You can claim Philhealth refunds if your Philhealth benefits were not deducted from your hospital bill because you failed to submit required Philhealth documents before discharge.
Submit the required documents directly to a Philhealth branch or submit them through the hospital, depending on instructions or suggestions from hospital staff.
Submit documents within 60 calendar days (including Saturdays, Sundays and holidays) after discharge from the hospital.
These are the required documents:
1. 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).
2. Philhealth Claim Form 1 — Get this form from Philhealth, the hospital or your employer, accomplish it and sign it.
3. Philhealth Claim Form 2 — Get this from the hospital. It should be signed by the doctors who attended to you.
4. Philhealth Claim Form 3 — Get this also from the hospital. Claim Form 3 is required for the following cases:
– Treatment in a Level 1 hospital
– Case Type D
– Maternity Care Package
– Transferred Emergency Cases
– Confinement of less than 24 hours
5. Official receipts of payments made to the hospital
6. Operative record for surgical procedures performed
After processing, Philhealth will send your reimbursement or refund check, and your Benefit Payment Notice (BPN) to you, using the address you wrote in your Claim Form.
If you have concerns about your refunds or Philhealth payments, write to Philhealth and refer to your BPN number.
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.