How to Claim PhilHealth Benefits – Requirements and Procedures

When my father-in-law was hospitalized for 7 days in a private hospital early this year, his bill reached ₱150,000. Around ₱30,000 was deducted because he was a senior citizen, and almost ₱20,000 was deducted because he was a PhilHealth member.

He used to have a health card sponsored by his youngest daughter, but 3 days before he was hospitalized, her daughter resigned from work and his health card was no longer active when he was admitted.

So, we ended up paying around ₱100,000 for his hospitalization. And because it was a huge amount, we had to find various ways to come up with that amount before he was discharged.

His PhilHealth benefits may have not covered the total bill, but the ₱20,000 that he received from PhilHealth was a huge help.

If you’re not a member yet or you’re an inactive member of PhilHealth, I encourage you to continue your membership and pay your premiums continuously because you wouldn’t know when you’re going to need it. It would be a big help in case you or your dependents get sick or hospitalized.

In this article, I’ll share with you the requirements and procedures on how to claim PhilHealth benefits.

philhealth-mdr

Eligibility Requirements and Conditions

  • PhilHealth member must have paid at least 3 months of premiums/contributions within the immediate 6 months of confinement.
    • For pregnancies, to avail of the newborn care package, dialysis, chemotherapy, radiotherapy and selected surgical procedures, PhilHealth member must have paid at least 9 months of contributions in the last 12 months.
  • Confinement in an accredited hospital for 24 hours due to illness or disease requiring hospitalization.
    • Attending physician(s) must also be PhilHealth accredited.
  • Claim is within the 45 days allowance for room and board.

Requirements and Documents Needed

For members who get hospitalized, you need to submit the following documents before being discharged from the hospital for automatic deduction:

  • Updated copy of your Member Data Record (MDR).
    • If you are a dependent, make sure you are listed in the MDR.
  • Original copy of PhilHealth Claim Form 1 (download here).
    • You can get this at the Philhealth office, or at the hospital, or from your employer.
    • If employed, submit the original copy signed by your employer.
  • Receipt of Premium payments.
    • If employed, you only need to submit the Certificate of Premium Payments with OR numbers.
  • PhilHealth ID and a valid ID

A staff from the hospital should explain to you the rules and process of PhilHealth benefit availment. If you have any questions regarding PhilHealth, don’t hesitate to ask.

Click here for guidelines on how to fill out PhilHealth Claim Form 1.

If you can’t file or submit the PhilHealth claim form personally, you may authorization a relative or friend to do it on your behalf. Just give an authorization letter and a valid ID together with your representative’s ID.

Procedures of Claiming PhilHealth Benefits

Once you have submitted the documents to the hospital before you get discharged, your PhilHealth benefits will be automatically deducted from your total hospital bill.

PhilHealth will then send a benefit payment notice to the address declared in your MDR, which includes the actual payments made by PhilHealth for your benefit claim or confinement.

Fore more information about PhilHealth, click the link below:

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  1. […] a paper ID that you can use when claiming inpatient or outpatient hospital benefits. […]

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