Claiming your Philhealth Benefits

Why do we need Philhealth

• Helpful to health care expenses

• We need insurance

• It’s mandatory to employees (private, government, OFW, household)

• Health is wealth

• It’s frickin affordable

How to claim Philhealth benefits and what are the requirements? Philhealth is one of the major health insurance providers in the Philippines and it serves sufficient and affordable social health insurance coverage to all Filipinos. Whilst it is government owned and controlled corporation, it’s the most affordable health insurance service in the country.

Working as wing of the Department of Health, it is very important to be a member of Philhealth unless of course you’re not working and don’t want to be insured and don’t want any help with your medicare needs. Every employee, private or government employed, household helper, sea-based OFW automatically becomes a member of philhealth according to Republic Act 7875 or National Health Insurance Act of 1995, as amended by RA 9241.

Philhealth is continuously improving its inquiry system. Oh I wish there would be an online inquiry that could serve anytime. It’s gonna be cool to have text inquiry too just like of that of the SSS. Anyway, back to my main topic, what are the requirements in claiming for Philhealth benefits when you’re hospitalized or confined in the hospital? The answers are listed below. Read on.

Membership Category and Documents Needed
Employed Member

• Philhealth Claim Form 1

• Updated MDR (Member Data Record)

Individual Paying Member

• Philhealth Claim Form 1

• Premium payment receipts

• Updated MDR

Overseas Worker / OFW

• Philhealth Claim Form 1

• Premium payment receipts and/or

• Updated MDR

Sponsored Member

• Philhealth Claim Form 1

• Valid Philhealth ID (Identification Card,) and/or

• Updated MDR

Lifetime Retirees

• Philhealth Claim Form 1

• Philhealth Lifetime Member ID (Identification Card)

• Updated MDR

 

Steps on Availment of Philhealth Benefits

The following are the usual instructions and procedures on how to avail Philhealth benefits upon confinement or hospitalization. If you’re a member of Philhealth or a qualified dependent of a member, you can file for hospital bills deduction or reimburse some amount from your bills according to health coverage. Before you do, take note that the following conditions must be met:

• Have paid at least 3 months of premium contributions within the immediate 6 months before confinement. (9 months of premiums within the last 12 months -for pregnancy cases, dialysis, chemotherapy, radiotherapy and other selected surgical procedures)

• Be confined in an accredited hospital by Philhealth for at least 24 hours due to sickness requiring hospitalization. Also don’t forget that your attending doctor must also be Philhealth-accredited.

• Your availment is covered in the 45 days allowance for room and board under your Philhealth benefits.

2 Ways to Make Use of your Philhealth Benefits

By Automatic deduction
First, submit to the billing section of the hospital the requirements mentioned from the documents needed above. (I listed them earlier as each member has different doc requirements)
Talk to your attending doctor regarding the remaining fee for their service over the professional fee benefit you’ll get availing your Philhealth.

Then once your documents are completed and fees are finalized, the billing section will compute all hospital bills and deduct your Philhealth benefits.

If the member or beneficiary was confined abroad, the following documents must be submitted within 180 days after discharge from hospital:

• Philhealth claim form 1

• MDR or supporting documents

• Original official receipts

• Medical certificate written in English (with final diagnosis, confinement period and services rendered)

By Reimbursement or Direct Filling
This is when members and qualified dependents choose to make use their Philhealth benefits after they were confined or discharged from the hospital. You are required to submit the listed documents mentioned earlier within 60 days after you are discharged together with the following docs.

• Philhealth Claim Form 2 (this is to be filled up by the hospital and your doctor)

• OR / Official Receipts

• Operative record for surgical procedures done

Finally, Philhealth will send you (to your address) a BPN (benefit payment notice)

Hope this post was helpful. Before I forget, all Philhealth forms are available to download for free from the company’s official website. The most demand Philhealth contribution table is also displayed there. I just hope the website loads faster than today’s coz I know lots of people prefer online inquiry than going to any Philhealth branch offices nationwide.

http://www.philhealth.gov.ph

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