What PhilHealth is not...

This post is intended to clarify the misconceptions of some members with regard to the National Health Insurance Program (NHIP), PhilHealth as the administrator of the NHIP and benefits it offers.

• PhilHealth does not provide a pension nor can you withdraw your contributions.
Contrary to the belief of some members, PhilHealth does not provide any financial benefits to members such as loans or pensions as compared to the other government institutions such as the Social Security System or the Government Service Insurance System. Moreover, unlike the GSIS or Pag-IBIG Fund where you are able to withdraw all or a portion of your contributions, the contributions you pay to PhilHealth cannot be withdrawn, unless in the case discussed here;


• PhilHealth does not reimburse all expenses incurred when you are hospitalized.
At the present time, PhilHealth only covers or reimburses a portion of your hospitalization bills. As we see it, PhilHealth should eventually cover all of them, however, due to unavailable standards in the health industry such as standard professional fees, hospital room rates or prices of drugs and medicines, there is difficulty in setting the amount that may be reimbursed by PhilHealth, not to mention the fact that PhilHealth is maintaining the program's viability;


• PhilHealth does not pay for all medical related services.
Unlike HMOs, PhilHealth does not cover preventive healthcare such as annual physical check-ups, counseling or routine immunization except those covered in the prenatal care package. The corporation also does not pay for oral health services, unless those requiring hospitalization;


• PhilHealth does not provide different health coverage or packages.
Whether you are contributing more or less to the program, PhilHealth only offers a uniform or standard benefit service or rates. This means that no specific packages are available for those wanting to increase PhilHealth benefit rates or coverage;


• PhilHealth only covers a limited number of out-patient benefits.
Among these benefits are day surgeries, dialysis and cancer treatments, treatment on tuberculosis through TB-DOTS health care facilities, normal spontaneous delivery up to the 4th child, new born care package, voluntary surgical contraception procedures, OPB malaria package, cataract package and the influenza AH1N1 package;


• PhilHealth does not cover all drugs and medicines.
PhilHealth only covers the drugs and medicines as enumerated in the Philippine National Drug Formulary (PNDF) for the listing of compensable drugs and medicines click here. You may refer to this PhilHealth Advisory.

We will try to include additional information in relation to this post once we gather more data.

Region I: Directory of PhilHealth Offices

PhilHealth Regional Office I

Esperacion Building #23 M.H. Del Pilar Dagupan City, Pangasinan

Tel no. (075) 515-3333, 515-1111, 523-3127

• Batanes Service Office
Capitol Building, National Road, Kayhovukan, Basco, Batanes
Tel no. 0920-9045228
• Candon Service Office
G/F Old City Hall, National Highway, San Juan, Candon City, Ilocos Sur
Tel no. (077) 742-1111
• Mangatarem Service Office
2/F Sison Commercial Building, cor. Calvo and Mc Arthur St., Mangatarem Pangasinan
Tel no. (075) 546-1111
• San Carlos Service Office
2/F New San Carlos City Public Market, San Carlos City, Pangasinan
Tel no. (075) 532-1111
• Alaminos Service Office
2/F Perez Building, Marcos Ave., cor. Montemayor St. Alaminos City, Pangasinan
Tel no. (075) 552-1111
• Laoag Service Office
Jommel Building A Castro St., Laoag City, Ilocos Norte
Tel no. (077) 771-2222
• San Fernando Service Office
Juanita Commercial Building, Quezon Avenue, San Fernando City, La Union
Tel no. (072) 700-1778
• OWP San Fernando
3/F AGZ Building, Quezon Avenue, San Fernando City, La Union
Tel no. (072) 700-1111
• Urdaneta Service Office
3/F Sanctuary Building, Mc Arthur Highway, Nancayasan, Urdaneta City Pangasinan
Tel no. (075) 568-1111
• Vigan Service Office
Galleria De Vigan, Plaza Burgos, Vigan City Ilocos Sur
Tel no. (077) 722-1960
• Dagupan Service Office
M.H. del Pilar St., Dagupan City
Tel no. (075) 515-333 locals 156 - 158

NCR: Directory of PhilHealth Offices

PhilHealth NCR - South Branch

Citystate Center 709 Shaw Blvd., Brgy Oranbo, Pasig City

Tel no. 637-8239; 637-1284

• Pasig Service Office
DAP Building Ground Flr., One San Miguel Avenue, Pasig City
Tel no. 683-0206, 447-6806
• Las Pinas Service Office
471 Editha Bldg., Alabang, Zapote Road, Almanza I, Las Pinas City
so.laspinas@philhealth.gov.ph
Tel no. 556-5687
Covered Areas: Las Piñas, Muntinlupa, Parañaque
• Makati Service Office
337 ITC Building, Gil Puyat Avenue Makati City
Tel no. 897-6389 and 897-3337
Covered Areas: Makati, Pasay

PhilHealth NCR - North Branch

MARC I Building, 1971 Taft Avenue, Manila

Tel no. 523-9481, 523-9842, 524-9839

• Caloocan Service Office
G/F REMCOR Building, Lot 5, Blk. 172 Rizal Avenue, Ext. (Bet. 10th & 11th Ave) Caloocan City
Tel no. 365-2012 and 365-2014
• Mandaluyong Service Office
Liberty Boni Bldg., #94 Boni Ave. cor. P. Cruz St., Brgy. San Jose, Mandaluyong City
Tel no. 532-1905 and 532-0095

PhilHealth NCR - Central Branch

#880 F.R. Estuar Building, Quezon Avenue, Quezon City

Tel no. 332-1550, 332-1551

• Rizal Service Office
The Brick Road, Sta Lucia East Grand Mall, Marcos Hi-way cor. Felix Ave., Cainta Rizal
Tel no. 681-5499, 681-5111

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).

PhilHealth Call Center

PhilHealth recently unveiled its new call center to address the numerous calls and queries regarding PhilHealth services and benefits.

The access number is 441-7442. Outside Metro Manila, you may need to append the area code (02). Again, the access number for PhilHealth's call center is (02) 441-7442.

It is manned by ten customer relations agents, and is available weekdays from 8:00 AM to 5:00 PM.

Honestly speaking, I don't think this is nearly enough. If it were up to me, it would be open 24 hours a day, 7 days a week in order to address the PhilHealth concerns of members. Imagine someone rushing a loved one to the hospital during the wee hours of the morning with no one to talk to about their PhilHealth benefits. Sure, hospitals have their own designated PhilHealth officers. But the sad truth is sometimes these PhilHealth officers are not fully aware of the correct guidelines when availing of PhilHealth benefits...or worse, have their own procedures which may even be totally different from the actual ones.

Private hospitals are businesses first and foremost, meant to earn profit. Sometimes the procedures they give to the members are meant to benefit the hospital, and not necessarily the member.

Well enough about that, let's explore that aspect in a future post. For now at least, PhilHealth should be more accessible to members queries and concerns.

If you do try calling the hotline, let us know how it worked out for you. Feel free to enter whatever comments or observations you may have. We're pretty sure someone from PhilHealth will get to visit this blog sooner or later and pick up on your feedback...whether good or bad.