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benefit availment procedures

Outright/automatic deduction of benefits

1. Submit the following to the billing section prior to hospital discharge:

  • Duly accomplished PhilHealth Claim Form 1
  • Clear copy of Member Data Record (MDR)

    For qualified dependent not listed in the MDR, submit clear copy of applicable proof of dependency.

2. Agree with your attending physicians on how much is left to be paid for their services over the professional fee (PF) benefit.

3. Upon submission of all applicable documents, the billing section will compute and deduct your benefits from your total hospital bill.

Direct Filing/reimbursement

Submit the following to PhilHealth or through the hospital in addition to the documents mentioned earlier within 60 calendar days from the date of discharge:

  • PhilHealth Claim Form 2 (to be filled up by the hospital and attending physicians)
  • Official receipts of payments made to the hospital and to the doctor's waiver
  • Operative record, if surgical procedures was performed
Confinement abroad

Submit the following within180 days from the date of discharge. Overseas confinements shall be paid based on Level 3 hospital benefit rates and in the Philippine peso equivalent. Overseas confinements shall be paid based on Level 3 hospital benefit rates.

  • PhilHealth Claim Form 1
  • MDR or supporting documents
  • Original official receipt or detailed statement of account (written in English)
  • Medical certificate (written in English) indicating the final diagnosis, confinement period and services rendered.