Am I eligible to avail of PhilHealth Benefits?
- 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;
- You have not exhausted the 45 days allowable period (explained here);
- The hospital and doctor are accredited by PhilHealth;
- Confinement period should not be less than 24 hours except in emergency cases;
- The laboratory procedures, surgical procedures and medicines are compensable with PhilHealth; and
- 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.
- 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.