How to File a Claim for Philhealth Reimbursement or Refund

Update as of May 28, 2014:

You can NO longer file your claim for refund or reimbursement from Philhealth.

NO MORE DIRECT FILING WITH PHILHEALTH!

Submit your Philhealth documents to the hospital.  Submit documents on the day of admission so you will have time to remedy your papers if incomplete or not valid.

It is the hospital that will file your claim with Philhealth.  Your Philhealth coverage should be deducted from your hospital bill.

Make sure your Philhealth coverage has been deducted from your hospital bill before discharge.

If the hospital asks you to sign a waiver, read the waiver.  Do not sign any waiver that you do not understand.

Only members hospitalized abroad can file their claim directly with Philhealth.

 

Documents to submit to the hospital:

1.  Philhealth Claim Form 1  (original copy, filled-up and signed by you, and your employer if you’re employed)

2.  Updated and clear copy of Member Data Record (MDR) (Get this from Philhealth)

. If patient is a dependent, patient’s name should be written in the MDR as dependent.

If dependent’s name is not in the MDR, submit proof of dependency (birth certificate or         marriage certificate).  Some hospitals require you to update your MDR so that the          dependent’s name is in the MDR.

3.  Official Receipt of Philhealth premium payments (receipt showing payment for the required number of months)

. If employed, submit a Certificate of Premium Payments with OR numbers.

4.  Some hospitals require a Copy of Philhealth ID, or Philhealth card, or valid ID

5.  Authorization letter from Philhealth member, plus a copy of his or her ID, if not present to sign the Philhealth Claim Form 1

 

NOTES: 

After months of processing, you will receive a mailed or courier-delivered Benefit Payment Notice (BPN) from Philhealth. Philhealth will mail the benefit notice to the address you wrote in your claim form.

NOTE:  Merong additional required documents for confinements abroad. How to claim Philhealth reimbursement for hospitalization overseas How to Claim Philhealth Refunds or Reimbursements

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