Updated July 29, 2023
Yes, you can avail of your Philhealth benefits as an individual payor. Under the Universal Health Care Law na naging batas noong 2019, lahat na ng Filipinos ay puedeng maka-avail ng Philhealth benefits, either complete ang bayad o kulang, basta mabayaran mo before your discharge ang mga monthly contributions na dapat nabayaran mo.
Under the Universal Law, bawat Pilipino ay merong Immediate Eligibility to Philhealth benefits.
Pero pag basahin mo yong buong Law, i-explain din na kelangan magbayad ng Philhealth contributions ang mga members para hindi ma-zero ang funds ng Philhealth.
At para wala ka nang problema habang naka-confine, at hindi ka na kelangang makipag-argue sa hospital, bayaran mo regularly ang Philhealth contributions mo.
Ang sabi ng Philhealth, dapat merong regularity of payments. At least, nakabayad ka ng 3 monthly contributions within 6 months prior to month of confinement. Confinement month is included in the 6-month count.
At ang pinakamabuti, nakabayad ka ng 9 monthly contributions within 12 months prior to month of confinement para wala nang question question about eligibility sa hospital. Isama mo sa pagbilang ng 12 months ang month of confinement.
At baka lang walang Internet connection yong billing department ng hospital, dalhin mo ang mga Philhealth payment receipts mo for the required 9 months.
KNOW YOUR HOSPITAL’S PHILHEALTH FILING POLICY
Many hospitals require you to submit your Philhealth documents upon admission, or 1 day before your discharge.
Many hospitals do not deduct your Philhealth benefits if your Philhealth documents are not complete.
Magkano na ba ang Philhealth contributions ngayon?
As of July 2023, ang minimum monthly Philhealth contribution ay 400 pesos. Ito ay para sa mga sumasahod ng 10k pesos or lower. Siempre, kung empleyado ka, paghatian nio ng employer mo ang bayad. 200 pesos from you; 200 pesos from your employer.
Pero kapag self-employed ka, freelancer, business owner, or professional doing own work, bayaran mo yong buong 400 pesos.
For self-earners earning more than 10k pesos, it’s 4% of your actual monthly earnings. Kung 20k pesos ang monthly income mo, multiply 20k by 4%, which is 800 pesos.
Ang maximum monthly payment as of 2023 is 3,200 pesos, para doon sa mga people earning 80k pesos or more.
Para sa Year 2024, hindi pa alam kung 4% pa rin, o gawing 4.5% or 5%.
NO MORE DIRECT FILING WITH PHILHEALTH
Submit your Philhealth documents to your hospital upon admission or at least 1 day before discharge. You can no longer file your own claim at a Philhealth branch.
Only members hospitalized overseas can file with Philhealth. Certain emergency cases may be considered.
Note: For those who were hospitalized in January 2018 and whose claims were denied due to the new 9-months-within-12-months rule, request for your Philhealth claim forms and documents at the hospital where you were confined. and then file for refund directly at the nearest Philhealth branch.
YOUR PHILHEALTH PREMIUM PAYMENTS IN THE PAST YEARS — ARE THEY USELESS?
Yes and No.
Useless because you CANNOT use your premium payments in the 1990s, 2000s, 2010, 2011, 2012, 2013, 2014, and 2015 for your current confinement.
Your premium payments in the past are useful ONLY for your application for Free Lifetime Membership when you turn 60 years old.
Actually, past years’ payments have become useless already because now, all Senior Citizens — lahat — can get Free Lifetime Philhealth membership, whether they were paying members before or not.
DOCUMENTS TO SUBMIT TO THE HOSPITAL TO AVAIL OF PHILHEALTH BENEFITS
1. Receipt of Premium Payment
2. Updated MDR from Philhealth
3. Claim Form 1 (usually available at the hospital)
* For maternity cases, submit 2 sheets of Claim Form 1 (one for your maternity coverage and the other for your baby’s newborn care or other types of medical care. You can use your baby’s birth certificate which will be issued by the hospital.)
* Some hospitals might require additional documents:
. Philhealth ID or any valid ID
. Marriage certificate (if patient is a dependent spouse)
. Birth certificate of child (if patient is a dependent child)
. Birth certificate of member and senior citizen ID of parent
(if patient is a dependent parent)
Note: Present original and xerox copies. The hospital will decide which to accept, whether the original or the xerox copy.
MAKE SURE BOTH YOUR DOCTOR AND YOUR HOSPITAL ARE PHILHEALTH-ACCREDITED.
MAKE SURE BOTH YOUR MIDWIFE AND CLINIC ARE PHILHEALTH-ACCREDITED.