How to Claim Philhealth Benefit for Overseas Hospitalization

Updated March 2015

You have 180 calendar days from date of discharge to file your claim for your Philhealth benefit for your hospitalization abroad.

Where to File:  File at any Philhealth branch in the Philippines

Documents to submit:

1.  PhilHealth Claim Form 1 (filled-up and signed)

2.  Member Data Record (MDR)

– If the patient is a dependent, his/her name must be written as dependent in the member’s MDR.

If not yet written, present birth certificate (if child) or marriage certificate (if spouse).

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 premium receipt)

– For Individual Payors or Voluntary members, submit receipts of Philhealth premium payments for at least 3 months within the 6-month period prior to hospitalization (Count month of hospitalization as the 6th month).

– 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 Individual Payors or Voluntary members, bring original copy of Philhealth premium receipts in case Philhealth wants to check them.

4.  Statement of Account or Original Official Receipt with Itemized Charges (written in English; if written in foreign language, English translation must be included)

5.  Medical Abstract, or Medical Record, or Medical Certificate indicating the final diagnosis, period of confinement and services rendered (written in English;  if written in foreign language,  English translation must be included)

6.  If surgery was performed, submit a Copy of the Operative Record, written in English or with English translation

Note 1:  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.

Note 2:  Starting 2014, only members hospitalized abroad can file their claim directly with Philhealth. Direct claim filing by members at Philhealth offices is no longer allowed for all hospitalizations in the Philippines. It will be the hospitals that will file claims with Philhealth. Members must file their Philhealth documents with the hospital upon admission or before discharge.  Many hospitals require members to file Philhealth documents 1 day before discharge.

Claim Philhealth benefit for overseas hospitalization

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  1. Hi, would like to ask if got an out patient breast surgical procedure for one day, can i still get reimbursement from philhealth? how?

    1. 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.

  2. hi i give birth here in dubai last june 2013 can i submit all my payment receipt for the reinbursement in philippine consulate of dubai?please let me know thanks

    1. Hi ann, is there a Philhealth desk office there in the Dubai consulate? I think it’s better if you submit your docs directly to Philhealth here in the Philippines through your representative. I hope you have a bank account here so your rep can deposit your refund check to your account. Include an authorization letter authorizing your rep to receive the refund check plus a scan of your IDs.

  3. i give birth here in dubai last june 2013, can i claim for my maternity benefits, where can i send all my documents? can i send here in Philippine consulate in dubai?

    thanks

  4. Hi Ms Nors. We received a BPN from philhealth showing a hospital charge of 8000 pesos from the dialysis center where my mother has sought treatment. It’s not only that dialysis center where we go to, and her session is 4 hrs twice a week. we have not received a hospital bill from tms. that notice was last july 10 2014? what should i do?
    Mam my mother was admitted at nkti for 5 days, then i paid for her hemodialysis, and we used my father’s Philhealth to pay for her hospital bill. can i still refund the 7000php that we spent for my mother’s hemo last year? we didn’t receive any bpn.

    1. Hi jackie, how much did you pay this dialysis center that was paid by Philhealth as shown in the BPN? If 4000 pesos was deducted from each of two bills (4000 x 2 = 8000 pesos), then you don’t need to refund anything from the dialysis center, because the Philhealth benefits (4k pesos per session) were already deducted. If you paid in full (no 4000 pesos deduction), then you go to the dialysis center with your bill, OR and BPN and ask for refund.
      About the 7000 pesos you spent last year: did you submit Philhealth papers to the dialysis center? If you submitted papers and 4000 pesos was not deducted, you can ask this dialysis center for your refund (bring bill and OR)

  5. The Philhealth office at PGH said we can refund from Philhealth if the prescription shows a mark of NOT AVAILABLE at the PGH pharmacy for medicines bought outside. We did as advised. We filed with PGH. How do we know if the refund is approved?

    1. Hi Angel, wait for your benefit payment notice from Philhealth. Xerox this and then ask for your refund from Philhealth.

  6. I am Ofw, and my daughter has been hospitalized in Vietnam and we received her billing in foreign language. Can i just write by pen the english translation? How much is the maximum we can receive as reinbursement?

    1. Hi ma luisa, sorry I’m not so sure as Philhealth did not specify who can translate papers in foreign language. Your translation could be valid for Philhealth if someone in the hospital (accounting/billing/admin) sign your translation. Here’s the Philhealth Case Rate list

  7. Hi, im an ofw, i gave birth to my son last january 2012 here in dubai, all necessary documents including bank account was submitted in philhealth laguna branch by my representative,last 2 weeks ago my representative made follow up again, they keep on telling no funds available, kindly please help me on this matter, Happy New Year.

    1. Hi catherine, this is my first time to read about that reason of funds not being available. Did you give birth in Jan 2012? Or Jan 2014? Were you able to file within 180 days after discharge? You can email actioncenter@philhealth.gov.ph

  8. I’m currently in Bahrain and gave birth last december 2014. Do i need to submit the original documents or scanned copy of the documents will do.

    1. Hi Era, Philhealth needs the original copies, plus translation for non-English documents. If you’ll be spending much for processing, note that the maternity benefit is only 5k and newborn care is 1750. But coverage for CS is 19k. Ask others too

  9. Hi, I am currently in Singapore and was hospitalized for 2 days. How can I file for reimbursement here at Singapore?

    1. Hi nancy, there are no Philhealth branches abroad, so you authorize someone in the Phils to file your claim with Philhealth

  10. gud eve. If I’m on leave from work and I’m paying monthly contributions to philhealth branch, will my benefit be for reimbursement if I’m confined?

    1. Hi debbie, make sure your Philhealth benefit is deducted from your hospital bill, as Philhealth no longer accepts direct filing by member.

  11. Hello, I am currently working in Bangkok and was hospitalized last October. My CF1 form application was submitted today. My question is how long will it take to get my claim and how many percent of the total hospitalization bills will I get?

    1. Hi Ann, the benefit is no longer computed in %. Rates are fixed, depending on the illness or procedure. Refund will be sent to your home address via registered mail in 2 months to 5 months or more. You can check rates at philhealth.gov.ph; write your illness on the Case Rates Search box.

  12. Hello, I just want to know if I can still get a refund from St. Luke’s Hospital. I just received the Benefit Payment Notice today but I was hospitalized January last year. The date listed under Date Claim/ Refile by PhilHealth is 02/05/2014. Need your insight regarding this. Thanks.

    1. Hi May J, do you mean your Philhealth benefit was not deducted from your bill? Or was the deduction was only partial? Check your hospital statement of account, bill and OR, and how much was deducted. If your actual deduction was less than the amount paid by Philhealth to St Lukes, then request for refund for the balance. If you ask for refund, bring xerox and orig copies of docs and BPN

  13. Hi I am an OFW here in Dubai and was wondrin’ if I can claim anything from Philhealth as a member. My expected date will be this coming March 22, 2015.what would be the requirements and where should I go to file them here in dubai? Is there any number that I can call from here for further questions? Thank you very much.

    1. Hi Xylee, see the required documents above. Send these docs to the Phils, and authorize someone in the Phils to file your claim with Philhealth within 180 days of your discharge. Refund is only 5k pesos for normal delivery and 1750 for newborn care.

  14. Hi! I’m an OFW here in Jeddah, Saudi Arabia and I was hospitalized for 12 days from February 3, 2015 to February 15, 2015 due to intestinal obstruction.
    Questions:
    1.What are the required documents from my local hospital here in Jeddah? I came in Saudi Arabia last June 18, 2014 and I paid one year contribution already in my agency in Manila.
    2. Can my aunt in the Philippines claim my benefits in PhilHealth on my behalf? If so, may I know the documents needed?

    1. Hi Charlie, yes, your aunt can file your claim with Philhealth on your behalf. Include your authorization letter and a copy of your IDs. See the documents listed above. File within 180 days of your discharge.

  15. Hi, my mother has been admitted in the hospital in Davao. She depend on the Philhealth of my brother who is working OFW. What should we do to get refund of all the expenses? What procedure should we follow?
    Thank you, Jocelyn.

    1. Hi jocelyn, you ask your brother to email his Philhealth premium payment receipt or OEC where the Philhealth payment appears plus a scan of his IDs plus authorization letter for you to process all his Philhealth documents. Get his MDR from Philhealth. File Philhealth docs before discharge.

  16. Hi Im living here in California but im still a philhealth member as individually paying member. I already paid my contribution until june 2015. i am 38wks pregnant and expecting to deliver my baby this coming march 26 via CS delivery. My spouse insurance here will cover my hospitalization cause im his dependent. My question is could i stil file a reimbursement in philhealth? And if yes l, what are the step should i do and where can i file it. Im not sure if we have.philhealth here in california. Other question is If i can still file my philhealth reimbursement in PH on behalf of my parents? And could i just sent the scanned copy of documents needed or i need to.mail the original. Thanks

    1. Hi kristine, here are the docs required: http://www.healthphilippines.net/2012/03/how-to-claim-philhealth-benefit-for-overseas-hospitalization/ Include authorization letter authorizing your parents to file, including a photocopy/scan of your ID. Do they issue the hospital official receipt in the patient’s name there, even if paid by the insurer? Or you can try filing just the detailed statement of account. About sending: The original documents are required so use registered mail.

  17. Hi, my sister was confined here in China,I would like to ask if we still need the Philippine Consulate here in China to notarize the receipt. She is an OFW member. Also, as we are here in abroad her employer advised her to keep the original receipt incase there will be a problem. Can you give us advise what to do if we can’t submit the original receipt?Thanks

    1. Hi Rosem, maybe it’s wise if you ask the consulate to certify/authenticate the photocopy of the OR, so you can keep the original copy, and you can send the photocopy with consulate’s certification to Philhealth. The OR, account statement and medical certificate should be translated to English.

  18. Hi. how much philhealth coverage for renal biopsy and every session of chemo? Thank you!

  19. good day!my husband had a surgery here in saudi and im planning the claim his benefits..however,i will not be able to go home soon..operation was dine last april 18 and im planning the let my mother gile gor my husband..is there anything i need to accomplish so that she can claim on my husband’s behalf?is it still also valid to claim the benefit because its already june now..pls let me know also what to bring so i can send home all complete requirements.thanks

    1. Hi france, you have 180 days since discharge date to file for refund. See the list of requirements above in the post. Include your husband’s authorization letter authorizing his mother in law to file his Philhealth claim. Include a photocopy of his IDs (with photo and signature). Your mother in law should also bring her IDs. The refund will be issued through a cheque. Does your husband a bank account in the Philippines?

  20. Hi i have Goiter and went to Blood test, biopsy test and ultrasound. I am here in Russia. But after few days we will move to other country ( Europe)and not come back here. So how can i claim my medical expenses. I am member of Philhealt and OFW.

    1. Hi Isa, sorry, Philhealth does not cover outpatient diagnostic tests. A fixed amount, depending on illness or treatment, is given if hospitalized for at least 24 hours, with definite diagnosis and definite treatment.

  21. Hi Ms.Nors! Good day! I would just like to know and hope you could help me if I am entitled for claims in Philhealth. I’ve had philhealth before when I was working. Then when I get married, I stopped and changed category to voluntary, however I wasn’t able to continue even one payment to that.
    My husband is an OFW and I am with him abroad but not working. I have been advised that there’s no need for me to activate my Philhealth because I will be his dependent. Is this true?
    And unfortunately,I was hospitalized for 4days herein abroad. What claims could I have then if my MDR says Informal Category and have zero (0) premiums? Would it be beneficial if I now pay the premiums or should I update to inactive as dependent spouse?
    Thank you very much. Hope you can enlighten me.

    1. Hi Anne, yes, since you’re no longer employed in the Philippines, you’re qualified as a dependent of your husband under Philhealth. Your husband can update his MDR by downloading the PMRF form, complete the form, check FOR UPDATING, write you as dependent, sign, and email to ofp@philhealth.gov.ph. Attach a scan of your marriage cert. About your claim, you can try filing if your documents are ready and you don’t need to spend much to obtain the documents. Anong diagnosis or treatment ba? The dates of confinement should be within the dates of your husband’s Philhealth receipt, and 180 days have not yet passed since your discharge. See the list of requirements above in the post.

  22. Hello this is alzaeson Amin, I am currently hospitalized here in Saudi for 53 days exactly today, and currently counting, I had undergone too many orthopedic operations due to a heavy accident happened on February 5 2018, I am an active philhealth member, Can I have the reimbursement? I will be discharged this week and will be sent to Philippines as soon as possible, for I am currently disabled condition still, I will have a continuous monthly checking up with orthopedic hospital in Philippines to monitor the development of my fracture, will this be reimbursement a 100% amount that my company paid?or the 100% amount of bill after my check out.. please, need a reply

    1. Hi Alzaeson, sad you had an accident. And sad that Philhealth has been using the Case Rate basis for many years now. Refund will not depend on actual hospitalization costs but on how much Philhealth has allotted for certain illnesses or procedures. Since you had many operations, Philhealth will choose only one — the major operation to cover, and there’s a fixed coverage for each kind of operation. There could be a second coverage, depending on your case. Philhealth also allots only 45 confinement days per year, so I hope you can go to the Phil Orthopedic to save on costs. You can download the Philhealth ACR Search from Google Play so you can check how much is the allocation for your major surgery. You can enter “fracture” into the “Description” and click Search, kahit wala kang ma-enter sa ICD 10 code or RVS code.
      If you have paid at least one SSS contribution prior to Oct 1, 2017, you can apply later on for SSS partial disability benefit: Fracture — File 4 months from injury/operation. Required documents: Certified true copy of any of the following:
      – Record of consultation, or
      – Hospital Abstract/Discharge Summary, or
      – Record of Operation (if operated), or
      – X-ray plate of affected part/s
      If you have paid at least 3 SSS contributions within Oct 2016 to Sep 2017, you can also file for SSS sickness benefit and EC benefit. If qualified, you can comment again and I can send you links to forms and lists of requirements.

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