benefit availment procedures

Outright/automatic deduction of benefits

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

• Duly accomplished PhilHealth Claim Form 1
• Proof of applicable premium payments
• Clear copy of Member Data Record (MDR)
  
  If patient is a qualified dependent but is not listed in the MDR, the member must submit 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.

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 after discharge:

• PhilHealth Claim Form 2 (to be filled up by the hospital and attending physicians)
• Official receipts or hospital and doctor's waiver
• Operative record for surgical procedures performed

Confinements abroad

Submit the following within 180 days after discharge. Overseas confinements shall be paid based on Level 3 hospital benefit rates.

• PhilHealth Claim Form 1
• Member Data Record (MDR) or supporting documents
• Proof of applicable premium payments
• 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