Update as of May 28, 2014:
NO, you can no longer claim your refund from Philhealth.
NO MORE DIRECT FILING with PHILHEALTH!
You can NO longer file your claim directly with Philhealth.
Submit your Philhealth documents to the hospital before discharge. It is the hospital that will file your claim with Philhealth. On the day of admission, ask the hospital about their Philhealth submission rules. If you ask early, you will have time to fix your papers if incomplete or invalid.
Make sure your Philhealth coverage has been deducted from your hospital bill before discharge.
If the hospital asks you to sign a waiver, read the waiver. Do not sign any waiver that you do not understand.
Only Philhealth members hospitalized overseas can file their claim directly with Philhealth.
These are the required documents:
1. Clear and updated copy of Member Data Record (MDR)
If you are a dependent, make sure you are listed in the MDR. If you’re not yet listed in the MDR, include your birth certificate (for children or parents) or marriage certificate (for spouses). Some hospitals require that dependents’ names are written in the MDR.
2. Original copy of Philhealth Claim Form 1
Get this form from Philhealth, the hospital or your employer, accomplish it and sign it. Submit original copy. If employed, this should be signed by your employer.
3. Receipt of premium payments.
If Employed, submit your Certificate of Premium Payments with OR numbers.
4. Some hospitals require a copy of your Philhealth ID, or Philhealth card or valid ID.
If Lifetime Member or Sponsored Member, Philhealth ID is required.
After several weeks or several months, Philhealth will mail your Benefit Payment Notice (BPN) to you, using the address you wrote in your Claim Form.
5. If abroad and not able to sign Claim Form 1, send an authorization letter authorizing your wife, parent or child to process your Philhealth papers. Include a copy of your ID.
ONLY Hospitalizations ABROAD can be filed for REFUND:
For Philhealth refunds for hospitalizations abroad:
Submit your documents within 180 days after discharge:
1. Philhealth Claim Form 1
2. MDR or supporting documents
3. Original Official Receipts, or detailed Statement of Account (in English language)
4. Medical certificate, including the final diagnosis, dates of confinement and services rendered (in English language)
Note: Refunds for overseas hospitalization are based on Level 3 hospital benefit rates.