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).

Members with Multiple Employment Can Avail Refund or Adjustment for Overpayment of Personal Share

Overpayment of Premium Contribution due to multiple employment is a situation where a person is employed in more than one employer and both employers are remitting PhilHealth contributions as mandated by Section 18-20 of the Implementing Rules and Regulations of R.A. 7875.

To resolve this situation, PhilHealth has released PhilHealth Circular No. 05 s-2009. In this circular PhilHealth members are given the option to apply the overpayment to succeeding months or to request for a refund of the personal share. The personal share is the amount being deducted to the employee. Discussed below are the two options.

Overpayment of Personal Share Applied to Succeeding Months

• Adjustment can be done only once.
• The following qualifications/conditions must be met by the requesting member:
• Member is currently unemployed;
• Aggregate monthly premium contribution is greater than the maximum premium rate in the prescribed premium contribution schedule (this may be based on the current rate at the time of the contribution);
• Overpayment occurred due to multiple employment;
• Overpayment incurred from January 2009 onwards (based on effectivity of the Circular);
• The period covered for adjustment is posted in PhilHealth's contribution database and Treasury database. (This means that you should be included in the monthly report prepared by your employer and the employer is paying the contribution as evidenced by the record in the Treasury database.)
• The overpayment of the personal share shall be reflected or adjusted as an advance payment of the premium contribution for the Individually Paying Member.

This alternative may be used by those shifting to the Individually Paying Member (IPM) category. It is advised however, that prior to paying the premium contribution as an IPM, you may request for the adjustment so that you will only be paying the remaining balance of your premium contribution dues for the current year.

Request for Refund of Personal Share

• This alternative is only available to members under the Lifetime membership program or eligible members of the said program.
• Qualifications are as follows:
• Overpayment was due to multiple employment;
• Overpayment was incurred only upon effectivity of the Circular;
• The period covered for adjustment is posted in PhilHealth's contribution and treasury database (This means that you should be included in the monthly report prepared by your employer and the employer is paying the contribution as evidenced by the record in the Treasury database.);
• Member is no longer employed;
• Member is 60 years old and above and has paid the 120 monthly premium contributions.
• Only the personal share shall be refunded to the member.

Documentary Requirements to avail of the Two (2) Options:

• Filled-out request form/letter requesting of adjustment or refund of overpayment in personal share (specify the period where you are being deducted more than once, include the names of your employers for the corresponding period);
• Copy of any 2 valid IDs with photo;
• Copy of Employment Contract reflecting monthly income and status of employment from each of your employers;
• Certificate of Employment with monthly income and status of of employment signed by the employers;
• Other documents required by the Collection Section of PhilHealth.

Before going to the PhilHealth Office, call the Collection Section first so that you will be sure what other documents they will be requiring you to bring.