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benefit availment conditions

Eligibility Requirements
  • Payment of at least three monthly premiums within the immediate six months prior to the month of confinement. For pregnancy-related cases, dialysis (except those undergoing emergency dialysis service during confinement), chemotherapy, radiotherapy and selected surgical procedures, payment of nine (9) monthly premium contributions within the last 12 months shall be required except for those enrolled under the KASAPI program.
  • Confinement in an accredited hospital for at least 24 hours (except when availing of outpatient care and special packages) due to an illness or injury requiring hospitalization.
  • Attending physicians must also be PhilHealth-accredited.
  • Availment is within the 45-day allowance for room and board.
Post availment reminders

After the automatic deduction or reimbursement of your benefits, PhilHealth will send the Benefit Payment Notice or BPN to the address indicated in the member’s claim form. The BPN is a report of actual payments made by PhilHealth relative to member’s the confinement/availment. Should there be discrepancies between the amounts reflected in the BPN and in the member’s final billing statement issued by the hospital, or if the member has other concerns pertaining to benefit availment, he may contact PhilHealth or the health care provider. The member must bring the BPN as reference document.