How to Claim Philhealth Benefit for Overseas Hospitalization
You have 180 calendar days from date of discharge to file your claim for your Philhealth benefit for your hospitalization overseas.
In cases where hospital category or level is considered to calculate benefits, refunds for overseas hospitalization are based on payments made to Level 3 hospitals in the Philippines. For example, the maternity benefit for a normal spontaneous delivery (NSD) in a hospital overseas would be the maternity benefit paid to a Level 3 hospital in the Philippines, which is 5,000 pesos. An additional 1,500 pesos would be reimbursed if Official Receipts of eligible Prenatal Care expenses amounting to at least 1,500 pesos are submitted.
Go here to see a list of qualified Prenatal Care Expenses.
Where to File: File at any Philhealth branch.
Documents to submit:
1. PhilHealth Claim Form 1 (filled-up and signed)
2. Member Data Record (MDR)
- For dependents, show proof of dependency, namely birth certificate or marriage certificate. This is important if name is not yet written as dependent in the MDR
3. Proof of applicable premium payments
- For OFW members, submit a copy of OEC receipt that includes Philhealth premium payment or receipt of Philhealth payment made through accredited overseas collectors of Philhealth (Dates of hospitalization should be within validity dates, as written in the receipt)
- For Individually Paying members, submit receipts of Philhealth premium payments for at least 9 months within the 12-month period prior to hospitalization (for maternity cases and certain surgical cases), or for at least 3 months within the 6-month period prior to hospitalization (for non-maternity cases and regular surgical cases)
- For Employed members, submit employer’s certification of Philhealth premium payments for at least 3 months within the 6-month period prior to hospitalization
Note: For OFWs and Individually Paying members, bring original copy of Philhealth premium receipts in case Philhealth wants to check them.
4. Original official receipt or detailed statement of account (written in English)
5. Medical certificate indicating the final diagnosis, confinement period and services rendered (written in English)
Note: You can download Claim Form 1 from the Philhealth website, or you can ask for it when you go to a Philhealth branch to get your MDR.
Claim Philhealth benefit for overseas hospitalization
Molino, Cavite
Photo Credit: glenmcbethlaw, CC-BY 2.0, via flickr
My wife is a member of philhealth and she getting birth last january 27 2013 here in UK. Is she eligible to claim the maternity benifits and what are the requirement and when to claim.
Hi Jerwin, yes, she is eligible if she has paid her Philhealth for 9 of the 12 months before Jan 2013. If her category is OFW, Jan 27, 2013 should be within the validity dates in her premium receipt or OEC receipt.
She can file her claim within 180 days after discharge. Was it a normal delivery? It’s 5k plus 1500 if she can submit prenatal care ORs. She can include a second claim for the newborn care benefit worth 1750 if she has newborn care receipts. If CS, the coverage is 19k. The documents required are listed in the article above. Refund will be in check in the name of the claimant, delivered via registered mail to the Philippine address written on the claim.
My wife is dependent of mine her due date is july 23, 2013 and she’s giving birth here in dubai, she is eligible to claim the maternity benefits?
Hi jonathan, yes, as long as July 23, 2013 is within your validity dates in your Philhealth receipt. 5k for normal plus 1500 prenatal if there are prenatal ORs. 19k for Indicated CS (no prenatal benefit). Newborn package is up to 1750 if there are newborn care ORs. File within 180 days from discharge date.
Hi, would like to ask if got an out patient breast surgical procedure for one day, can i still get reimbursement from philhealth? how?
Hi Russel, is this a quick surgery, such as a breast cyst removal? First, find a Philhealth-accredited surgeon who’s willing to fill up claim forms and to wait for their PF refund from Philhealth for months. Ask them if you can use your Philhealth. Be ready with your MDR, premium receipts, claim form 1 and ID.