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Do Indigents Have PhilHealth Benefits in Private Hospitals?

Do Indigents Have PhilHealth Benefits in Private Hospitals?

Are you an indigent member of PhilHealth? Learn the PhilHealth benefits you’re qualified for, and whether or not you can use PhilHealth if hospitalized in a private institution. 

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

Who Is Considered “Indigent” by PhilHealth?

Indigent members1 are people with no visible means of income or have insufficient income for family subsistence as per definitions set by the Department of Social Welfare and Development (DSWD). 

What Is PhilHealth Indigent Program?

PhilHealth has a category that covers indigent members. 

Those who are under this category are automatic members of PhilHealth and are subsidized by the Philippine government. As it is, they enjoy benefits covered by PhilHealth both in government and private hospitals. 

PhilHealth Indigent Benefits in Public Hospital

In PhilHealth accredited government hospitals, as per PhilHealth Circular 2017-0006, a no-balance billing policy2 is implemented for indigents, sponsored members, senior citizens, and household help. This means that for admission to a PhilHealth-accredited hospital, these members will not be charged or spend out-of-pocket for services beyond the packaged rates. 

NBB patients shall be given access to social welfare funds or other medical assistance programs to augment the benefits package to cover all facility charges. 

PhilHealth Indigent Benefits in Private Hospital

In private hospitals, PhilHealth will only cover up to the limit set by the case rate, and the no-balance billing policy is subject to the approval of the corporation. As it is, the NBB is applicable mainly to government hospital PhilHealth beds or service beds and very selected private hospitals.

In the event that the indigent patient is admitted to a private facility, PhilHealth benefits will still be deducted depending on the case rate, but any other additional expenses set by the private hospital (if the hospital does not have an NBB policy)  will either be shouldered out-of-pocket by the patient or coursed through the hospital’s charity/social services. 

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

Reference

  1. Indigent Member. (n.d.). Retrieved October 4, 2022, from https://www.philhealth.gov.ph/members/indigent/
  2. Philippine Health Insurance Corporation (PhilHealth). (2017, January 20). PhilHealth Circular No. 2017-0006: Strengthening the Implementation of the No Balance Billing Policy (Revision 1) [Press release]. Retrieved October 4, 2022, from https://www.philhealth.gov.ph/circulars/2017/circ2017-0006.pdf

Written by Camille Lamera, MD

in Ask an Expert, Government Services, PhilHealth

Last Updated

Camille Lamera, MD

Camille Lamera is a medical doctor with clinical and government work experience. She has always been passionate about health education and public service, having worked in two government offices and as a part-time educator in Preventive and Community Medicine. She is currently working as a doctor in public health while also doing freelance academic and scientific writing.

Browse all articles written by Camille Lamera, MD

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