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How to file for PHILHEALTH benefits, especially for an operation

First of all, a Merry Christmas to my dear readers!

This year’s Yuletide season is particularly more momentous for me since I just underwent a gallbladder removal surgery last December 20 at a private hospital here in Metro Manila. My internal medicine doctor recommended me for an operation because of the presence of stones in my gallbladder (gallstones or “bato sa apdo” in Filipino).

The whole ordeal will be tackled at length in future posts, but for now, I’ll focus on how you can apply for PhilHealth benefits because it can really help a lot. The cost of my hospitalization almost reached P100, 000 (hospital bill plus the professional fees), and luckily, PhilHealth shouldered roughly a third of it. Please take note of the fact that I’ve only made 28 contributions to them so far.

First question: Does your employer deduct PhilHealth (or Philippine Health Insurance Corporation) contributions from your regular salary? You can check that in your latest pay slip.

Monthly premiums are shared equally between the employee and the employer. These, according to the PHIC website, are remitted by the employer through accredited payment centers nationwide. Keep in mind however that some companies do not entitle contractual employees (or casual, non-permanent) to PhilHealth benefits.

PhilHealth benefits can be very helpful during prolonged hospitalization

Second question: Does your employer remit these contributions to PhilHealth? You can proceed to your HR department (or the payroll unit) to ask for a Certificate of Contribution (CoC). If needed, you may also have to contact your former employer/s for this. This will be required by the hospital as soon as you apply for PhilHealth benefits. What should be included in the CoC? The certification that I got is only one page long, and it contained the following information:

1) Your name and PhilHealth number

2)  Months covered by the payment

3) The dates when the company remitted the contribution

4) OR (Official Receipts) numbers of these payments

5) The amount of contributions

6) Signature of the designated company official

After securing this, you also have to submit your updated Member Data Record sheet. In case this is not provided by your employer, proceed directly to the nearest PhilHealth office. For those living in Metro Manila, this directory may be helpful.

Let’s now proceed to Claim Form 1, which is the most important since it has to be signed by your employer. My company has ready-to-claim CF1s (signed in advance by our HR head). You must submit the sheet originally signed by your employer. You can download PhilHealth Claim Form 1 here.

Claim Form 2 is usually not provided by employers (alongside Claim Form 3), since hospital staffs are the one working on this. In any case, you can download PhilHealth_ClaimForm2 here and PhilHealth_ClaimForm3 here.

Why is it more convenient to file PhilHealth claims before your hospitalization? This is helpful if you do not have large cash on hand (some hospitals won’t allow you to be discharged unless you settle all incurred bills). If you opt to instead seek reimbursement for the expenses after the operation, the processing of claims takes 60 working days. Also, some HMOs require their members to immediately file for PhilHealth benefits.

PS: What I’ve written here applies only for locally employed PhILHEALTH members.

Comments

comments

26 thoughts on “How to file for PHILHEALTH benefits, especially for an operation”

  1. morion says:

    nice post!very informational,
    laking tulong tlga pg may philhealth:)

    1. markpere2010 says:

      Salamat po for reading. Hope you can visit again. 🙂

      1. morion says:

        sure mark! will visit dis blog daily

      2. markpere2010 says:

        Thank you so much. Sir, please feel free po to browse my site. I also post pics every now and then, though I do not have a flashy camera. 🙂

  2. chrisair says:

    Thanks for this helpful info, so confused to used it, the last time that I pay for my sons hosptal bill blew out to 20k for ordinary fever

    1. markpere2010 says:

      That’s a lot. In the form that I signed, you can actually indicate there whether your dependent is the one using it. The hospital/clinic you went to should have assisted you on that.

  3. Gil Camporazo says:

    Thank you for sharing your experience on how you went along in processing your PhilHealth coverage since you’re confined lately to a hospital. I had a very disgusting experience with regards to claiming a hospitalization benefits. I’m a government employee. My insurance before was GSIS. My eldest daughter was confined to a hospital for 5 days. When she was about to be discharged from the hospital I had to file a claim. Just to find out that I need documents and everything that signifies that I’m a GSIS member. To my dismay, I knew from my employer that I was not covered for I did not apply according to them. So I had to usher my application, filed it and had my daughter out from the hospital. Just imagine I’ve been paying the GSIS for almost a year, but I’m yet a member. Very disgusting!

    1. markpere2010 says:

      Hi, Mr. Gil. Thanks for sharing your experience here. I know that can really happen, which is why I am advising my readers here to check with their employers first if their contributions are indeed being remitted to PHILHEALTH. It is very frustrating to belatedly know of these problems at the last minute.

  4. sarj says:

    Hi Mark!

    Thanks for the info ha..nakuu, super tagal ko ng ala sa gov’t nakalimutan ko na ang mga bagay bagay.LOL. very informative:)

    1. markpere2010 says:

      Hi, Sarj! Thanks for dropping by. Actually, kahit naman wala ka sa government dapat alam mo pa rin ito. 😛

  5. Tess Torrecampo-Chancellor says:

    Ofw’s are not happy sbout the phil health being added to their yearly payment but i think it is worth it .it’s a big help for their family back home .

  6. Ako Tungaw says:

    Maganda sana ang philhealth lalo ung mga nasa Pinas mismo…Kaso ang problema mukhang ginagatasan lang ng PhilHealth ang mga OFW dahil sa pagdagdag ng monthly na binabayran ng ofw para jan…

    1. markpere2010 says:

      Mr. Ako Tungaw, I am not privy as to PhilHealth rules on OFWs. Pero if what you said is indeed happening, it should be investigated. Re Miss Tess’ point: definitely, PHILHEALTH contributions will reduce your monthly take-home pay, but in times of prolonged hospitalization, it will be a big help.

      Thanks for visiting

  7. c5 @ house-lot-laguna-cavite.com says:

    Hubby has only claimed once. It was not easy but glad it was over.

  8. Career Mom Online says:

    First off, I hope you’re doing much better now. I agree with all of the points you’ve made above. Me and my kids have gone through some hospitalizations in the past. Although you’ve already pointed out the word “updated,” I would like to reiterate though that it is IMPORTANT to make sure that the company you work for NOW (if you are employed, that is,) and the company you have listed in your MDR (Member Data Record) should be one and the same. There’s a chance the hospitals won’t honor the MDR otherwise.

    1. markpere2010 says:

      Thanks for stressing that point! I’m sure my other readers will find that information very useful.

      Right now, the abdominal incisions still hurts a bit although I can already walk continuously unlike before when merely standing up straight was very difficult.

  9. jquiogue says:

    Ateneo has this movement wherein they would like to provide PhilHealth for poor families around the country. It’s a big movement and I hope you check it out. It’s called Project LAAN!

    1. markpere2010 says:

      You seem to be a part of it. I just wonder how they’ll go about the need for monthly contributions.

  10. Z says:

    Thank you for the valuable info. 🙂

    1. markpere2010 says:

      Happy to be of help!

  11. Janice Viterbo says:

    Good day,

    I had read your blog about philhealth benefits and it really helps a lot to me give some information about this,especially that I have to go under operations this November to remove my gallstones,can I ask you a question is it really a requirement to a hospital to submit my COC? because I have a problem with my employer because they cannot provide me a coc they said that the only requirements to Philhealth benefit claims is at least latest 6mos contributions and I have checked to Philhealth action center that I have some missing contributions since I was hired in 2010 in their company,please help me with this. Thank you so much.

  12. TinaB says:

    Can I ask for a copy of my certificate of employment even if Im not planning to avail of any of the services (claims, etc.)? Thank you

  13. E. Jack says:

    Sana po ay pwedeng madownload ang MDR on-line by simply entering our Philhealth ID# napakahirap pong pumila sa Philhealth offices para lamang kumuha ng MDR bakit po ganito ang service ng philhealth bago ka makakuha ng Member Data Record ay magkakasakit ka na rin.

    1. Mark Madrona says:

      Naku, sana nga. Maybe in the future.

  14. joey dela cruz says:

    pwede ho bang gamitin ang old mdr sa mga claims

  15. cheap cosmetic dentistry says:

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