PhilHealth


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Members


Frequently Asked Questions


Membership and premiums concerns

1. If I get separated from employment, how do I continue my PhilHealth membership?

In case you get separated from employment, you may continue your PhilHealth membership by becoming an Individually Paying Member and paying the applicable premium. Simply accomplish the PhilHealth Member Registration Form (PMRF) and tick the box "For Updating" and the appropriate box of the membership category to which you are shifting. Make sure you continuously and religiously pay your premiums so as to avoid suspension of benefits.

2. I'm a newly-hired employee. How do I get a PhilHealth Identification Number (PIN)?

To obtain your PIN, please do the following:

  • • Accomplish the PhilHealth Member Registration Form (PMRF) in duplicate copies.
  • • Attach a clear copy of your Birth/Baptismal Certificate (with Registry Number).
  • • Attach a clear copy of the applicable legal supporting document/s for dependent/s to be declared.
  • • Submit these to your HR Department. The latter shall submit your application to PhilHealth, together with the Report of Employee-Members (Er2 Form) accomplished by your employer.
  • • After processing, you shall receive, through your employer, your PhilHealth Identification Card (PIC) containing your PhilHealth Identification Number (PIN) and a copy of your Member Data Record (MDR).
3. My spouse is also a PhilHealth member. Are we allowed to declare our only child so that we can both apply our separate coverage in the event she gets sick?

PhilHealth does not allow multiple declaration and application of PhilHealth entitlements of both spouses. We advise you to decide who among you will declare and provide for the PhilHealth coverage of your only child as a dependent.

4. What if I have multiple jobs? Can I just be deducted with my PhilHealth only once?

Section 18-20 of the Implementing Rules and Regulations of RA 7875, as amended, mandates employers to enroll their employees, deduct from their salaries the required premium contribution, and remit the same, together with the corresponding employer share, to PhilHealth. As each employer has to adhere to this law, those who are engaged in multiple employment should consequently be deducted of their corresponding employee share by each and every employer with which they are currently employed.

5. How do I continue paying my PhilHealth premiums if I'm on leave without pay?

You may continue paying your premiums for months you are on leave without pay as an Individually Paying Member (IPM). To pay your premiums as an IPM, visit any PhilHealth office and present a copy of the RF-1 from your employer indicating that you are on leave without pay or a Certification from your employer indicating the same.


Benefits and availment concerns

1. I am a newly hired employee. When will I become eligible to avail of PhilHealth benefits?

Payment of at least three monthly premium contributions within the last six months immediately prior to the month of confinement shall be required of you to be able to avail yourself of your benefits.

2. In case my qualified dependent is not included in the Member Data Record (MDR) and he/she gets sick, what applicable document should I submit?

If your dependent gets hospitalized and he/she is not listed in your MDR yet, you may submit a clear copy of the following:


  • • Spouse - marriage contract/certificate
  • • Children - birth certificate
  • • Parents - birth certificate of member and patient or Senior Citizen's ID
3. Will PhilHealth reimburse my hospitalization in a foreign country even if the hospital is not accredited by PhilHealth?

Overseas confinements of PhilHealth members, regardless of their membership category, and their dependents are still covered and shall be paid based on Level 3 Hospital benefit rates.

4. What is a "single period of confinement"?

It refers to a confinement or series of confinements for the same illness with intervals of not more than 90 days. In such cases, members are not entitled to another set of benefits/allowances until after 90 days. They can only avail of the unused portion of their benefits, and their room and board allowance until their 45-day allowance in a year is exhausted. Each member is entitled to a maximum of 45 days for room and board allowance per calendar year and another 45 days to be shared by all of the dependents.

However, members can avail themselves of a new set of benefits if succeeding confinements are of different illnesses or conditions.

5. What if I am not readily available to sign the PhilHealth Claim Form 1?

The following are allowed to sign the said form on your behalf:

Member Status Authorized person (in order of priority)
Member is married Legal spouse
Child 18 years old and above in the absence of spouse.
Parent (mother or father) in the absence
of spouse and child.
Member is single Parent (mother or father)
Member is orphaned Brother/sister/guardian
Other individuals as duly Authorized Representative

Clearly state in the form the reason for signing on behalf of the member, or a certification (on a separate sheet of paper) may also may be issued to this effect, with the full name, complete address and contact number/s of the authorized signatory also indicated.

Provide a photocopy of the authorized signatory's identification card (ID) and/or proof establishing his/her relationship to the member.

6. What if the hospital is not accredited? Will I still get paid?

Claims of members confined in non-accredited hospitals shall not be compensated unless all of the following conditions are met:

  • • Case is emergency as determined by PhilHealth
  • • The hospital or facility has a current DOH license
  • • Physical transfer/referral to an accredited facility is impossible as determined by PhilHealth
7. Are emergency cases covered?

Emergency cases as defined by PhilHealth shall be paid.

8. How will I know if I was deducted the correct amount of benefits?

Members are sent a benefit payment notice or BPN to report the actual payments made by PhilHealth relative to their confinement/availment. The BPN is sent to the address indicated by the member in their claim form.

Should there be discrepancies in the payments and the actual benefits deducted from your hospital and doctors' bills, you may present your BPN, your copy of the hospital's Statement of Account/Billing Statement, and Official Receipts to your health care provider.

9. How long does it take to process a PhilHealth claim?

All claims with complete and properly accomplished documents except those under investigation shall be processed and paid within 60 calendar days from receipt thereof.