PhilHealth


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Members

Frequently Asked Questions


Membership and premiums concerns

1. How do I enroll with PhilHealth and renew my membership thereafter?

If in the Philippines, submit the following documents to any PhilHealth office:

  • • Properly accomplished duplicate copies of the PhilHealth Member Registration Form (PMRF);
  • • Supporting documents for legal dependents to be declared;
  • • Any proof of being an active OFW and;
  • • Pay the corresponding premium contribution to any PhilHealth office

If overseas, submit the following documents to any PhilHealth office:

  • • Properly accomplished PhilHealth Premium Payment Slip (PPPS);
  • • Duplicate copies of the PhilHealth Member Registration Form (PMRF) - for initial registration only;
  • • Any of the following documents: Birth Certificate, Baptismal Certificate, POEA ECARD/SSS/Company ID, Passport, Any valid ID / document acceptable to the Corporation and;
  • • Pay the corresponding premium contribution of P1,200.00 (for Year 2012) or its equivalent in the local currency of the host country to any accredited collecting agent
2. Are we going to use the same PhilHealth Identification Number (PIN) if we are shifting to another membership category?

Your PhilHealth Identification Number (PIN) is your PhilHealth number for life. Hence, if you are shifting to another membership category, you will be using the same PIN.

3. Why do I have to renew my PhilHealth membership every time I leave the country and work as an OFW?

It's not actually renewal of membership but an updating of your premiums, which shall be equivalent to the length (in years) of your fresh contract. It will also ensure your continuous eligibility to PhilHealth benefits.

4. I am already an immigrant here in the US. Can I still continue my membership with PhilHealth?

You can still continue paying for your PhilHealth coverage as an Individually Paying Member and not as an Overseas Worker Member.

5. How about those granted dual citizenship? Can they continue with their PhilHealth membership?

Those with dual citizenship still have the option to continue paying for their PhilHealth coverage also as Individually Paying Members.

6. What is the effectivity date of PhilHealth coverage?

PhilHealth benefit coverage starts upon payment of premium (no waiting period) and is valid for one year from the date of payment.

7. I am currently abroad and my coverage is about to expire. How do I continue paying for my PhilHealth in case that there are no available payment centers where I am?

You may ask your relatives in the Philippines to pay your premiums on your behalf to avoid any lapses or delays. They only need to present a valid ID & an authorization letter from you as the member and any document that would attest that you are still an active OFW.

8. Are the payments for OWWA Contributions and PhilHealth Premiums different?

OWWA contributions serve as a life insurance of the OFW abroad while PhilHealth premiums ensure the health benefits of the OFW and his/her dependents in case of illness or injury requiring hospitalization.

9. I am a PhilHealth member sponsored by an LGU; is it still necessary for me to pay my PhilHealth membership as an OFW?

If a member is sponsored by an LGU and the membership is still active, the member shall pay for his/her PhilHealth membership as an OFW when the coverage of his/her sponsored membership expires.

If in case the member already paid his/her membership as an OFW while his/her sponsored membership is still active, the member is advised to go to any PhilHealth office to make necessary adjustments on his/her membership coverage.

10. Where can I pay my Premium Contribution?

Overseas, you may pay at any PhilHealth Overseas Accredited Payment Center. In the Philippines, you or your immediate family or representative may pay at any PhilHealth Office and Accredited Collecting Partner.

11. How much is the Premium Contribution?

OFW members are required to pay the one-year premium of Php1,200.00 for CY 2012. However, they may pay more than one year depending on the number of years provided in their contract.

12. What is the grace period of OWP membership renewal?

OFWs are allowed to pay the applicable premium within one (1) month from the date of expiry. Payment within this period shall retroactively commence the coverage of membership from date of expiration.


Benefits and availment concerns

1. In the absence of the MDR, is there a substitute document that my family back in the Philippines could use if someone gets sick?

In case the MDR is not available or not yet updated and someone among your qualified dependents gets sick, the following documents must be submitted:

  • • E-Receipt as proof of applicable premium payment
  • • Clear copy of the following:
    • Spouse - Marriage Contract/Certificate
    • Child/children - Birth Certificate
    • Parents - Birth Certificate of Member and any proof of the parents' date of birth
2: What do I need to submit to have my reimbursement cheque named after my wife in the Philippines?

Simply submit an authorization letter for us to issue the cheque under the name of your legal spouse, together with clear copies of your two valid IDs, two valid IDs of your wife, as well as of your Marriage Contract. A Special Power of Attorney (SPA) may also be issued to your wife.

3. I am scheduled for confinement abroad for an operation; is this confinement covered by PhilHealth?

Confinement due to sickness or for an operation is compensable with PhilHealth even if it is done abroad. You have 180 days or 6 months within which to file your claim for reimbursement at any PhilHealth office near your local residence.

4. What are the documentary requirements?

The following documents must be submitted for your claim processing:

  • a. PhilHealth Claim Form 1 accomplished and signed by the member or his authorized representatives;
  • b. Photocopy of MDR or latest receipt;
  • c. Medical certificate with complete diagnosis, period of confinement and services rendered;
  • d. Statement of Account and/or Official Receipts with itemized charges; and other supporting documents.
    (Items c & d should be translated in ENGLISH)
5. While working abroad our employer provided us with a health insurance that will cover my expenses during hospitalization. In case of confinement can I still file for a reimbursement with PhilHealth?

The insurance was part of your benefit as an employee of your employer abroad. You may file your claim reimbursement at any PhilHealth office in the Philippines as long as the documentary requirements are complete and properly submitted.

6. How will I avail of PhilHealth benefits if I or my dependents are confined in the Philippines?

PhilHealth benefits can be availed of through outright/automatic deduction from hospital bills. Submit the following documents to the hospital:

  • • PhilHealth Claim Form 1 accomplished and signed by the member or its immediate family member
  • • Photocopy of MDR or latest receipt and other supporting document if the patient is not reflected as dependent in the MDR
7. How long does it take to process a PhilHealth claim?

All claims except those under investigation shall be processed and paid within 60 calendar days from receipt thereof.

8. I have read in your website that one of the requirements for filing of claim for confinement abroad is a copy of receipt for the hospital bill and professional fee (PF) of the doctor. What other documents can I submit as a substitute for this if I have not been issued an official receipt?

If you were not given an official receipt for the payment you made for the hospital bill and professional fee, you may submit instead a copy of your Statement of Account. It must contain the breakdown of charges for room and board, medical supplies, laboratory procedures, operating room fee and professional fee.

9. 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 themselves of the unused portion of the benefits and room and board allowance until the 45 days allowance is exhausted.

However, members can avail themselves of a new set of benefits if succeeding confinements are of different illnesses or conditions.

10. I am currently working abroad; who can sign in my behalf on PhilHealth Claim Forms?

If the member is not readily available to sign the forms when reimbursing with PhilHealth, a married member may let his/her spouse sign in his/her behalf or his/her children as long as they are at least 18 years old or the parents in the absence of his/her spouse and children. Meanwhile a member who is single can let his/her parents sign in his/her behalf, or any authorized representative as long as the representative has an authorization letter from the member and a photocopy of his/her 2 valid IDs as well as 2 valid IDs of the member.

11. How can I verify the status of my claim?

You may e-mail us at owp@philhealth.gov.ph or call at (+63)09175129149.


The following information are needed for proper verification of your claim:

  • • Patient's Complete Name
  • • Date of Confinement
  • • Name of Hospital
12. What are the cases that are not compensable with PhilHealth?

  • • Fifth and subsequent normal obstetrical deliveries
  • • Non-prescription drugs & devices
  • • Alcohol abuse or dependency treatment
  • • Cosmetic Surgery
  • • Optometric Services
  • • Cost-ineffective procedures that shall be defined by PhilHealths
13. How are in-patient benefits computed?

  • • Benefits are computed based on ward type accommodations only
  • • Benefits have limits/ceilings
  • • Based on hospital category and case/type of illness
    • Level 1 Hospitals (Primary)
    • Level 2 Hospitals (Secondary)
    • Level 3 & 4 Hospitals (Tertiary)
14. How can I avail of the Out-Patient Benefit Package (OPB) for OFWs?

Simply present a photocopy of your Member Data Record (MDR) or latest receipts and supporting documents (for dependents who are not listed in the MDR) to any of the 42 participating DOH hospitals in the Philippines.