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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41 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.

    ReplyDelete
    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.

      Delete
    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.

      Delete
  4. Masasama po kaya ung mga laboratory ng asawa ko at biling pg nag pa reimburse kame sa philhealth? Nanganak po kc ung asawa ko dun at hnd po namen na file ung philhealth bago manganak eh nakalabas na po kame sa chinese pwede pa kaya kame mag file ng reimbursement? 1 week p lng po kame nakalabas

    ReplyDelete
    Replies
    1. Hi Anonymous,

      Hindi ko sigurado kung ano ang masasama sa PhilHealth reimbursement, o kung gaano ka-laki ang reimbursement na ibibigay sa iyo.

      Pero sigurado ko na pwede pa kayo mag file ng reimbursement. Kunin mo lang lahat ng requirments na nabanggit, tapos siguraduhin na mag file bago lumagpas ang 60 days mula ng ma release ang asawa mo. Mas maaga mas mainam.

      Delete
  5. Good day po!

    My beneficiary is about to receive the reimbursement. Naconfine po siya this year, March. However, she cannot claim the money dahil kelangan daw po ng authorization letter and 2 valid id's from me(phil health member). All the while, I thought pwede niang makuha un without my authorization since beneficiary ko naman po siya. Ang hassle lang po dun is andito po ako abroad and it's somewhat not convenient para maipadala ko po ung mga documents na hinihingi... Ask ko po if ok lang po ba na scan ng authorization letter with my signature saka scan din ng 2 valid id's ko ung ipapasa para makuha ung refund?.. Ask ko din po if may time limit po ba ung pagkuha ng reimbursement. Ok lang din po ba na sa pag uwi ko nlng sa December ko makukuha ung refund personally?salamat po...

    ReplyDelete
    Replies
    1. Hi Anonymous,

      Oo merong time limit ang pag reimburse.Kung nanganak, 60 days ang limit. Hindi ko sigurado kung ano yung limit sa ibang operasyon, pero baka 60 days dn yung iba.

      Yung tungkol sa scanned copy, pasensya na pero hindi ko sigurado. Parang hindi ata pwede, pero mas maganda kung maitatanong mo mismo sa philhealth. Baka pwede naman sa sitwasyon modahil nga nasa abroad ka.

      Delete
  6. Hi Sir Carlos,

    Ask ko lang po kung may reimburse din ba sa Philhealth na pinamigay ng local government? Thanks!

    ReplyDelete
    Replies
    1. Hi Jaypee,

      I think so. The benefits should be the same.

      Delete
    2. Ganito po kse ung nangyare sir Carlos, naconfine ang mama ko sa private hospital na Philhealth accredited, then tinanong nya sa nurse kung pwde gamitin ung philhealth nya na bigay ng local government ang sbe eh hindi pwde .. wla kse ako nung time na un sa hospital dhil nanganak misis ko sa kabilang ospital na public. may nagsabi sa amin na pwde nmn daw un basta accredited ng Philhealth. kaso nbyaran na lahat ng bill. Sa tingin nyo po ba pwdeng ire'imburse? Thanks!

      Delete
    3. Ah definitely pwede reimburse yun. Di ko alam kung bakit sinabing "hindi" nung nurse; baka misunderstanding lang.

      Gawin mo lang yung ginwa ko dn sa blog post ko. Kunin mo lahat ng forms at requirements, tapos punta ka sa nearest philhealth office para mag file ng reimbursement.

      Delete
    4. I think misunderstanding nga ung nangyari Sir Carlos .. Anyway, thanks for the info, feed back ako kung anu magging result ..marami kpa sanang matulungan ..God Bless!

      Delete
  7. We had several bad experiences with our Philhealth benefits. Syempre, that includes the Philhealth's present policies. To start with, just recently, my husband went to Orthopedic's Philhealth Section to check on his claim because last August 2014, he had a motor accident and unfortunately underwent a minor surgical operation. His pinky finger needed to be amputated and two more of his fingers had to put a brace (bakal) to save from being amputated too. Syempre government hospital so we needed to buy everything that they asked us to buy. There were prescriptions also which include things to be used for surgery. All in all, I spent almost 8k including some other medications. He was not confined since according to them, there was no need for confinement as this was only minor operation. But upon asking the doctor in-charge, she said that there is a corresponding rate case for that so we thought that this will really help us a lot. What we did is keep all the official receipts from all the pharmacies where we bought all the prescriptions of the doctors. Even the small "bakal" used which amounted to P1500 each, we kept the OR. That same night, we were discharged and since it was night time we were unable to accomplish a CF1 form to be signed by my husband's employer. There was no direct filing in Philhealth, because the new procedure is to file to the hospital and the hospital will claim to Philhealth. After which, we will wait for 3 to 4 months to get our reimbursement. This day, my husband took a leave of absence since, upon checking with Philhealth office, Orthopedic Hospital had already received the claim amounting to P15,000 for professional fee and hospital charges. We thought we can have a share of that amount even for the receipts which we submitted to them. But to our dismay, they said, "yung bakal out na to kasi hindi ito binabayaran ni Philhealth. Yung ibang resibo ng biniling gamot, ipapacheck pa sa pharmacy ng orthopedic kung available ito nung time na inoperahan ka kasi binibigay ito ng libre ng ospital." So, my husband reacted negatively and said " So, mga magkano lang ang makukuha ko? Walang isang libo?", they answered, "Ganun talaga, Sir." I cannot understand why we are not entitled to reimbursing everything we bought for my husband’s surgical procedure and medication. It was so disappointing that for more than 12 years of working, and this are rare chances of using the insurance and we are to receive only this? What can you say about that?

    ReplyDelete
    Replies
    1. Wow, that's tough. How come they didn't just give you the meds in the first place, and yet now they say you can't reimburse because it's given for free?

      I don't have much experience with government hospitals. But from my experience with private hospitals, Philhealth is almost like a subsidy or rebate. It only gives a small amount - an almost tiny fraction of the hospital bill, and also makes you wait for it. It helps, but not enough to lean on it.

      Delete
  8. Dear Sir,
    Na hospital po ako dito sa cavite dahil napilayan ako last april 14... na operahan ako that night at na discharge ako the following day April 15 na hinhindi ko nagamit ang philhealth ng husband ko na seaman na on board sa ngaun. Balak kong mag re inverse pero sabi aa hospital hindi daw pwede kasi wala 24 hours akong na admit. na admit ako ng 2.30 pm April 14, at lumabas ako 3pm ng 15. Pero according to their documents, na discharge ako ng 8 am. Hindi na ba talaga ako pwede mag re inverse? Please advise.

    ReplyDelete
    Replies
    1. Hi Anonymous,

      Kung less than 24 hours, talagang walang ma re-reimburse Philhealth.

      Ang problem yata ay yung documents. kung 8am ka na discharge, wala talagang reimbursement. Kung 3pm sana yung nakalagay sa documents, may makukuha ka siguro.

      Possible ba na 8am ka na discharge pero may aberya lang kaya 3pm ka na naka alis ng hospital?

      Delete
  9. Hi Sir Carlos ask ko lang po kung possible po ba ako makakuha ng refund if may hindi ako nahulugan na contribution last January February and March? ganito po kasi nangyari naoperahan po ako sa apendiks tapos nung ipapafile ko na po na philhealth member ko hinanap po receipt ng hulog ko ng January Feb at March sabi ko di ko nahulugan sabi sakin sa hospital sa mismong philhealth office ko na asikasuhin kaya nung madidischarged na ako sa hospital binayaran na po lahat ng bill ko. possible parin po ba na makakuha ako ng refund?

    ReplyDelete
    Replies
    1. Hi Ejhay,

      Subukan mo pa dn.

      ANg pagkaka alam ko kasi, dapat "updated" yung member. Ibig sabihin tama yung record, pero bukod dun kadalsan ibig sabihin dn na nakapag hulog.

      Baka naman pagbigyan ka kung nakakapag hulog ka bago mag January at after nang March. Pero hindi ko kasi kabisado ang patakaran nila sa ganyan.

      Kung may malapit na Philhealth office sa inyo, subukan mo na dn.

      Delete
  10. ask ko lng po anu po requirments pag nag file ng reimbursment sa resibo?salamat po

    ReplyDelete
    Replies
    1. Paanong reimbursement sa resibo? I mean, ano ba yunng situatiion/nangyari?

      Delete
  11. For the reimbursement po did you file it yourself sa pholheath or had the hopsital donthe filling

    ReplyDelete
    Replies
    1. It depends.

      If you were able to submit all the requirements on time to the hospital, they'll be the one claiming for you. Basically they won't charge the philhealth portion and reimburse with philhealth themselves.

      If, like me, you were not bale to submit on time, you'll have to go to philhealth and file the claim yourself.

      Delete
  12. Ask ko lang po, sa PGH po naconfine yung anak ko sa ward. Yung binibiling gamot sa labas ng ospital ang sabi samin kapag may philhealth pwede ma-reimburse, ngayon po may dumating na letter may price na nakasulat 6,180 pwede kaya namin makuha yun or sa contribution ng husband ko babagsak yung 6,180?

    ReplyDelete
    Replies
    1. Hi Jhoanna,

      Hindi ko nasundan masyado yung storya. Sai pwede daw ma reimburse yung gamot? kung ganon, mabuting mag punta sa philhealth para mag file ng reimbursement.

      Ano ba yung letter na dumating? tungkol saan at galing kanino? Yung price na 6180 ay para saan ba?

      Delete
  13. pwede pa po b mkpgrefund kht mg 2 wiks n nklabas sa hospital?san po b dadalhin mga papel..at ano mga kailngan?thanx

    ReplyDelete
    Replies
    1. Hi Anonymous,

      Meron time limit. Pero in my case 60 days yun. Palagay ko ganu din sayo. Dalhin mo lahat ng documents na kailngan at pumunta sa nearest philhealth branch.

      Kailnang mo ng:
      All three claim forms (filled out and signed)
      Copy of Updated Philhealth Member Data Record with list of dependents (From your employer)
      All official receipts and statement of accounts (copy; from the hospital)
      Waiver from hospital's Philhealth section (from the hospital)

      Kung may mga iba ka pang documents dalhin mo na dn.

      Delete
  14. Naka confine ang mother ko sa heart center and may mga gamot kaming binibili pwede bang i reimburse sa phil health yun?

    ReplyDelete
  15. Hi Mr. Carlos

    Sorry to disturb you, girlfriend ko kasi nanganak last july 09, 2015 employed po kami pariho pero na deduct na sa sahod naming and payment for the contribution of the month of June 2015 pero since nasa BPO kami ung payment naming for June mag rereflect on the 15th of July 2015 tapos naka labas kami 13th of July di naming nagami ung benefit naming sa Philhealth dahil delayed ung posting ng payment naming pwede po ba kami mag request ng reimbursement sir?

    Tapos kung pwede san po naming ibibigay ang requirements po?

    Thank you very much

    ReplyDelete
    Replies
    1. Hi,

      I'm not sure. they might not let you reimburse if technically the payment was made after the incident.

      But it should be ok to try; they might be accommodate you anyway. Just go to the nearest Philhealth office. I'm not sure what the requiremetns are, but bring your memeber data forms, all three claim forms, and all the papers from the hospital that you have.

      Delete
  16. ask ko lang, my husband died June 28. That was a Sunday. So walang pipirmang mga doctors so binayaran muna namin lahat. Paano ang requirements non for reimbursement kapag deceased na ang member?

    Thanks

    ReplyDelete
    Replies
    1. Hi Anonymous,

      Hindi ko rin sigurado sa case na yan. Pero malamang kakailanganin mo pa dn ang claim forms 1, 2, at 3, plus yung member data record ng husband mo.

      Waiver na dn ng hospital na hindi sila ang nag claim ng Philhealth portion dahil ikaw nag bayad at mag reimburse, pati na mga statement/resibo ng mga binayaran ninyo sa ospital.

      Baka dn hingan kayo ng katibayan na kasal nga kayo at ikaw nga ang misis niya - so marriage license and/or ID mo.

      Delete
  17. Hi, question po. About sa story nyo, so same din sya ng story ko, na admit ako more than 24 hours pero di ko nabigay on time yung documents sa hospital for philhealth so shinoulder ko muna ung philhealth part ng bill amounting to 6600, then nacover naman ng maxicare ung rest na 10000. So anu po dapat ko gawin after? Kasi Unfair naman kung hindi ko marereimburse yung 6600 dahil lang 1 day late ko maipapasa yung requirements. Pwede ko po ba ifile sa Philhealth yung claim ko for reimbursement? Thanks po

    ReplyDelete
    Replies
    1. Hi JM,

      Yes, you can reimburse. Just submit all the necessary forms. You have probably up to 60 days after the date of confinement to do so.

      Delete
    2. Hi Sir Carlos,thanks po sa reply. Nagemail po ako sa philhealth explaining what happened. Eto po sabi nila

      Dear Sir/Madam:

      Greetings from Team PhilHealth!

      Based on PhilHealth Cicular 35 series 2013, direct filing of claims shall not be allowed for confinements starting January 01, 2014 except in the following cases:

      Claims for confinements abroad
      Emergency in non-accredited health care institutions
      Thus, the Health Care Institution shall deduct the appropriate PhilHealth benefits from the total actual charges (health care institution & professional fees) of the beneficiary.



      As regards to your case, please be advised that you may opt to file for claim reimbursement subject to Motion for Reconsideration. The Motion should be duly signed by the filing party, stating the merits of the appeal. Afterwards, the movant will be receiving a written order on the Committee's decision on the said Motion.

      Submit the following to PhilHealth office within 60 days upon discharge:
      To be provided by member:
      Claim Form 1 (CF1)
      Member Data Record (MDR)
      Proof of Contribution
      Official Receipt and Statement of account
      Motion for Reconsideration (letter of appeal); subject for evaluation
      To be secured from the hospital
      Claim Form 2 (CF2)
      Waiver from hospital and doctors

      Thank you.

      --------

      Ayan po, ganyan din po ba ang ginawa nyong pagclaim noon? January
      Januacy 2014 po ung circular issuance, what date po kau nag file ng reimbursement dati? Im worried na baka hindi nila iapprove ung claim ko. Thank you po.

      Delete
    3. Hi JM,

      2013 pa ko huling naka pag claim. Mukhang hindi nga talaga ma re reimburse na based sa new rule nila.

      Pwede siguro mag submit ka na lang ng letter of appeal tulad ng sabi nila. Bigyan mo na lang ng magandang reason.

      Delete
    4. Hi JM,

      2013 pa ko huling naka pag claim. Mukhang hindi nga talaga ma re reimburse na based sa new rule nila.

      Pwede siguro mag submit ka na lang ng letter of appeal tulad ng sabi nila. Bigyan mo na lang ng magandang reason.

      Delete