Wednesday, March 30, 2011

OFWs: How to Avail PhilHealth Benefits (Local Confinement)

Are you currently out of the country and want to know how to avail your PhilHealth Benefits? Then read on.

Am I eligible to avail of PhilHealth Benefits?
  1. You and your dependents are covered for one year per payment of 900.00 Php starting from the date of your payment. This is shown in your Member Data Record (MDR) provided by PhilHealth upon registration or updating of your membership record;
  2. You have not exhausted the 45 days allowable period (explained here);
  3. The hospital and doctor are accredited by PhilHealth;
  4. Confinement period should not be less than 24 hours except in emergency cases;
  5. The laboratory procedures, surgical procedures and medicines are compensable with PhilHealth; and
  6. Claim is not within the single period of confinement (to be explained in succeeding posts).
The same is true for the other membership categories, except for item no. 1 where other categories would qualify if there is a 9 month contribution within a 12 month period prior confinement (starting July 2011).

Requirements for Local Confinement:

1. Automatic Deduction from Hospital
  • Hospital may require you to present your PhilHealth Identification Card (PIC);
  • Fully accomplished PhilHealth Claim Form 1 (PCF 1);
  • Updated Member Data Record (MDR) or in case of undeclared dependents attached supporting documents such as birth certificate;
  • Submission to the hospital's billing section the PCF 1 and MDR;
  • Receipts for payment of the balance of the professional fees (should display amount deducted from PhilHealth);
    Some hospitals would request you to submit the original receipts from medicines/drugs purchases, receipts for payment of laboratory and/or surgical procedures and doctor's fees for them to complete the PhilHealth Claim Form 2. Be sure to retain a photocopy of what you will give them and request for a copy of the Statement of Account from the Hospital. The receipts that was paid fully by you should be reflected in the Benefit Payment Notice as "Pay to Member" so that reimbursement will be directly made to you through check.
2. Direct Filing of Claims / Direct Reimbursement
  • Payment of the hospital bill and doctor's fee in full;
  • Disclaimer/waiver of full payment from the doctor/surgeon/anesthesiologist;
  • All receipts from drugs/medicines (purchased within confinement period), laboratory procedures, surgical procedures and hospital bills;
  • Fully accomplished and original PhilHealth Claim Form 1 (PCF 1) and an updated MDR;
  • Fully accomplished and original PhilHealth Claim Form 2 (PCF 2) by the doctor's and hospital;
  • Fully accomplished and original PhilHealth Claim Form 3 for confinement in Primary Hospitals;
  • Operative Record (if applicable); and
  • Hospital Statement of Account (this includes breakdown of charges).
    The Hospital may request for you to submit all receipts to prepare the PhilHealth Claim Form 2. Just provide them a photocopy of the documents they would need and do not give the original. Be sure to go back to the hospital to retrieve the Claim Form and then submit the form and corresponding required attachments to the PhilHealth Office assigned to the area of the hospital. This should also be filed within 60 days from date of discharge. Ensure that the PhilHealth Claim Form 2 waiver portion for full payment is accomplished by the Hospital. You will need this to be reimbursed.
    For inquiries on the status of your claim, you may call PhilHealth's call center or the PhilHealth Office - Claims Department.

9 comments:

  1. how to get a philihealth number or card? i just paid philhealth fee 900 pesos last January when i went back to Jordan.What proof i will show the Hospital is this my OEC?

    ReplyDelete
  2. Have you filled-out a PhilHealth registration form? If so, you may simply request for a PhilHealth ID Card see this post: http://philhealth101.blogspot.com/2011/05/how-to-request-for-new-philhealth-id.html

    For availment of benefits, you or an authorized representative would need to get a copy of the Member Data Record (MDR) in any PhilHealth Office. Your active payment/s will be reflected in the document. In order to avail, the period of confinement should be within the applicable payment reflected in your MDR.

    ReplyDelete
  3. Nag file po kami ng 2nd week Nov 2011, gusto lang namin e update kung ano ang status ng pina file namin,,di ba sabi nyo na within 60 days ang processing ng reimbursement...so may possibility ba na na release na yon?

    ReplyDelete
    Replies
    1. We are not directly connecteed with philhealth and will be unable to transact on your behalf. You may try to contact their call center to inquire the status of your claim. It is possible that if there are no problems with the document, the check might be available for pickup or mailing. You will know your claim has been processed if you receive a benefit payment notice. You can also try their official facebook or twitter account or email info@philhealth.gov.ph

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  4. pano pohh ba namin ma avail ang aming philhealth while abroad pano poh pag nag kasakit kami dito ano ang magagawa ng philhealth para tulungan kaming ofw habang may sakit sa ibang bansa na valid pa ang philhealth card.

    ReplyDelete
    Replies
    1. pls refer in this post:

      http://philhealth101.blogspot.com/2011/05/avail-philhealth-benefits-for.html

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  5. pano malalaman ng isang ofw kung naka ilang contribution na sya sa philheath at ang sinasabi na premium at the age of 60 ay di mo na huhulugan pag umabot na sa 120 months ang contribution mo ibig bang sabihin nito sa ofw is equivalent to 10 years contribution din at exempted na din once na umabot ka na sa edad na 60 at mahigit kana 10 taon na nag babayad ng philhealth mo

    ReplyDelete
    Replies
    1. maaari kang magemail or inquire sa info@philhealth.gov.ph pang malaman kung ilang contributions na ang nabayaran mo.

      Ang requirement sa pagiging lifetime member ay dapat 60yrs old ka na at may 120 months contributions. So kung hindi ka pa 60 kailangan mo pa rin ipagpatuloy ang paghuhulog kahit na naka 120 contributions ka na para makapag avail ng benefits sa PhilHealth.

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  6. akoy isang OFW at ang aking ina ay naka confine sa hospital at example ang bill namin is 87,000PHP mga ilang percent ang ma di discount namin.

    ReplyDelete