Sunday, April 24, 2011

Tips in Availing PhilHealth Benefits

These are simple tips to guide and help you in availing PhilHealth benefits:

  • Know your PhilHealth Identification Number (PIN) or always have your PhilHealth ID Card (PIC). Most hospitals will ask you to present your PhilHealth ID Card in order for them to acknowledge that you are a PhilHealth member. Those under the sponsored program will be required to present their ID card for the hospital to validate your PhilHealth coverage. If you do not have a PhilHealth Identification Number (PIN) yet, then go to this post;

  • Make sure that your registration details with PhilHealth is up-to-date. An updated record is usually the cause of problems in availing PhilHealth benefits. Be sure to update PhilHealth about your change in address, civil status and new dependents. If you find that there is a discrepancy in your record, have it corrected immediately. If you are unable to do so, make sure that you attach the required supporting document in the availment/claim document;

  • Always have your PhilHealth Official Receipt (POR), PhilHealth Agent Receipt (PAR) or other receipt acknowledged by PhilHealth as proof of payment. Hospitals may require you to present proof of your latest payments especially if you are under the Individually Paying Member category. You should have the receipt/s of your latest nine (9) months payment prior confinement.

  • For employed members, request your employer to certify the Claim Form 1 (CF1). This will be required by the hospital for automatic deduction of PhilHealth benefits. Ensure that your contributions are being reported and remitted by your employer. As of now PhilHealth does not have an online facility accessible by its members to inquire about their contributions. You may however contact PhilHealth's call center or the Collection Section of PhilHealth Offices to verify your contributions.

    For OFWs, your Member Data Record (MDR) will show your recent payments with PhilHealth. Sponsored members' coverage will be visible in their Phil Hea lth ID Card;

  • Your or your dependent's confinement should be in a PhilHealth accredited hospital or facility. If you or any of your dependents are confined in an unaccredited hospital or facility then you might not be able to avail of PhilHealth benefits for bills paid to the institution. Accredited hospitals/facilities have a PhilHealth signage at their entrance. You should also know that hospitals and facilities should ha ve a n active accreditation period with PhilHealth in order to avail PhilHealth benefits.

  • The doctor, anesthesiologist and other professionals should also be PhilHealth accredited. If your doctor is not accredited, then you will not be able to reimburse the professional fees paid to them. You should also be aware that like the accredited health institutions, there are instances when you may not be paid depending on their accreditation period with PhilHealth;

  • Inquire how much is the regular professional fee and how much would be the PhilHealth deduction from your doctor. Some doctors have different rates for a non-PhilHealth and a PhilHealth member. This question should be asked as soon as possible as you might find it a pain if you fully pay the professional fee and then later want to reimburse it directly with PhilHealth only to find out that the doctor will not sign or provide you a disclaimer for full payment. This is usually the cause of conflict between the member and the doctor;

  • Inquire whether the hospital allows the senior citizen or government employee discount combined with PhilHealth benefits. Aside from PhilHealth benefits, your hospital bill may still be lessened if the patient is a senior citizen or the member is a government employee. Ask if the hospital/facility is implementing this scheme and if the senior citizen or government employee discount can be combined with the deduction from PhilHealth. As per experience, we have previously availed the senior citizen discount plus the PhilHealth benefit;

  • Retain a copy of the hospital and professional receipts, statement of accounts and other documents that will be attached to the PhilHealth claim. This can be used in requesting for adjustments, you may use these as evidence in cases of conflicts and may further be used in ensuring that you have received the right amount of benefits due to you.

  • Evaluate the Benefit Payment Notice (BPN) sent by PhilHealth. The Benefit Payment Notice (BPN) is basically a document informing you of how much the hospital, doctor or you as the member received from PhilHealth for your confinement. You may use this document to validate if the amount deducted by the hospital and doctor tallies with the amount they received from PhilHealth. If the amount they received from PhilHealth is greater than the amount they have deducted, then you may request for a refund from the hospital and the doctor. If the balance was returned to PhilHealth you may contact the PhilHealth Office near you. So save your receipts and make sure that the address you have in the PhilHealth record is updated.

Hope this helps you improve your experience in availing benefits under the National Health Insurance Program (NHIP).

26 comments:

  1. may diarrhea ang baby q...saklaw b ng philhealth e2?

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  2. naconfine c baby ng 2 days s public hospital...ang bills q ay umabot s 1,707pesos s loob lang ng hospital iba p s labas n halos 500pesos...marerefund ko kaya un gamit ang philhealth?pls help...

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    Replies
    1. Bastat naconfine pwede mo reimburse sa philhealth kung na meet mo ang qualifications nila ikaw ay mababayaran ng portion of your bill. Isubmit ang claim tog with the receipts bago mag 30 days from discharge date

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    2. my 3 mos aqng hulog tapos nanganak aq pde q b mgmit ang phlhealth

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  3. puede po bang ikuha ng philhealth ang 3 yrs old babayaran n lng po nmin

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    Replies
    1. Yes, pwede maging member ang minor provided may ide-declare na guardian supported by legal or official documents.

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  4. pno ko po mlalaman f kelan ko mku2ha ung maternity reimbursement kpo?tnx

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  5. pno kpo mla2mn f approve ung maternity reimbursement kpo.my ibi2gy pba sking mga stub? tnx

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    Replies
    1. usually dine-deduct na agad ng ospital ang benepisyo galing Philhealth, maaari mo itong i-validate using yung statement of accounts na galing sa ospital. Kung deducted na ang PhilHealth, wala ka nang mae-expect na reimbursement. however, kung hindi dineduct ang Philhealth benefits mo, pwede mo ito i-reimburse. Maaaring tumawag sa call center para i-follow-up ang iyong reimbursement. Usually takes around 60days para maprocess ang claim assuming na kumpleto ang mga required attachments.

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  6. hi gud pm, ask ko lang po sana kung up to what extent po ung maa-avail na benefits sa panganganak nung qualified dependents ng isang philhealth member? ung tatay po nung manganganak ung philhealth member tapos po ung philhealth po ay given by the municipal government po. thank you.

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  7. naraspa aq nung aug 22 sa isang maternity clinic, ang sabi nila panganganak lang daw ang cover ng philhealth nila at hindi cover ng clinic nila ang raspa. pwede pa kayang mareimburse sa philhealth ang mga nagastos namin

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  8. Kung mag memember po ako ng Philhealth ngayon buwan, pwede ko po bang bayaran ang membership fee for the whole year 2012, sa ganun po ba pwede akong maka avail ng Philhealth kaagad?

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  9. If our hospital bills is 25k pesos..
    Ilan percent ang dededuct sa phil health?

    ReplyDelete
    Replies
    1. we would have no way of knowing how much if the benefit is a fee-for-service since marami pong factors ang computation nito. For case rates however, you may go to this link:

      http://philhealth101.blogspot.com/2011/08/philhealth-benefit-packages-case_17.html

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  10. Hi, I had a hysterectomy at Asian Hospital and the total bill was 170,000,
    Excluding the Doctor professional fees. This total bill had philhealth deductions of about 18,000.

    I paid the Doctor in her Clinic 70,000 for her PF. But Since it was not included in the total hospital bill-- Philhealth was not deducted in this PF.

    I would like to know: Can I have some reimbursement on Philhealth or somekind of monetary benefit to Lessen the professional fee that I already paid to the doctor? How to do?

    Please e-mail me
    ethon.miller@yahoo.com

    thank you. :)







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  11. Thanks for providing such detailed and comprehensive info!

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  12. tanong ko lang po.

    last year month of february 2012 nagresign po ako sa work ko then nagaral..at that time naputol na ung hulog ko sa philhealth..then pagdating po ng december 2012 nagkatrabaho po ulit ako until now..

    nahospital po tatay ko sa east ave. hindi ko pa po naasikaso kung marereimburse po ba ung bill namin sa hospital?

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  13. tanong lang po. may dumating pong BPN smin may mrerefund pa po kme fronm philhealth pero almost 1month na po pero di pa po dumadating yung refund namin pano po ba makuha yun ng mabilis?

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  14. hi gud day.ask ko lang kung panu mkakahuha ng copy ng bpn!kc s lying in bumagsak ung refund ko.gusto ko lng masure kung tamang amount ung binigay sken.thanx

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  15. hi gud day! ask ko lang po if may marereimburse po ako sa hospital, public po ang hospital wala po kaming binayaran pero lahat po ng gamot ay binili namin sa labas umabot po ng 3000, sept po ako naconfined and upon discharge po ay nagfile na ako sa philhealth at sabi nila wait po ng 3 to 4 months, kaso po 7 months na po ay wala pa akong natatanggap na notice.. tnx po and you hope na masagot po ninyo ang aking katanungan....

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  16. Hi, i gave birth last March 19, 2014. I received my BPN last week September 21, 2015, Just wanna ask pag nakapackage ba sa Hospital hindi na marereimburse yung BPN? need ba dapat buo ung bayaran para mareimburse un? Thanks.

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  17. Hi,i just wanna know if can get a reimbursement yung remaining balance na binayaran ko sa hospital.

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  18. Good day.. Na admit ang anak ko po for 2 nights and 2 days..kc nag lbm po, dn the hosp doc found out dengue daw po..dn ang bill.ko po eh.. 6,522 less pf 840, 5,682. Dn add pf 300 dw po 5,982
    . I doubt kc po 2,260 po ang refund sa akin..bali 3,722 po nkabayad kmi personally.. Tama po ba?? Kala ko po ba 8,000'ang cover ng philhealth pag dengue? Pls advice me

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  19. ask ko lng nanganak kc ako nun july.29,2017 CS ako . Covered nmn sya kc 17,500 un bills ko . then binigay smin ng philhealth sa hosp un copy ng bills ko at itago ko daw un mga resibo ksi 10k ngastos nmin sa gamotn.. may marereimburse ba kami ???

    ReplyDelete
  20. ask ko lng nanganak kc ako nun july.29,2017 CS ako . Covered nmn sya kc 17,500 un bills ko . then binigay smin ng philhealth sa hosp un copy ng bills ko at itago ko daw un mga resibo ksi 10k ngastos nmin sa gamotn.. may marereimburse ba kami ???

    ReplyDelete
  21. Hello po,tatanong kolang po kung may marereimburse papo kami?,naoperahan po kasi lola ko sa Jose Reyes bumili po kami ng dugo sa labas ng 4 bags na nagkakahalaga ng 7,200 at ctscan sa labas na 8k+ at ibang gamot.may marerefund poba kami.

    ReplyDelete