What is the Philhealth category for a Seaman?
Is it OFW or Employed?
According to Philhealth, a SEAMAN is considered an EMPLOYED member. He is not OFW.
Philhealth says that all SEA-based OFWs are EMPLOYED members. This is because seamen receive their salaries through allotments facilitated by their maritime manning agencies based in the Philippines.
Because the Philhealth category of a SEAMAN is EMPLOYED, his Philhealth eligibility requirement for Philhealth benefits is the same as the eligibility requirement for Employed members working in the Philippines.
For EMPLOYED members, they are eligible for Philhealth benefits if they have paid at least 3 monthly premiums within the 6-month period immediately prior to month of hospitalization.
Count 6 months immediately before month of hospitalization. Within these six months, have you paid for at least 3 months? If yes, then you are eligible for Philhealth coverage.
There are some healthcare providers that require payment of 6 months or 9 months. They’re sigurista or not updated. Call Philhealth Call Center 441-7442 and ask for help.
Prepare your Philhealth documents and submit to the hospital one day before discharge. Why one day before? So you’ll have time to remedy in case there’s a problem with your documents. Some hospitals also require submission 1 day before discharge.
Remember: Filing for refund directly with Philhealth is NO longer allowed. So submit your Philhealth papers to the hospital upon admission or 1 day before discharge.
Documents to submit to the hospital:
1. Philhealth Claim Form 1 — filled-up, signed by you (Philhealth member) and your company. Prepare 2 sheets if it’s for maternity coverage (one for the mother and one for the baby).
2. Member Data Form (MDR) — Get this from Philhealth
If the patient is the seaman’s dependent and his or her name is not yet written in the MDR as dependent, submit birth certificate (if child or parent) or marriage certificate (if spouse) to the hospital. Many hospitals require the MDR to be updated, so update your MDR.
3. For Maternity Patients, submit official receipts of prenatal care (total is at least 1,500 pesos) to get reimbursement of up to 1,500 pesos. This is optional and this is only for normal delivery cases.
4. Bring your Philhealth ID or Philhealth card or any valid ID, in case the hospital requires your ID.
If the SEAMAN is not in the Philippines to process Philhealth papers, he can email an authorization letter authorizing his wife or family member to process all Philhealth documents needed for Philhealth coverage, including a photo or scan of his ID.
If the SEAMAN is on VACATION or ON LEAVE WITHOUT PAY for more than 2 or 3 months, he should pay his Philhealth premiums as Individual Payor.
Philhealth for Seaman — Employed Category, Not OFW