For one to become eligible for the benefits, payment of at least three (3) months within the immediate six (6) months prior to the month of confinement shall be required. However, payment of at least nine months within the last 12 months shall be asked of Individually Paying Members availing of the following procedures/packages:
However, beginning July 2011 (as per PhilHealth Circular #25, s-2010), Individually Paying Members and Employed Members will now be required to have at least nine (9) months contributions within twelve (12) months prior to the month of availment for all confinements including availment of outpatient benefits.
If your dependent gets hospitalized and he/she is not listed in your MDR yet, you may submit a clear copy of the following:
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.
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.
Claims of members confined in non-accredited hospitals shall not be compensated unless all of the following conditions are met:
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.
All claims with complete and properly accomplished documents except those under investigation shall be processed and paid within 60 calendar days from receipt thereof.
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