Home GUIDE: PhilHealth Hospitalization Coverage and Benefits

GUIDE: PhilHealth Hospitalization Coverage and Benefits

guide philhealth hospitalization coverage and benefits

Estimated reading time: 4 minutes

Understanding your PhilHealth coverage for hospitalization is crucial for tackling the challenges of the healthcare system. With that, this guide aims to elucidate PhilHealth benefits comprehensively, covering hospitalization, eligibility criteria, claims processing, and additional perks.

PhilHealth Hospitalization Coverage

PhilHealth extends coverage for various medical services during hospitalization. This way, they offer financial relief to members. Key points include:

  • Case Rate Amount: The benefit amount hinges on the medical treatment received, with each disease or condition corresponding to a specific case rate. This rate covers professional fees, laboratory tests, operating room use, and room and board fees. Familiarize yourself with the applicable case rate for your condition.
  • Automatic Deduction: Inpatient benefits are automatically deducted from hospital bills upon submission of necessary documents. Ensure your contributions are up to date to qualify. The hospital will liaise with PhilHealth for seamless claims processing.

How to become a PhilHealth Member

To become a PhilHealth member, you need to assemble the following prerequisites:

  1. PhilHealth Essential Documents
  • Two valid IDs or a PSA Birth Certificate
  • Two duplicates of the PhilHealth Member Registration Form (PMRF)
  • Two passport-sized photos (1×1)
  1. For Foreign Retirees
  • Enrollment with the Philippine Retirement Authority (PRA)
  • Completed PhilHealth Member Registration Form (PMRF) for Foreign Nationals, to be submitted to any PRA office
  • Special Resident Retiree’s Visa (SRRV)
  • Permanent residency status
  1. For Foreign Nationals Residing or Employed in the Philippines
  • Valid Alien Certificate of Registration Identity Card (ACR I-Card) issued by the Bureau of Immigration
  • Valid working permit
  • Completed PMRF for Foreign Nationals, to be submitted to any Local Health Insurance Office
  1. For Filipinos with Dual Citizenship
  • Completed PMRF
  • Certificate of Re-acquisition/Retention of Philippine Citizenship (CRPC)
  • Identification Certificate (IC) issued by the Philippine Embassy or Philippine Consulate abroad or by the Bureau of Immigration

Once you’ve gathered all the necessary PhilHealth requirements, follow these steps:

  1. Visit your nearest Local Health Insurance Office or PhilHealth branch.
  2. Ensure you have all the necessary documents. You can obtain the PMRF at the branch you’re visiting.
  3. Complete two copies of the PMRF and submit the filled-out forms.
  4. Await the release of your PhilHealth Member Data Record (MDR) and ID from the staff.

Availing PhilHealth Benefits: Step by Step

Meanwhile, to avail and maximize your PhilHealth benefits, you may adhere to these steps:

  • Eligibility: Fulfill conditions, including payment of at least 3 months’ worth of premiums within the immediate 6 months of confinement. Additional contributions may apply to specific procedures.
  • Regular Premium Payments: Maintain regular premium contributions to remain eligible for benefits.
  • Accredited Hospital: Choose a PhilHealth-accredited hospital for admission, facilitating direct claims processing.
  • Documentary Requirements: Submit an updated PhilHealth Member Data Record (MDR) and the original PhilHealth Claim Form 1 for processing your benefits.

Understanding PhilHealth Confinement Coverage

PhilHealth requires a minimum 24-hour hospital confinement for benefits. The maximum confinement duration is 45 days per member, with a total of 45 days to be shared among dependents.

Senior Citizen PhilHealth Coverage

Senior citizens aged 60 years and above are entitled to PhilHealth benefits, including both inpatient and outpatient coverage.

  • Enrollment Options: Register through the Office for the Senior Citizens Affairs (OSCA) or the PhilHealth Local Health Insurance Office (LHIO).

Exploring PhilHealth Benefits

Beyond hospitalization, PhilHealth also offers coverage for various medical expenses:

  • Inpatient Benefits: Covering room and board, professional fees, and related costs.
  • Outpatient Benefits: Encompassing consultations and diagnostic tests.
  • Z Benefits: Specialized treatment for conditions like leukemia, cancer, and other severe illnesses.
  • SDG-Related Benefits: Covering animal bites, HIV-AIDS, and anti-tuberculosis treatment.

Loaning Options in PhilHealth

How to Loan in PhilHealth: While direct loans aren’t provided, alternative financial assistance options can aid with healthcare expenses.

Maximizing PhilHealth Benefits

Take full advantage of PhilHealth benefits, including coverage for maternity, outpatient services, and specific illnesses.

Final thoughts

By understanding and maximizing PhilHealth benefits, individuals can ensure financial security and access to essential healthcare services. For the latest updates and specifics about PhilHealth membership, referring to the official PhilHealth website or consulting relevant authorities is recommended.

Source: (1)

Leave a Reply

Your email address will not be published. Required fields are marked *