First time using PhilHealth in a hospital? Do you have zero clue what benefits PhilHealth can provide once you’re admitted to a hospital? Here’s a complete guide to making the most of PhilHealth’s hospitalization benefits. 

Disclaimer: This article has been published for educational purposes only. Neither the author nor FilipiKnow is affiliated with PhilHealth, so specific queries about your membership and insurance benefits must be forwarded to the proper authority.

Table of Contents

• What Are PhilHealth Hospitalization Benefits?
• Who Can Avail of PhilHealth’s Hospitalization Benefits?
• PhilHealth Requirements for Hospitalization 
• How To Claim PhilHealth Hospitalization Benefits
• References

What Are PhilHealth Hospitalization Benefits?

Also known as inpatient benefits¹, these benefits are paid by PhilHealth to accredited hospitals where you’re admitted for at least 24 hours. The amount depends on the medical treatment you received as each disease has a corresponding case rate amount. In turn, the hospital will then deduct this case rate amount (inclusive of professional fees of attending physicians, laboratory tests, operating room use, and room and board fees) from your total bill before discharge. 

Inpatient benefits differ from outpatient benefits, which cover medical treatments and procedures that don’t require hospitalization. 

PhilHealth inpatient benefits should be automatically deducted from your hospital bill without separate filing once you have submitted the documentary requirements. 

Another thing to check is if your contributions are up to date. While all members are automatically entitled to PhilHealth benefits because of the Universal Health Care Law, you will still have to pay for unpaid contributions. 

Who Can Avail of PhilHealth’s Hospitalization Benefits?

To be eligible, you must have satisfied the following conditions²:

• Payment of at least 3 months’ worth of premiums within the immediate 6 months of confinement. For pregnancies, availing of the newborn care package, dialysis, chemotherapy, radiotherapy, and selected surgical procedures, nine months’ worth of contributions in the last 12 months is needed.
• Sufficient regularity of payment of premium contributions.
• No legal penalties as defined in RA 7875
• The hospital must be PhilHealth-accredited
• For hospital admissions, the period of confinement must be at least 24 hours 
• 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 dependents. 

PhilHealth Requirements for Hospitalization

The hospital will ask you to submit the following documents: 

• An updated copy of PhilHealth Member Data Record (MDR). If for a dependent, it must be stated in the MDR
• Original copy of PhilHealth Claim Form 1 
• PhilHealth ID and Valid ID

How To Claim PhilHealth Hospitalization Benefits

The process of using PhilHealth benefits in accredited hospitals is as follows: 

1. As early as being admitted to the Emergency Room, inform the hospital staff that you have an active PhilHealth membership and show your PhilHealth ID in the admitting section.
2. Before discharge, fill up a PhilHealth Claim Form 1. Submit this to the ward nurse or the billing section (depending on hospital protocol). Ensure your supporting documents are attached, especially a copy of your PhilHealth ID and MDR. 
3. Check with the Billing section on coverage and if there are other fees.
4. PhilHealth coverage should be automatically deducted from your hospital bill before discharge. 

Return to the main article: How To Register in PhilHealth Online: A Complete Guide for New Members

References

1. Inpatient Benefits. (n.d.). Retrieved September 14, 2022, from https://www.philhealth.gov.ph/benefits/
2. Philippine Health Insurance Corporation (PhilHealth). (2019, March 26). PhilHealth Circular No. 2019-0004 [Press release]. Retrieved September 14, 2022, from https://www.philhealth.gov.ph/circulars/2019/circ2019-0004.pdf