How to Process PhilHealth Papers for Hospitalization Benefits

Processing PhilHealth papers is not only difficult but it is also tough to claim for hospitalization benefits.  It's disappointing enough to know that you cannot claim your PhilHealth benefits caused by lack of requirements.  What's worse is when you don't have the financial capacity to pay for hospitalization resulting to your patient being unable to be released in the hospital.  

PhilHealth reimbursement will only be given after a few days of hospitalization. If you have a friend or relative that can lend you money, well then, good for you. But if not, you will be in major trouble.

Even without hospitalization, there are some helpful tips to prepare you for PhilHealth benefits so that you will not rush when the need arises:

Step 1. Ask a copy of your  Member Data Record (MDR) from your employer or from accredited PhilHealth Offices. The MDR is very important because it is your evidence that you are indeed a member of PhilHealth. It contains your basic information especially your beneficiaries.  If your patient is one of your beneficiary, it will reflect on your MDR and you have lesser trouble in claiming for benefits.  If your main office is far from the hospital you are admitting your patient, then there is no truble asking for your MDR because you already have it.

Step 2. The government is requiring employers to register in the portal of accredited hospital institutions for easy application of its employees for benefits. With this feature, in place of the MDR, the PhilHealth Benefit Eligibility Form (PBEF) is used instead.  A one click away that signifies yes from your employer’s compliance to the portal will not need any MDR from you or your employer. You can ask your employer or employment agency about this eligibility to help you to avail of this instant process

Step 3. Be sure that you/ your employer/employment agency have paid the required monthly contribution to PhilHealth. Members must have at least three months monthly contributions within the immediate six months prior to the month of availing it.  So you have to ensure that you pay the monthly contributions to give you security to claim benefits.  Anyway, what is a 200 pesos a month compared to long lasting benefit that you can have.

When you comply with the three listed above, the only thing you now have to fill up is the PhilHealth Form given to you by the hospital for processing.  This will require the signature of your employer if you are using the traditional MDR.  But if you are qualified for the PBEF, there is even no need for your employer’s signature because the rule is automatic reimbursement with this kind of automation.

Read Also: How to check PhilHealth contribution online

However, if you have not prepared for the three above, there are still some things that you could do to hasten your processing.  Upon the first day of hospitalization, go to your employer right away or to any Phil Health Office for the papers.  Check your listed beneficiaries with them.  If the patient is not listed among the beneficiaries, you can still include him/her in your membership especially if he/she is a newborn baby.

For the nonpayment of continuous premium contributions, this will hardly be solved.  But at times, depending on the situation, the office is allowing a method to pay for the unpaid contributions through the help of the hospital.  You can ask assistance from hospital administrators regarding the matter.

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Procedure for using PhilHealth benefits in accredited hospitals

1. Inform the emergency room nurse that you are going to use PhilHealth for the admission.

2. Show your PhilHealth ID at the admitting section of the hospital.

3. The period of confinement must be for at least 24 hours, and the maximum number of days per confinement is a total of 45 days for the member and a total of 45 days to be shared among all dependents.

4. The PhilHealth ID must be valid for the current year and the patient must use a PhilHealth-accredited rural health unit, clinic or hospital.

Preparing for claiming PhilHealth Benefits ahead of time is a wise thing to do.  Start to prepare now to avoid problems in the future.  

Remember, PhilHealth is increasing its monetary benefits to its members.

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