Filing for Philhealth Benefits and Reimbursement
A few months ago, for the first time, I experienced being the one arranging the paperwork and payments in a hospital.
Plus, while going through the process I overheard one person who was not able to take advantage of his PhilHealth benefits. He was employed, and was getting the premiums deducted from his salary.
But apparently, their Human Resource department did not really enroll him and gave him the application number instead of a real PhilHealth number. I usually hear something like this from those working in agencies or doing manual labor. But this guy was from a BPO. He got asked by the guy manning the PhilHealth booth if he was working for a BPO, so I’m thinking this might happen more often than I think.
So I thought it might be interesting to share my experience and the info I picked up along the way and save people some headache (and money) in the process.
First, before anything happens, check your philhealth membership.
The official PhilHealth site is http://www.philhealth.gov.ph. Unfortunately it doesn’t yet let you check your contributions online. But you can email them or call them up. I suggest looking at the Contact Us page on the official page to get their contact info.
It’s important to check that you really are a registered member, the number given to you is really yours, and your information is updated (civil status, name changes, etc.)
It’s important to note that Health Insurance companies don’t pay the PhilHealth portion of the bill. So if there’s something wrong with your philhealth membership, you’re going to end up paying a portion of the bill yourself, even if you are theoretically fully covered by your health card.
Once you have a reason to use your philhealth benefits you will need to fill up three forms: Claim Form1, Claim Form2, and Claim Form3. Depending on the situation, you may need to fill out only 2 out of 3 forms. But it’s better to assume you will need all three.This might be handed to you by the hospital staff. If not, there should be a booth (probably near the billing department) where you can get these forms.
Claim Form1 needs to be signed by your employer. So when you get the time, take care of this first. My wife was confined for just one day and I didn’t do this right away. We ended up having to reimburse the philhealth portion.
You will also need to submit your Member Data Record (MDR). You can get this from the nearest Philhealth office. Some companies may also be able to get this for you, so try to ask them. This contains the member’s name and PhilHealth ID number, and list of valid dependents. You can actually file a claim without this document, but you might be required to submit other supporting documents like birth certificates or marriage license.
When paying, go to the billing department and submit all the papers (filled out and signed as necessary).
If you were not able to get the paper work in order before the patient gets discharged, don’t worry you still have 60 days upon discharge to file for reimbursement.
For re-imbursement, you will need:
- All three claim forms (filled out and signed)
- Copy of Updated Philhealth Member Data Record with list of dependents (From your employer)
- Copy of Marriage certificate with registry (if married and Philhealth info doesn’t reflect it yet)
- All official receipts and statement of accounts (copy; from the hospital)
- Waiver from hospital’s Philhealth section (from the hospital)
- Other supporting documents; like birth certificates (if no MDR; to establish relationship with the primary member)
Of course, the reimbursement will take a while before you receive it – anywhere from 2 to 6 months.
Update: Starting January 1, 2014, filing reimbursements for confinement isn’t allowed anymore. In my case I would have had to just shoulder the philhealth portion. In other cases, you could try to file for reimbursement with a Motion for Reconsideration along with the requirements stated above.
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