Filing for Philhealth Benefits and Reimbursement

How to avail of your PhilHealth benefits and what forms need to be filled out. And how to file for reimbursement with PhilHealth
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.

How to avail of your PhilHealth benefits and what forms need to be filled out. And how to file for reimbursement with PhilHealth

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.


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photo credit: Forever Photo via photopin cc

7 comments:

  1. Very timely post. I will be using my Philhealth benefit for the first time soon. I'm crossing my fingers that everything goes well.

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    Replies
    1. Good luck! And I'm sure everything will go well :)

      And remember to bring a marriage certificate (and signed CF1) if your philhealth doesn't an updated name yet.

      But from experience, filing for reimbursement in the Makati office is painless - but of course involves a long agonizing wait for the money afterwards.

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    2. I didn't change my name, too tedious, so there shouldn't be a problem.

      Delete
  2. Na operahan po ako sa st. Lukes under ng social service. Nung june 30 lang po. Dapat po ang bill ko 95k since under po ng social service yung project po ng doctors nila 35% lang po yung share na ibibigay ko sa bill, 24/25k po. Nag down po ako ng 20k tapos po before discharge hinihingian pa po kami ng 5500. Nung pnrocess po namin yung philhealth worth 24k po ang benefit na makuha ko. Pwede po bang ako na lang mag reimburse noon? Or pwede po ba mag refund sa sobrang naibayad na cash? Kasi po dumoble na po yung nabayaran namin pag ginamit po yung philhealth ko

    ReplyDelete
    Replies
    1. Hi Marienel!

      Short answer: Hindi ko sigurado, pero try mo reimburse.

      Nabayaran mo na kasi yung bill (20k down + 5.5K bago discharge). Kung makukuha mo yung requirements para sa philhealth reimbursement, mag reimburse ka.

      Ang hindi ko lang sigurado, baka naman expect ng st. luke's na makukuha nila yung philhealth portion. Hindi kasi ako familiar sa social service na project nila. Baka malaki ang discount sayo kasi baka pwera dun eh inaasahan nila dn yung bayad galing philhealth. Pwede din naman na hindi; kaya try mo na lang dn.

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  3. Naipasa ko na po yung requirements sa billing ng st. Lukes before discharge then binigyan po ako ng 1/4 size na paper para ibigay sa social service dun po naka lagay yung amt ng benefit na makukuha ko from philhealth. Gusto ko lang po malaman kung may right po ba ako na mag ask ng refund dun sa nai down na cash / sa mismong benefit na galing sa philhealth. Ang lumalabas po kasi 2x na po ng amt ng dapat ko ishare ang maibigay ko kung gamitin ko parin yung sa benefit. Hindi ko po kasi alam ano gagawin baka mamaya po mag ask ako ng refund then tanggalan naman nila ko ng social service id. May right po ba ako?

    ReplyDelete
    Replies
    1. Hi Marienel,

      Pasensya na pero katulad nung nasabi ko sa taas, hindi talaga ako familiar sa social service nila. Mas mainam kung mag-tanong ka sa billing dept or doon sa nagpasok sayo or pinag applyan mo para mapasama sa social service.

      Lahat kasi ng operasyon, mya philhealth share. At kadalasan, yung hospital na ang bahala dun. Tatanggalin nila sa isisingil sayo, pero sila mag file sa philhealth para sa iyo. Pero yang social service nila, hindi ko alam kung ano ang process.

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