For an indigent to be enrolled as a PhilHealth Sponsored Member, he/she can go to the local office of the DSWD who in turn, will evaluate and determine if he/she is qualified to join the program. The DSWD shall then endorse the list of possible beneficiaries to the Local Government Unit (LGU) or any Sponsor.
A Sponsored Member doesn't pay any PhilHealth premiums since these are being subsidized by the National Government through PhilHealth and a Sponsor such as the LGU. The National Government and the Sponsor jointly pay the annual premium for each enrolled family.
To continue his PhilHealth membership once his ID expires and his coverage has not been renewed by his Sponsor yet, a Sponsored Member should enroll as an Individually Paying Member and pay his premiums within the calendar quarter or before the expiry date as reflected in the PhilHealth Identification Card.
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 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.
Emergency cases as defined by PhilHealth shall be paid.
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.
Simply present your valid PhilHealth Identification Card to your PhilHealth-accredited Health Center to avail of any of the following outpatient benefits FOR FREE:
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