Dr. Sergio S. Cao
Dr. Sergio S. Cao
UP employees in active service who were hospitalized due to ailment can now reimburse their medical expenses through the University’s Financial Assistance Program for Hospitalization Expenses (FAPHE).
UP Diliman, through Chancellor Sergio S. Cao, initiated the proposal which would help relieve faculty, REPS and employees of the burden of hospitalization expenses in excess of their PhilHealth benefits. This proposal was approved by the Board of Regents (BOR) in its 1255th meeting held on May 27, 2010. The same proposal was also adopted to be implemented in the other campuses of UP System.
Cao said the FAPHE is on top of the additional 10 percent discount on the government-mandated 20 percent discount to PGH to all government employees, the medical expenses covered by PhilHeath and other private medical health card benefits.
FAPHE’s for reimbursement ceiling is a maximum amount of P200, 000 per employee. According to the FAPHE implementing guidelines, if claim is less than the ceiling, the balance shall be available to the employee for other succeeding hospitalization expenses that may be incurred while in active service in the University and shall be processed until the maximum amount of P200,000 is used up by the employee.
The Chancellor said the proposal was triggered by the hospitalization of a College dean, who, after shouldering a hefty hospital bill, asked the Chancellor if there is a way for UP to provide medical assistance to hospitalized faculty.
Looking at the provisions of the UP Charter, the Chancellor said, “Ang nakalagay naman sa UP Charter, isa sa mga power at authority ng BOR ay maaprubahan ang benepisyo para sa mga empleyado. Batas naman ‘yun…ang medical benefits, covered naman ng batas.”
He said a medical insurance would have been an ideal benefit for UP employees but it did not prosper because it would require employees to shoulder the payment for the premium, and there is not enough number of employees who are willing to enroll in the medical insurance program that would make the premium payments lower.
He initially requested College of Business Administration Professor Mia Pang Rey, an expert in insurance, to do an actuarial study on the possible financial assistance for hospitalization to faculty members, staff and REPS. Rey proposed that if FAPHE will be implemented, UP should have a reserve fund of at least P4.5 million per year under the assumptions of a utilization rate of 10 percent and average hospitalization expenses after PhilHealth of P15,000.
In the proposal submitted to and approved by the BOR on May 27, 2010, those who are qualified to avail of the FAPHE are the tenured faculty members, staff and REPS, regular full-time faculty who are not tenured and occupying plantilla items and UP contractual who have rendered five years of continuous service in the University and are in active service at the time of their claim. This was amended during the 1260th meeting of the BOR on September 24, 2010 and included the casual employees, who are in active service under the coverage of the program provided they have also rendered five years of continuous service to the University.
According to Human Resources and Development Office (HRDO) director Dr. Angela D. Escoto, upon the implementation of the FAPHE, HRDO have received 46 applications from UPD employees as of December 6, 2010 and granted P1.2-million in reimbursements to 25. A direct payment was also made to the Philippine General Hospital (PGH) for the medical expenses of one beneficiary.
Escoto said UPD has made an internal arrangement with PGH and directly paid the hospitalization bill of one FAPHE applicant because the patient had no more cash after hopping from one hospital to another to seek medical treatment.
Of the 46 applications, five were disapproved or without action because the applications were filed prior to May 27, 2010 while 14 applications are still for evaluation from the standing committee composed of Escoto, UP Health Service director Dr. Claro R. Baluis, M.D. and Dr. Ma. Pythias B. Espino of the Institute of Chemistry. Escoto chairs the FAPHE standing committee.
In addition, Escoto said, “All applications made prior to May 27, 2010, we cannot approve and we cannot recommend because essentially, it was only on May 27 that this thing was approved.” The committee evaluates the applications at least once a month but, if there is a sense of urgency in the application, Escoto said they conduct emergency meetings to fast-track the evaluation.
Medical expenses that may be reimbursed may consist of the following: a) medical/diagnostic procedures, e.g., ultrasound, MRI, x-ray, CT scan, biopsy, mammography, echocardiography, angiogram, blood chemistry, etc. and other laboratory examinations, as recommended by the attending physician/specialist, excluding those for cosmetic surgery due to vanity and those for executive/annual check-up; b) prescribed drugs and medicines, in accordance with the Generics Law; c) professional fees of preferably PhilHealth-accredited physicians/specialists; and d) room and board for the duration of the confinement. This benefit shall also cover those who are on sick leave without pay, study leave with pay, secondment and special detail with pay, while those on leave without pay for reasons other than sickness or grave illness shall not be considered for this purpose.
UPD employees may get the complete implementing guidelines and file application forms for FAPHE at the HRDO.
Since the FAPHE is just an initial program to augment the UP employees’ medical benefits, the Chancellor said it is still open for more improvements. He said considering FAPHE is only limited to UP employees and does not extend to their dependents, he hopes that the next administration will review its implementing guidelines to check if there is a way to include dependents in the coverage of the program.
The Chancellor also suggested to study the P 4.5 million fund allotted to FAPHE as well as the categories of diseases. He said hospitalization expenses for some dreaded or life-threatening diseases can consume the entire ceiling for medical reimbursements in one claim therefore, it is important to include it in the FAPHE’s implementing guidelines.
Moreover, Cao hoped the next administration will augment P200,000 ceiling for medical reimbursements per employee. He said, “Iyon ang pinakamadali, ang i-increase ang ceiling. Ang isang dapat pag-aralan diyan ay kung magkano ba ‘yung nagagasta taon-taon ng UP? Kasi nag-allot kami ng P4.5 million initially. Kung kunyari, hindi naman P4.5 million, baka naman ‘yung P 200,000 ay puwedeng i-increase kasi hindi ka naman lumagpas sa allotted na budget.”
Cao also said he asked UP Provident director Dr. Lina J. Valcarcel to study the possibility of paying medical insurance premium through the UP Provident Fund, Inc. He added, “But, as I said, baka eventually pag nag-improve ito (FAPHE), magiging medical insurance siya…Hopefully, we will reach that situation also.”
— Haidee C. Pineda