Philhealth Documents Required from Employed Member

 

If you are an EMPLOYED MEMBER of Philhealth, 

submit these documents to the hospital or clinic BEFORE discharge:

1.  Clear copy of your MDR or Member Data Record

(Get your MDR from Philhealth)

2.  Philhealth Claim Form 1

(Signed by you and your Employer.  Your employer or HR usually have this form.

If for maternity coverage, request 2 claim forms — one for you and one for your baby)

3. Certificate of Applicable Premium Payments with OR numbers

(Get this from your Employer)

Notes:

Some hospitals require submission of documents 1 day before discharge.

Bring your Philhealth card or any valid ID, in case it’s needed.

If the patient is your dependent, update your MDR so that your dependent is written in your MDR as your dependent. If the patient is your spouse, bring your marriage certificate, and if it’s your child, bring your child’s birth certificate, in case it’s needed.

Direct filing by patient with Philhealth is no longer allowed by Philhealth. 

But if you were admitted on a Friday or  a Saturday and discharged the next day, which is a Sunday or Monday, and was not able to have your Claim Form 1 signed by your employer, ask the hospital to give you the accomplished claim forms so you can file for refund directly at the nearest Philhealth branch.

41 thoughts on “Philhealth Documents Required from Employed Member”

  1. How do we know if the refund for my father is already sent. Had appendix operation in august in San Jose antique hospital. Can it be forwarded here in Pangasinan as we’re now here?

    Reply
    • Hi Jonaisa, what address did you use in the philhealth claim forms? Who lives there in that address? Ask the person there to forward to you the registered mail from Philhealth after they receive it. But you need to send them an authorization letter with a copy of the member’s ID authorizing them to receive the registered mail from Philhealth.

      Reply
  2. Hello, my sister just started to pay philhealth this oct-dec. 2014 her expected delivery is january 2015, she should be able to get maternity benefits right? But what if the hospital requires the 6 months contribution, can her husband who has resumed paying philhealth since may 2014, make her his dependent then, so she could still avail? Thank you so much for this very helpful website

    Reply
    • Hi Mona, your sister should be able to use Philhealth in January. But it’s best that you ask the hospital now, so you can remedy the situation, as a Philhealth member cannot be a member and a dependent at the same time. Philhealth requires formal membership cancellation and registration of dependent (with marriage certificate) before your sister can become a dependent of her husband, and her name should be written on her husband’s MDR as dependent. Thanks for appreciating my efforts.

      Reply
  3. Hi po! Im a government employee(depEd) and on leave(sick leave without pay from august 2014- JAN 2015) currently due to a complicated pregnancy. I’ll be giving birth -scheduled CS this january 5, 2015. Upon inquiring philhealth,it was found out that there were no contributions for the last quarter this year(may be it was not yet updated by my employer,i have no idea actually) so i made voluntary payments for the months of oct to december,2014, as suggested by the office(philhealth).. if i will not able to pay my contributions for january-March,2015 due to my health condition, will i able to enjoy the maternity benefits this january 2015? ?? Thanks po

    Reply
  4. good day if my wife gives birth today (jan. 2, 2015) or tomorrow (jan. 3, 2015) and these are holidays, and offices will resume only on jan. 5, 2015, how is the procedure? thanks.GOD BLESS ALWAYS.

    Reply
    • Hi jeffrey, talk with your hospital or clinic so that they’ll accept your available Philhealth documents, you pay in cash, but they’ll give you your refund immediately after you submit the claim form and cert of premium payment signed by your employer. If they refuse, ask them to give you the claim forms plus waiver, and then file directly with Philhealth after you get your papers from your employer.

      Reply
  5. My husband and I are both active philhealth members. can i use both together for my delivery this coming april2015?

    Reply
    • Hi Karla May, sorry no. You can use only one membership for a confinement. In your case, you can use only your Philhealth for your delivery in April.

      Reply
  6. Can i use philhealth for raspa (D&C)? I’m currently employed, but started contributions in may. want D&C in jan 4 2015.thanks and hoping for your reply

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  7. Hi, il give birth on jan 15 2014, i am currently employed and started last sept 29, 2014. Im sure my employer paid for my philhealth since its shown in my payslip. I have them signed the form given by philhealth but i wasnt able to ask for the certificate of contribution. Can i still avail the benefits? I need answer asap. Thanks

    Reply
  8. hi, i am a gov’t employee and a Philhealth member in zamboanga but presently assigned here in manila main. All my documents/membership is in Philhealth Zamboanga. Can i aquire the MDR here in Philhealth manila? and so with the signature of employer for CF1 here in manila? my son is scheduled for surgery. thanks and God bless.

    Reply
  9. Hi roel, yes, go to the nearest Philhealth with your ID and request for your MDR. If your institution has an office in Manila, request your claim form 1 and cert of premium payments. If not, authorize someone to get these 2 docs in Zamboanga

    Reply
    • Hi jovie, parents should be 60 years old or older. But now, all senior citizens can have their own Philhealth membership for free. The initial instruction is to show your senior citizen ID if you need treatment. Or you can go to Philhealth with your ID and apply for your own Philhealth card.

      Reply
  10. Hi, how does Philhealth work? If I submit the requirements, is my benefit automatically deducted? or will I be getting some sort of a check (for reimbursement)?

    Reply
    • Hi Scarlet, your benefit should be deducted before discharge. Philhealth no longer accepts direct filing, except from OFWs and other exceptional cases.

      Reply
  11. Hi, im having my c section delivery on march. Im a dependent of my husband who is a philhealth mrmber. Im already listed on his dependents on his MDR which is issued last November 2014. Do we need to get a new MDR so that the issuance date is updated?

    Reply
  12. Im a dependent of my husband who is a philhealth member. Im already listed on his dependents on his MDR which is issued last November 2014. Is it still valid? Does it expire? BTW, Im having my c-section delivery this March

    Reply
  13. Hi,just want to ask..my daughter is in hospital right now.she’s ok now and ready for discharge..but the hospital said we can only use my phil health if my daughter stay there for 24hrs..but the doctor didnt let her go home yet.so now she’s there for more than 24hrs.now they said she need to stay for 3days so that we can use my phil health bec.24hrs.already had passed..pls.help me clarify this..

    Reply
    • Hi jocelyn, 24 hours is enough to avail of Philhealth. Plead with the doctor about discharge; tell doctor that you don’t have enough to pay for 3 days.

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  14. Hi po,i just to ask po. I paid philhealth oct-april. I’ll give birth this july. Am i Covered or should I pay may-july? Thank you po

    Reply
  15. Hello po. how can i continue my contribution in philhealth from employed to voluntary? my employer last payment was february..can i still pay my philhealth from da month of april-june in bayad center or i should go first to the nearest philhealth office before i pay. tnx

    Reply
    • Hi Chel, you can pay for April to June at Bayad Center. Pay tomorrow or June 30. In July, your payment will no longer be accepted by Philhealth.

      Reply
  16. Hi. Im on my 7 months already. When is the perfect time to process this claim form 1? I need two forms right? One for me and one copy to the hospital. My employer really needs to signed those two forms? Sorry for so many questions its my first time to be a mommy. Thank you!

    Reply
    • Hi Michelle, request your forms maybe a day or a few days before your due. Ask your HR their SOP on requesting forms. Do they give forms quickly upon request or do they need advance requests. Yes, 2 claim forms signed by your employer and 1 cert of applicable premium payment.

      Reply
  17. my daughter is included in my beneficiary, she is 20yo, is she entitled to maternity benefits on my philhealth..she has no husband.

    Reply
    • Hi Dennis, yes, your daughter can use your Philhealth as your dependent. Her name should be in your MDR as your dependent. But I suggest that she applies for her own Philhealth so her baby will be covered as her own dependent. Her baby is not qualified as your dependent. Grandchildren are not qualified as dependents.

      Reply
  18. Blessed Day Nora,

    I would be confine at a hospital because I was required undergo MRI due to sudden elevate of BP and uncontrollable headache. I was asked by a known hospital for confinement but I disagree with the doctor. The doctor then asked me to come for referral for my preferred hospital once ready. Now that I am ready and dont have a companion to fix my document. I would like to have them prepared ahead of time. Are the only requirement I need are your qouted numbers 1 upto 3? or that is different in my situation. I am full time currently employed from a private owned company. Would you be kind enough to enlight me on the requirement please?

    Reply
    • Hi Tristan, try to relax and feel calm. So sad but I think MRI is not covered by Philhealth because it is not a treatment procedure, but a diagnostic procedure. MRI is only covered if it’s used to guide biopsy and tissue ablation. But to be sure, ask the hospital. About requirements if treatment is covered: Cert of applicable Philhealth premium payments from employer, MDR and Philhealth claim form 1 signed by employer and ID

      Reply
  19. Hi. I have a question, my partner and I are still not married but we’re going to have a baby soon around february next year. I read the documents and otger researches about requirements ti avail maternity benefits. I saw on the last oart that we need to submit a marriage certificate. I will be using my philhealth and I already have 1 year contribution and still will continue to cobtribute until due date. Is the marriage contract necessary?

    Reply
    • Hi Rhona, dahil ikaw ay Philhealth member, at continuous naman ang premium payments mo, at membership mo ang gagamitin mo, hindi kelangan ang marriage certificate. Kelangan lang ang marriage cert kapag hindi ka member at gagamitin mo ang membership ng husband mo as his dependent.

      Reply
  20. hi, i was employed until 2013 from then wla na ako contribution then i switched to informal economy member i paid my philhealth for the month of oct-dec2018 because i was 9weeks pregnant but i had a miscarriage and schedule ng d&c or raspa next week. magagamit ko ba ang philhealth q. tnx sa sagot

    Reply

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