Can I Avail of My Philhealth Benefit? I’m an Individual Payor

Updated February 8, 2018

There are so many readers asking about their eligibility for Philhealth benefits, so I am again responding with the most important details.

3 MONTHLY PREMIUMS up to September 30, 2018 only

For Individual Payors, the eligibility requirement of 3 monthly payments within 6 months prior to month of confinement is effective until September 30, 2018 only. Confinement month is included in the 6-month count.

 

Starting October 1, 2018, effective na ang 9-months-within-12-months eligibility rule ng Philhealth.

Para ma-qualify for Philhealth coverage, show receipts showing your payment for 9 months within the past 12 months prior to confinement. Isama mo sa pagbilang ng 12 months ang month of confinement.

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 if your Philhealth documents are not complete.

 

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 members before or not.

 

DOCUMENTS TO SUBMIT TO THE HOSPITAL

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.

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