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.
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_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.