I am writing this while my son is confined at The Medical City. Fortunately it is nothing serious but the need for observations and tests by doctors in lab coats required us to be here for more or less four days. I want to take this opportunity to share the requirements to claim PhilHealth benefits.
During our first night, a hospital staff has given me a list of requirements to submit to the Billing section. It is advised that we prepare this even before we are discharged, the requirements are as follows:
Note that this is based on my actual claiming experience.
1. Member Data Record - so remember to secure your MDR even before any of the family members are admitted or gets sick. I got my MDR when I paid the full year at the PhilHealth office. Make sure all details such as status (self-employed, employed, etc) and names (yours and dependents) are correct.
2. Birth certificates - always prepare NSO birth certificates or those that have a registry number. This goes for both the principal member and dependent. Example: My son is confined so I should have my birth certificate and his certificate ready. Actually I don’t get why this is required when members have submitted such documents to PhilHealth initially.
3. Marriage certificate – if married and if your child is confined and the mother is the claimant.
4. PhilHealth Official Receipts – for every contribution you make, you will be issued an OR by PhilHealth. You would think you won’t need to keep these (I thought so but kept them anyways). Again I wish we have better systems in place and not have to deal with so many papers in different sizes.
5. Claim Form - you can download this from the PhilHealth website or ask your hospital for it. The Medical City just gave it to us right away together with the list of requirements. You only need one original accomplished copy.
Tip: I cannot stress how you should have these documents secured always, in one folder and with photocopies. Doing so will give you a peace of mind and the docs are always ready to go in case of emergencies. I have these legal documents in one folder and my life is less stressful ever since.
Am I eligible to claim? Yes, here are the terms of availment according to the PhilHealth official website:
The following must first be met to avail of your PhilHealth benefits:
1. Payment of at least three monthly premiums within the immediate six months prior to confinement.
2. For pregnancy-related cases and availment of the new born care package, dialysis (except those undergoing emergency dialysis service during confinement), chemotherapy, radiotherapy and selected surgical procedures, payment of nine (9) monthly premium contributions within the last 12 months shall be required except for those enrolled under the KASAPI program.
Confinement in an accredited hospital for at least 24 hours (except when availing of outpatient care and special packages) due to an illness or disease requiring hospitalization. Attending physicians must also be PhilHealth-accredited.
Availment is within the 45 days allowance for room and board.
Kindly stick around for part two because I have yet to find out if my PhilHealth claims will be successful and to what extent deductions would be from our hospital bills. Kudos to The Medical City for helping, reminding, and informing patients of PhilHealth stuff. It was one thing less to worry about.
You may want to read this related article from my mommy blog: