Frequently Asked Questions
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, you can submit the following:
- E-Receipt as proof of applicable premium payment
- Clear copy of the following:
- Spouse - Marriage Contract/Certificate
- Child/ren - Birth Certificate
- Parents - Birth Certificate of Member & Parents
2. What do I need to submit to have my reimbursement cheque named after my wife in the Philippines?
We need a letter from you authorizing PhilHealth 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 your Marriage Contract. You may also consider issuing your wife a Special Power of Attorney (SPA) to make it more convenient.
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:
- PhilHealth Claim Form 1 accomplished and signed by the member or his authorized representatives;
- Photocopy of MDR or latest receipt;
- Medical certificate with complete diagnosis, period of confinement and services rendered;
- Statement of Account and/or Official Receipts with itemized charges; and
- Other supporting documents.
(Items No. 3 & 4 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 in 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 completely 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 through outright/automatic deduction from hospital bills. Just 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 philhealth_hk@philhealth.gov.ph or call at +63 0917 5129149 or the address and phone nos. in the PhilHealth Directory of offices found in this website.
The following information are needed for proper verification of your claim:
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 PhilHealth
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
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 legal supporting documents (for dependents who are not listed in the MDR) to any of the 42 participating DOH hospitals in the Philippines.