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Prakas No.109 on Health Care Benefits
By Svetlena D. TE
On 17 March 2016, the Ministry of Labor and Vocational Training issued Prakas No. 109 (“Prakas 109”). The aim of Prakas 109 is to provide for health care benefits for every worker and employee who works in an enterprise or entity that has registered and complied with all requirements of the National Social Security Fund (“NSSF”). The health care benefits are of two types being, (i) a health benefit package and (ii) a health prevention service.
In terms of the health benefit package, the relevant matters covered include treatment, medical care, patient or victim referral service, corpse transportation service and daily allowance. In addition to reimbursement of certain medical expenses, Prakas 109 also provides for payments to be made, to a limited extent, in respect of lost salary.
Under article 4 of Prakas No.109,certain services are excluded (save in certain cases of emergency) from the services that are covered by the health benefits referred to above do not apply to certain services including, free medical care and other serious treatments, dental care (teeth cleaning, teeth filing, tooth implants), sexual surgery and treatment, organ transplantation, artificial fertilities, self-treatment, plastic surgery, eye treatment and laser-therapy, alcoholism treatment and drug abuse treatment, IVF treatment, coronary and heart surgery, hemodialysis and cancer treatment by chemotherapy.
With regards to the health prevention services, Prakas 109 contemplates that this will cover measures designed to detect and diagnose diseases and other health problems. However, Prakas 109 contains little detail regarding those services.
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