How to avail of your Philhealth benefits.
- 1. What is a complete claim to avail Philhealth benefits?
A complete claim is composed of:
1. Fully accomplished Philhealth form i
2. MDR (member data record)
3. Fully accomplished Philhealth form ii, part ii
• Philhealth form iii for one day confinement (available at the Philhealth section)
• Philhealth form iv for normal delivery (available at Philhealth section)
- 2. What is a MDR?
Member data record – member information from the database of Philhealth office. You can get a copy of your MDR from:
• Your employer
• Philhealth main office – city state tower 709 Shaw Blvd., brgy. Oranbo Pasig City
• Philhealth branches (Pasig, Manila and Quezon city)
- 3. Where can i get the fully accomplished Philhealth form ii?
• At the nurse station
- 4. When and where do I submit my Philhealth forms?
Upon discharge, go to Philhealth section at the ground floor and submit at windows 4, 5 or 6.
- 5. Is it possible to claim Philhealth benefits after full payment of hospital bills?
Yes, as a reimbursement.
- 6. Do I have to pass by the MMC Philhealth office before filing for a reimbursement?
- 7. Where & when can I file Philhealth reimbursement?
At the hospital – within 30 days from the date of discharge or direct to Philhealth main office - within 60 calendar days from the date of discharge
- 8. Where do I follow-up my reimbursement?
At the Philhealth main office or call Tel. No. 637.9999
- 9. I am a newly hired employee. When will I become eligible to avail of PhilHeath benefits?
Payment of at least three monthly premium contributions within the last six months immediately prior to the month of confinement shall be required of you to be able to avail yourself of your benefits.
- 10. My spouse is also a PhilHealth member. Are we allowed to declare our only child so that we can both apply our separate coverage in the event she gets sick?
PhilHealth does not allow multiple declaration and application of PhilHealth entitlements of both spouses. We advise you to decide who among you will declare and provide for the PhilHealth coverage of your only child as a dependent.
- 11. Is my lifetime coverage transferable?
Your PhilHealth coverage as a Lifetime Member is non-transferable.
- 12. Will my PhilHealth coverage affect my 20% discount as a senior citizen's cardholder?
No. Your privilege as a senior citizen is a separate benefit and it must be applied to the balance of your hospital bill after deducting your PhilHealth benefits.
- 13. Are there substitute documents that I can submit for my dependent's confinement if my MDR is not readily available or is not yet updated?
You can still proceed with your benefit claim with the following as substitute documents:
- Spouse - marriage contract/certificate
- Children - birth certificate
- Parents - birth certificate of member and patient
- 14. I am a new member. When will I become eligible to avail of PhilHealth benefits?
For one to become eligible for the benefits, payment of at least three (3) months within the immediate six (6) months prior to the month of confinement shall be required. However, payment of at least nine months within the last 12 months shall be asked of Individually Paying Members availing of the following procedures/packages:
- Pregnancy-related cases
- Dialysis (except those undergoing emergency dialysis service during confinement)
- Selected surgical procedures
- 15. What if I am not readily available to sign the PhilHealth Claim Form 1?
The following are allowed to sign the said form on your behalf:
Member Status Authorized person (in order of priority) Member is married Legal spouse Child 18 years old and above in the absence of spouse. Parent (mother or father) in the absence
of spouse and child.
Member is single Parent (mother or father) Member is orphaned Brother/sister/guardian
Clearly state in the form the reason for signing on behalf of the member, or a certification (on a separate sheet of paper) may also may be issued to this effect, with the full name, complete address and contact number/s of the authorized signatory also indicated.
Provide a photocopy of the authorized signatory's identification card (ID) and/or proof establishing his/her relationship to the member.
- 16. What is a single period of confinement?
It refers to a confinement or series of confinements for the same illness with intervals of not more than 90 days. In such cases, members are not entitled to another set of benefits/allowances until after 90 days. They can only avail of the unused portion of the benefits and room and board allowance until the 45 days allowance is exhausted.