HMBCs shall be authorized to enter into a Memorandum of Agreement (MOA)
with DOH hospitals for the required annual medical examination services of its
employees.
6. The payment of medical, dental and hospitalization expenses shall be made
through a mechanism known as Send Bill, where all fees and charges shall be
charged against the Medical, Dental and Hospital Fund (MDHF).
7. All concerned DOH offices/agencies/facilities shall allocate budget for the
medical, dental and hospitalization of its employees and shall be pooled as a
MDHF.
8. Access to existing DOH health facilities, services and programs shall be
maximized by DOH employees thru the existing DOH hospital networking and
referral system.

VI. SPECIFIC GUIDELINES

I. Organization and Functions of the Hospitalization and Medical Benefit

Committee (HMBC)

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 - - -----------

l.a In compliance with Item No. 2 of the Civil Service Commission's

Memorandum Circular No. 33, s. 1997, enjoining all government agencies
to create a Safety Committee that shall enforce safety and wellness
programs for its employees, the DOH Hospitalization and Medical Benefit
Committee shall be established.

This shall be composed of the following:

Chairperson: Director IV, Health Human Resource Development Bureau

(HHRDB)
Vice-Chairperson: Director IV, National Center for Disease Prevention and
Control (NCDPC)

Members:
Director III, Finance Service (FS)
Program Director - National Center for Pharmaceutical Access
Management (NCP AM)
President - Unyon ng mga Kawani ng Kagawaran ng Kalusugan
Sentral (UKKKS)
President- Association of Hospital Administrators, Inc. (AHA)

1.b A Secretariat shall be created and appointed by the Chairperson. The Chief
of the Personnel Division, HHRDB shall serve as the Head Secretariat.

1.c Similar HMBC shall also be constituted in the Bureau of Quarantine, Food
and Drug Administration/ CHDs/ Specialty/ Special Hospitals/ DOH
Retained Hospitals/ Attached Agencies/Other Health Facilities as
appointed/designated by their respective Head of Office.

l.d The HMBC shall implement and administer the provisions of this Order. It
shall formulate a Memorandum of Agreement with DOH hospitals to
provide the annual medical examination services for the employees.
HMBC shall also formulate the necessary guidelines to implement this
Order such as but not limited to: claim for reimbursement of maintenance
medicines, Send-Bill mechanisms, communication and reporting systems,
among others.

2. Annual Medical Examination Procedures

2.a All DOH employees must undergo the Annual Medical Examination and
participate in at least one (1) of the various health and physical activity
programs of the DOH, except when advised otherwise by a physician as
may be certified by HMBC. Failure to comply with these two essential
requirements will forfeit the privilege to avail of the Medical, Dental and
Hospital Benefit.

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 2.b The Annual Medical Examination shall include the Risk Factor Assessment
using the Non-Communicable Disease Risk Assessment Questionnaire
Form to assess:

• Use of tobacco or smoking status

• Nutritional status or diet
• Physical inactivity
• Alcohol drinking

2.c Based on the results of the Non-Communicable Disease Risk Assessment,

the DOH employees shall be provided with counseling and treatment
services to treat the illness or modify unhealthy behavior/practice.

2.d All DOH employees shall be entitled to a complete physical examination,

to specifically include: Blood Pressure (BP), Respiratory Rate (RR), Pulse
Rate (PR), Weight computing for Body Mass Index (BMI) and Waist/hip
Ratio.

Laboratory, Radiologic and other examinations shall be done annually but

not limited to the following:

A. For Employees who are FORTY YEARS OLD ( 40y/o) AND ABOVE
Male Female
1.Routine Urinalysis 1.Routine Urinalysis
2.Fecalysis with Occult Blood ( Ova 2.Fecalysis with Occult Blood (Ova
& Parasites, Ameba ) & Parasites, Ameba)
3. Complete Blood Count 3. Complete Blood Count
4. ABO & Rh Blood Typing 4. ABO & Rh Blood Typing
5. Fasting Blood Sugar 5. Fasting Blood Sugar
6. Lipid Profile (Total Cholesterol, 6. Lipid Profile (Total Cholesterol,
HDL, LDL, VLDL Triglycerides) HDL, LDL, VLDL Triglycerides)
7. Serum Creatinine, Uric Acid, 7. Serum Creatinine, Uric Acid,
BUN, Potassium BUN, Potassium
8. SGPT, Alkaline, Phosphatase, 8. SGPT, Alkaline, Phosphatase,
Serum Albumin Serum Albumin
9. Chest X-ray ( PA & Lateral ) 9. Chest X-ray ( PA & Lateral)
10. ElectroCardioGram (ECG) 10. ElectroCardioGram (ECG)
11. Visual Acuity Examination 11. Visual Acuity Examination
12. Abdominal ultrasound (Liver, 12. Abdominal ultrasound (Liver,
Spleen, Pancreas, Adrenals, Spleen, Pancreas, Adrenals,
Gallbladder, Kidneys and Urinary Gallbladder, Kidneys and Urinary
Bladder) Bladder)
13. Immunization ( Flu, 13. Immunization ( Flu,
Pneumococcal, Anti-Rabies Pneumococcal, Anti-Rabies
Prophylaxis, Anti- Tetanus) Prophylaxis, Anti- Tetanus)
14. Dental Profiling and prophylaxis 14. Dental Profiling and prophylaxis
15. Spirometry 15. Spirometry
16. Upper/lower GI series 16. Upper/lower GI series

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..

17. Neuro/Psychiatric Examination 17. Neuro/Psychiatric Examination

18. Prostate Specific Antigen 18. Pap Smear
19. Digital Rectal Exam ( DRE) 19. Breast Ultrasound
20. Pelvic ultrasound

B. For Employees who are Below 40 years old (Male and Female)
1. Routine Urinalysis
2. Fecalysis with Occult Blood (Ova & Parasites Ameba)
3. Complete Blood Count
4. ABO & Rh Blood Typing
5. Fasting Blood Sugar
6. Lipid Profile (Total Cholesterol, HDL, LDL, VLDL Triglycerides)
7. Serum Creatinine, Uric Acid, BUN, Potassium
8. SGPT, Alkaline, Phosphatase, Serum Albumin
9. Chest X-ray ( PA & Lateral)
10. ElectroCardioGram (ECG)
11. Visual Acuity Examination
12. Dental Profiling and prophylaxis
13. Immunization (Flu, Pneumococcal, Anti-Rabies Prophylaxis, Anti- Tetanus)
14. Neuro/Psychiatric Examination

3. Confirmatory laboratory, radiologic or other diagnostic procedures

shall be taken as may be advised by the attending physician for abnormal
findings.

4. Should the DOH employee require hospitalization or confinement, the

attending physician shall certify the essential health care services (i.e. Out-
patient/In-patient Care/Rehabilitative Care).

5. Billing/ Charges for Out-patient/In-patient Care/Rehabilitative Care and

Maintenance Medicines

5.1 "Send Bill" charges shall be sent by the DOH hospital to the concerned
DOH office/agency/facility within forty five (45) days. Claims in excess of
the employee's allotted budget for the year shall be charged from the
employees' succeeding year's allotment under the MDHF.

5.2 Maintenance Medicines shall be provided through the NCPAM-MAP. In

case said medicines are not available under NCPAM-MAP, the DOH
employee shall reimburse the cost of medicines from the employee's
allotted budget for the year under the MDHF by submitting the original
Doctor's Prescription and Official Receipt of the medicines within forty
five (45) days from purchase.

6. Budgeting for the Office/Agency MDHF

6.a The Central Office, Bureau of Quarantine, Food and Drug

Administration, Centers for Health Development, Specialty/Special
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 Hospitals, DOH Retained Hospitals, Attached Agencies and other DOH
Health Facilities shall allot funds in the amount of Ten Thousand Pesos
(PhplO,OOO.OO) for Item Number 2 for each employee annually.
Said amount shall vary subject to the review and recommendation by the
HMBC and as approved by the Head of Office.

6.b The Central Office, Bureau of Quarantine, Food and Drug Administration,
Centers for Health Development, Specialty/Special Hospitals, DOH
Retained Hospitals, Attached Agencies and Other DOH Health Facilities
shall allot funds with a maximum aggregate amount of Fifty Thousand
Pesos (Php50,000.00) for Item Numbers 3 and 4 for the employees
annually, adopting the formula developed by the National Center for
Health Facility Development (NCHFD) in determining Morbidity
Estimates based on Mortality Rate.

>- Total Number of employees x .10 (10%) = "A" (total number of

employees who may be hospitalized)
>- "A" x 50,000 = "B" (total amount to be allotted for Item Numbers 3 and
4).

The unutilized portion of the MDHF shall become part of the generated savings at the
end of the year and shall be subject to review for its utilization plans by the DOH
Execom.

VII. REPEALING CLAUSE:

All orders, rules, regulations, and other related issuances inconsistent with or
contrary to this Order are hereby repealed, amended, or modified accordingly. All
provisions of existing issuances which are not affected by this Order shall remain valid
and in effect.

VIII. EFFECTIVITY

This Order shall take effect immediately.

~
ENRIQUE T. ONA, MD, FPCS, FACS
Secretary of Health

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