Details about the PhilHealth Requirements for Hospitalization (Eligibility & Documentary)
PHILHEALTH REQUIREMENTS FOR HOSPITALIZATION – Here is a complete guide for the members in filing benefit claims.
In the Philippines, a huge part of the Filipino populace is composed of members of the Philippine Health Insurance Corporation. More popularly called PhilHealth, it is a health insurance entity under the government.
The health insurance coverage of PhilHealth is undeniably way cheaper compared with the costs of the insurance policies offered by private companies. Undeniably, most low-income earners in the country as well as middle class individuals prefer a PhilHealth membership.
There are several benefits that PhilHealth members may avail. One of these is the assistance in times of hospitalization due to certain medical conditions. Below, you can check the requirements and the process in availing the benefit for in-patient cases.
Having registered for a membership to the health insurance institution is not the sole requirement in availing its claims. It is important for a member to maintain an updated account by posting the PhilHealth Contribution based on the rate set by the office.
Also, there are specific PhilHealth requirements for hospitalization to qualify to file for a claim. The member must meet the following qualifications to be able to qualify for the claim:
- has paid at least 3 months’ worth of premiums within the immediate 6 months of confinement.
- In the case of pregnancies, availing of the newborn care package, radiotherapy, dialysis, chemotherapy, and selected surgical procedures, 9 months’ worth of contributions in the last 12 months is required
- confined in the hospital for at least 24 hours due to an illness or disease that requires hospitalization
- claim is within the 45-day allowance set for room and board
Aside from the eligibility requirements mentioned above, there are also documents that must be prepared and submitted by the member to the hospital prior to the discharge of the patient.
Here are the PhilHealth requirements for hospitalization:
- clear, updated copy of your Member Data Record (MDR). In the case of dependent, the beneficiary must have been listed in the MDR.
- original copy of PhilHealth Claim Form 1, which you can get at Philhealth, the hospital or your employer. Submit the original copy signed by your employer.
- receipt of premium payments. Employees only need to submit the Certificate of Premium Payments with OR numbers.
- PhilHealth ID and a valid ID
Submit the documents to the billing section of the hospital where you or your dependent is admitted. The hospital automatically deducts the PhilHealth benefits from the total bill of the patient.
