Availing PhilHealth Benefits for Direct Filing of Claims

Eligibility for Direct Filing:

• You have paid the hospital and doctor's fee in full (without PhilHealth benefit);
• You have the required number of premium payment (for employed and individually paying members) or date of availment is within your membership coverage (for sponsored and ofw members). Lifetime members are eligible to avail PhilHealth benefits and need not pay premiums;
• The hospital/facility is accredited from the time of confinement/admission;
• The doctor is accredited from the time of confinement/admission.

Documents Required to Submit:

• Fully accomplished and original PhilHealth Claim Form 1;
• An updated Member Data Record (MDR) or required supporting documents;
• Waiver from the Hospital and Doctor/s specifying fees are paid in full;
• Official Receipts from drugs/medicines (purchased within confinement period), laboratory procedures, surgical procedures, hospital bills and doctor's fee;
• Fully accomplished and original PhilHealth Claim Form 2 (to be provided by the hospital/facility);
• Fully accomplished and original PhilHealth Claim Form 3 for confinement in primary hospitals or availment of maternity benefit;
• Operative record (if applicable);
• Hospital Statement of Accounts which contains breakdown of charges;
• Authorization or Special Power of Attorney (SPA) for transactions made through an authorized representative (immediate family member).

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 Forms 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.