HOW TO BE COVERED WITH PHILHEALTH ?

1. You should register 

*photo credit: Philhealth leaflet 

Ask for the Philhealth Member Registration Form.
Fill in the form with complete and correct information. 

You can also download the form in www.philhealth.gov.ph then submit the completed form in any PhilHealth office. 

Dependents should be:

• Legal wife/husband that is not a PhilHealth member
• Children age from 21 and below, no work and not married
• Children that have permanent disabilities
• Foster child as per Foster Child Care Act of 2012 
• Parents from age 60 and above and not a Philhealth Member 
• Parent's with permanent disabilities 
• 
  

* You don't need to submit a supporting document for your declared PhilHealth dependents as long as PhilHealth doesn't require it for verification purposes.

You will receive Health Insurance ID Card and Member Data Record (MDR) after the documents are processed.

* you can register online through their website:                                                                                      www.philhealth.gov.ph

2. Payment of Contribution 

All members should pay their premium contribution at all times to use the Philhealth benefits.

3. Update your Records 

Submit to any Local Health Insurance Office (LHIO) your Philhealth Member Registration Form (PMRF) that has a correction, change in information like additional dependents. Don't also forget to check the box " FOR UPDATING" located at the top of the form. Just be ready with your supporting documents and present when they ask for it.

4. Claiming your Benefits 

 Before going out of the hospital, submit the following in the Billing Section :

• Completed PhilHealth Claim Form 1, you can get the form from the hospital, Philhealth Center, or download it online.
• Health Insurance ID Card and Updated Member Data Record (photocopy)
• Certification of updated contribution (photocopy)

* Medical expenses outside the hospital while confined can be reimbursed in the hospital if the benefits are not yet all consumed by the particular sickness. Make sure your Philhealth Benefits was credited in the hospital bills and doctor's fee before signing the Claim  Form 2. 

BENEFITS:

Any members and qualified dependents can claim the benefits for every expense that they encountered during their sickness or operation. Philhealth will be responsible for the case rate.

EXAMPLE OF CASE RATES;

z BENEFITS 

This is a benefit for those who have a severe sickness that needs long-term treatment. There is a pre-condition and criteria selection needed in order to use it in selected government hospitals.  

*Reminder: 
A member has 45 days in one year to use his/ her benefits and their qualified dependents have also 45 days in one year that will be divided among them.

CONDITIONS ON HOW TO AVAIL THE BENEFITS :

• should have contribution 
• The hospital should be Philhealth accredited including the doctor.
• Members didn't use all their benefits that are allotted within  45 days and also their dependents. 

NO MORE BALANCE BILLING IF INDIGENT, SPONSORED MEMBER OR KASAMBAHAY 

No more additional fee for Indigent, Sponsored Member, or Kasambahay if they will use the benefits in Health Centers that is owned by the government and for dialysis centers, birthing homes, ambulatory surgical clinics, and other non-hospital facilities. Philhealth is the one responsible for the payment of the bills. 

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Reference : 

Retrieved September 9, 2018 from www.philhealth.gov.ph 

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