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Field Orientation on the DepEd Order No. 16, s. 2025

Guidelines on the Grant of Medical Allowance to the Department of Education Personnel

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DepEd Order No. 16, s. 2025

Guidelines on the Grant of

Medical Allowance

to the Department of Education Personnel

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Legal Bases

Executive Order (EO) No. 64, s. 2024
Department of Budget and Management (DBM) Circular No. 2024-6

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Scope*

Non-teaching Personnel

Teaching Personnel

* under Permanent, Co-Terminus, Fixed Term, Casual, or Contractual appointment

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Eligible Personnel

The personnel are already in government service and are to render services for at least a total or an aggregate of six (6) months of service in a particular fiscal year, including leaves of absence with pay, and services rendered under any alternative work arrangements prescribed by the Civil Service Commission.

Newly hired personnel may qualify for the grant of the medical allowance after rendering 6 months of service in a particular year.

Personnel who transferred to the DepEd and was not granted medical allowance by the government agency they previously worked.

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Eligible Personnel

The medical allowance of a personnel on detail to another agency shall be granted by the mother agency, while those on secondment shall be paid by the recipient agency.

A compulsory retiree, whose services have been extended, may be granted the medical allowance, subject to the pertinent conditions and guidelines under this Order.

Personnel who are formally charged with administrative and/or criminal cases, which are still pending for resolution, shall be entitled to medical allowance until found guilty.

Personnel who are formally charged with administrative and/or criminal cases. And who are found guilty with a penalty of reprimand, shall still be entitled to the medical allowance.

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Eligible Personnel

Personnel on study leave with pay or on study/training/scholarship grant whether locally or abroad, and renders at least 6 months of service in the same year, including leaves of absence with pay prior to and/or after the study leave or study/training/scholarship grant shall be entitled to the medical allowance.

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Ineligible Personnel

Personnel without employer-employee relationship

Consultants and experts hired for limited period to perform specific programs/outputs.
Student laborers or apprentices.
Contract of Service (CoS), Job Orders (JOs) or other similarly situated.

Officials and personnel who are already receiving HMO-based health care service by virtue of special laws

Personnel already granted by their previous agency within the same year

Personnel funded by the Local Government Unit (LGU) but assigned in DepEd

Personnel found guilty of administrative/criminal case

The penalty imposed is higher than a reprimand

Personnel on study leave for the entire year

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Fund Sources

Available Personnel Services (PS) allotments. In case of deficiency, it may be charged against the Miscellaneous Personnel Benefits Fund.

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Availment of Medical Allowance

Group Availment via Agency Procurement

Individual Availment through cash for:

Availment of new/renewal of own HMO
Payment of medical expenses

Requisites

GIDA Localities (either by residency or assignment)
Localities with no HMO branch (either by residency or assignment)
Denied HMO application

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Annex A

Medical Allowance Registration Form

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Annex B

Individual Cash Claim Form

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General Procedures

STEP 1 – Generate List of Eligible Personnel

The Admin-Personnel Unit shall generate the list of qualified personnel and announce through a memorandum/advisory.

STEP 2 – Submission of Form

All eligible personnel are required to accomplish the Medical Allowance Registration Form (Annex A). The head-of-office will consolidate the forms and submit to Admin-Personnel Unit.

STEP 3 – Processing of Medical Allowance

As Focal Office, the Administrative Division shall ensure the release of Medical Allowance for both group and individual availment.

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Group Availment

The following shall be the minimum benefits for the acquired HMO package:

a. In-patient benefit

b. Out-patient benefit

c. Emergency care benefit

d. Annual Physical Exam

e. Dental benefit

The HMO coverage shall be valid for 12 months. Benefits for high-risk cases may be included.

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Group Availment

STEP 1 - As the End-User (EU), Administrative Division shall consolidate the forms to determine the number of personnel who availed of this mode.

STEP 2 – The EU shall prepare procurement planning documents and other documentary requirements.

STEP 3 – After successful procurement process, the awarded service provider shall deliver services as stated in the contract.*

*For newly hired employees, the HMO card shall only be released after rendering 6 months of service.

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Industry Study on HMO Plans

HMO A	HMO B	HMO C
Maximum benefit limit of P160,000.00 per year In-patient benefits including maximum of P40,000.00 per illness or confinement Room and board (semi-private ward) Out-patient benefits such as consultation and select laboratory and diagnostic procedures Dental care such as tooth extraction, temporary fillings, oral prophylaxis, adjustment of dentures	Maximum benefit limit of P75,000.00 per illness, including coverage for preexisting conditions. Annual Physical Examination Dental benefits In-patient services such as room and board (ward) Out-patient services such as consultation, treatment of minor injuries, and laboratory and diagnostic procedures	Maximum benefit limit of P50,000.00 Room and board (ward) Annual Physical Examination Preventive health care such as counseling Out-patient services such as consultations, treatment for minor injuries, and laboratory and diagnostic examinations Dental benefits such as consultation, tooth extractions, oral prophylaxis, gum treatment

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Individual Availment

Option 1: Payroll Disbursement for availment of new/renewal of own HMO

STEP 1 –As the Focal Office (FO), the Administrative Division shall determine the number of eligible personnel based on the consolidated Annex A forms who opted to avail of this option.

STEP 2 – The FO shall prepare the payroll together with the verified list of qualified personnel and submitted Annex A forms to Finance Unit to process the release of the allowance.

�STEP 3 – Personnel are required to submit any of the following reportorial requirements after receipt of cash.

a. copy of HMO agreement

b. valid identification (ID) card

c. official receipt of payment

*Note: The individual HMO-type product presented as proof shall at least cover any period within the particular given Fiscal Year.

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Individual Availment

Option 1: Payroll Disbursement for availment of new/renewal of own HMO

Personnel enrolled as supplemental members or dependents under a family member’s HMO plan must present any valid proof of enrollment or registration.

Personnel are required to submit reportorial requirements subject to the usual accounting and auditing rules and regulations. Failure to comply shall result in the withholding of the personnel’s Medical Allowance for the succeeding year until such obligations have been settled.

In cases where the HMO-type product availed is below the rate of P7,000 Medical Allowance, the personnel shall not be obliged to refund the excess amount.

*Note: The individual HMO-type product presented as proof shall at least cover any period within the particular given Fiscal Year.

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Individual Availment

Option 2: Cash form for payment of medical expenses

This shall only be granted to personnel who are:

a. Residing or assigned in localities/communities identified as GIDA;

b. Residing or assigned in localities/communities with no adequate HMO branch; or

c. Denied from applying from an HMO coverage.

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Individual Availment

Option 2: Cash form for payment of medical expenses

STEP 1 – The FO shall determine the eligible personnel based on the verified list and consolidated Annex A forms, who opted to avail of this option.

STEP 2 – The FO shall prepare the payroll together with the verified list of qualified personnel and submitted Annex A forms to Finance Unit to process the release of the allowance.

STEP 3 – Personnel are required to submit the Annex B (Signed Individual Cash Claim Form) and any of the following requirements after receipt of cash:

(i) Certification of GIDA, (ii) Certification of No Adequate HMO branch, or

(iii) Proof of Denial from any HMO including but not limited to letter or electronic mail.

Other requirements such as receipts of medical expenses (hospitalization, diagnostics, medicines etc.) are to be attached to Annex B.

Delivery Unit	Authorized Official to Certify
Regional Office	Regional Director
SDO and Schools	Schools Division Superintendent

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Responsibilities of Offices in RO

Administrative Division – shall serve as Focal Office (FO) and End-User (EU) in the RO and shall facilitate the implementation of the policy at the Regional level. Through its Personnel Unit, the Admin Division shall verify if personnel meet the qualifications and conditions provided by Section V.A (Eligible Personnel). The Administrative Division shall also be responsible in submitting the required DBM reports, referred in the Annex C, to the Central Office (CO) before the end of 3^rd and 4^th Quarter of the fiscal year or other reports may be required upon issuance of supplemental guidelines and other issuances.

Finance Division– shall facilitate the budget allocation for group and individual availment. It shall also monitor the disbursement/utilization/allocation reports from the SDOs and Schools and submit to the CO. Furthermore, it shall facilitated the processing of payment to the HMO service provider or disbursement to RO personnel of the said allowance.

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Responsibilities of Offices in SDO

Administrative Unit – shall serve as Focal Office (FO) and End-User (EU) an the SDO and Schools. It shall facilitate the implementation of the policy at the SDO and School level. However, the SDO may exercise the flexibility by allowing the Schools who are identified as Implementing Units (IUs) to undertake the availment process, as deemed practical and efficient.

Likewise, the FO shall shall verify if personnel meet the qualifications and conditions provided by Section V.A (Eligible Personnel). The Administrative Unit shall also be responsible in submitting the required DBM reports, referred in the Annex C, to the Regional Office (RO) before the end of 3^rd and 4^th Quarter of the fiscal year or other reports may be required upon issuance of supplemental guidelines and other issuances.

Finance Unit– shall oversee the fund management and utilization for this Order at the SDO and school level. It shall also monitor the disbursement/utilization/allocation reports from the SDO and schools and forward the said reports to the RO. Furthermore, it shall facilitated the processing of payments to the HMO service provider or disbursement to SDO and school personnel, as applicable.

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Disbursement Schedule

Both group and individual availment are subject to the release of notice of cash or fund allocation from DBM

Further, group availment shall rely on the existing procurement laws and processes.

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Monitoring and Evaluation

All FOs, including the CO, ROs, and SDOs along with accountable officials and personnel, shall ensure compliance with this Order along with adherence to existing budgeting, procurement, accounting and auditing laws, rules, and regulations regarding the appropriate use of funds for this purpose. FOs in the RO shall submit the consolidated Annex C-DBM monitoring reports to the CO (Employee Welfare Division). Other reports may be required upon issuance of supplemental guidelines and other issuances.

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Q & A