May 03 - 1

In a previous article, we featured the guidelines on how you can be sure that you are eligible to claim your PhilHealth benefits after you have been confined and treated in a hospital.  There are cases, however, when even a qualified PhilHealth member is not able to fully enjoy his privileges in spite of showing sufficient proof that he or she must be afforded his PhilHealth benefits.  Sadly though, the causes of these issues are often due to the medical facility’s negligence and refusal to abide by the policies set by PhilHealth for its affiliated clinics and hospitals.

To help you maximize your PhilHealth benefits, here are four important tips you need to know when applying your privileges as a PhilHealth member:

  • PhilHealth does not refund benefits directly to members.

This means that the hospital or clinic must deduct the amount of PhilHealth’s participation in your treatment, from your total hospital bill.  The benefits may not be converted to cash that the hospital “pays” to the patient.

  • The PhilHealth benefit must be applied AFTER other tax deductions, including the Senior Citizen discount.

The Senior Citizen discount and Value-added Tax (VAT) are different from PhilHealth benefits.  If the patient is a Senior Citizen, the SC and VAT must first be deducted from his total hospital bill, before his PhilHealth benefits are applied.

This computation is applicable only if the No Balance Billing was not applied to the patient’s case.

  • 3 Must-have documents when claiming your PhilHealth benefits:
    • PhilHealth Claim Form 1 (CF1)
    • Member Data Record (MDR)
    • Contributions Record
  • PhilHealth members with complete documents must not be made to pay the hospital bill in full.

Some health institutions make the patient pay the full hospital bill with the promise of refunding them their PhilHealth benefits after they have received the funds from PhilHealth.

This is not how PhilHealth benefits are disbursed to members.

Should the hospital demand that you pay the bill in full, even after you have satisfied all requirements for the application of your PhilHealth benefits, report them right away to PhilHealth.  Most hospitals have PhilHealth helpdesks in its premises; you may also call the PhilHealth call center at 02-441-7442.

Reference: www.philhealth.gov.ph

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