PhilHealth


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Members

Frequently Asked Questions


Membership and premiums concerns

1. I don't have a Birth Certificate anymore. What can I present to PhilHealth instead?

In the absence of your Birth Certificate, you may submit a clear copy of any two valid IDs/documents instead to register as a Lifetime Member.

2. In case of early retirement, can I already register as a Lifetime Member?

One is qualified to register as a Lifetime Member if he/she is already 60 years of age and has made at least 120 monthly contributions to PhilHealth and the previous Medicare. Hence, if you retired for instance, at the age of 50, you must continue paying premiums as an Individually Paying Member until you reach the age of 60 and have made the required number of premium contributions.

3. Is it true that retiring employees can now be automatically enrolled by the employer in the Lifetime Member Program?

YES. As per PhilHealth Circular No. 28, s-2010, retiring employees in the government and private sectors must be enrolled into the Lifetime Member Program and their enrollment must be facilitated by their employers at least three (3) months prior to the date of retirement.

The application for Lifetime Member Program shall be filed with PhilHealth as soon as the employee's retirement application has been approved by the employer. The employer's Human Resource Management Office, through its authorized representative, shall ensure that the documentary requirements for registration are forwarded to PhilHealth for processing.

4. Do I need to personally submit my registration documents or can I ask my representative to do so?

There is no need for you to personally submit your registration documents. Your representative is allowed to submit your documents to PhilHealth for processing as long as you have affixed your signature/thumbmark (whichever is applicable) on the registration form.

5. Is my lifetime coverage transferable?

Your PhilHealth coverage as a Lifetime Member is non-transferable.


Benefits and availment concerns

1. In case I get hospitalized, can I avail of benefits as a dependent of my son/daughter or is it required that I immediately register as a Lifetime Member to avail of my benefits?

In case you are hospitalized and it is not easily possible for you to register as a Lifetime Member, yes, you have the option to be declared as a dependent of only one of your children to immediately avail of your benefits.


It is advised, however, that you still register as a Lifetime Member afterward if you have already paid at least 120 monthly premiums.

2. Will my PhilHealth coverage affect my 20% discount as a senior citizen's cardholder?

No. Your privilege as a senior citizen is a separate benefit and the 20% discount must first be deducted from your hospital bill prior to the application of PhilHealth benefits.

3. 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
4. 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.

5. 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 days 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.

6. 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.

7. Are emergency cases covered?

Emergency cases as defined by PhilHealth shall be paid.

8. 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
9. 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.

10. 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.