Section 10Sec./Art. 10

Benefit Package. - Subject to the limitations specified in this Act and as may be determined by the Corporation, the following categories of personal health services granted to the member or his dependents as medically necessary or appropriate shall include:

a. Inpatient hospital care:

1. room and board;

2. services of health care professionals;

3. diagnostic, laboratory, and other medical examination services;

4. use of surgical or medical equipment and facilities;

5. prescription drugs and biologicals; subject to the limitations stated in Section 37 of this Act;

6. impatient education packages;

b. Outpatient care: -

1. services of health care professionals;

2. diagnostic, laboratory, and other medical examination services;

3. personal preventive services; and

4. prescription drugs and biologicals, subject to the limitations described in Section 37 of this Act;

c. Emergency and transfer services; and

d. Such other health care services that the Corporation shall determine to be appropriate and cost-effective: Provided, that the Program, during its initial phase of implementation, which shall not be more than five (5) years, shall provide a basic minimum package of benefits which shall be defined according to the following guidelines:

1. the cost of providing said package is such that the available national and local government subsidies for premium payments of indigents are sufficient to extend coverage to the widest possible population.

2. the initial set of services shall not be less than half of those provided under the current Medicare Program I in terms of overall average cost of claims paid per beneficiary household per year.

3. the services included are prioritized, first, according to its cost-effectiveness and, second, according to its potential of providing maximum relief from the financial burden on the beneficiary: Provided, That in addition to the basic minimum package, the Program shall provide supplemental health benefit coverage to beneficiaries of contributory funds, taking into consideration the availability of funds for the purpose from said contributory funds: Provided, further, That the Program shall progressively expand the basic minimum benefit package as the proportion of the population covered reaches targetted milestones so that the same benefits are extended to all members of the Program within five (5) years after the implementation of this Act.

Such expansion will provide for the gradual incorporation of supplementary health benefits previously extended only to some beneficiaries into the basic minimum package extended to all beneficiaries: and Provided finally, That in the phased implementation of this Act, there should be no reduction or interruption in the benefits currently enjoyed by present members of Medicare.