PhilHealth works like an insurance company, except that it is mandated by the government. The agency can help cover your medical bills or parts of it. However, there are eligibility requirements you must meet before you can enjoy PhilHealth benefits.
PhilHealth subsidizes your hospital bills based on the amount you have incurred. The agency typically pay parts of doctor’s professional fees, laboratory tests, and other medical costs.
To maximize your PhilHealth membership, it is important for you to know the benefits that you are entitled to, as well as the requirements you need to procure to allow you and your beneficiaries to fully enjoy your entitlements.
You as a member and your qualified dependents are entitled to benefits for medical expenses for every sickness or operation.
Both, you as a member and your legal dependents, can get equal benefits.
Every year, there is an allocated 45 days hospitalization allowance for the member and 45 days to be divided to all qualified dependents. Hospitalization days in excess of 45 days will not be covered by PhilHealth.
Secondly, these benefits can be used by you as a member and your qualified dependents, provided that:
- You, as a member, have updated contributions (except Lifetime and Senior Citizen Members) or valid PhilHealth coverage (for Sponsored, Indigent, and OFWs).
- That the hospital or clinic that you went to is PhilHealth-accredited.
- And that the allocated 45 days in a year has not yet been consumed (except for other PhilHealth benefits such as hemodialysis)
According to Philhealth’s December 2019 contribution table, members of the formal economy (kasambahay, family drivers, sea-based OFWs) and employees of both public and private sectors will have the following monthly premium. The contribution will be shared by both the employer and employee for those formally employed, meanwhile direct contributory members (freelancers, professional practitioners, self-employed, and OFWs) will pay it annually in full.
Other than the SSS and Pag-IBIG benefits, the company has also availed of the PhilHealth benefit.
Here are the steps on how to avail said benefit:
1. If an employee or his/her dependents are confined for at least 24 hours and have not used up the 45-day allowance for a room and board in the hospital for the current year, the employee shall inform his/her immediate head/team leader about their hospital confinement or their intention to claim the Philhealth Benefit for his/her dependent.
2. The immediate head will be the one to inform the finance department about the intention or the confinement by e-mailing them through this e-mail address: finance@houseofit.com.au.
3. The finance staff will then check the employee’s record for the Required Qualifying Contributions for Eligibility to PhilHealth Benefits. To do this, the finance staff shall refer to PhilHealth Circular No. 2019-0004 through this link: https://www.philhealth.gov.ph/circulars/2019/TS_circ2019-0004.pdf.
4. The next step to be taken is that the finance staff will prepare the Philhealth Claim Form 1 (CF-1) by filling out the Part IV – employer’s certification, signed by the authorized signatory: Ivy Gay Mabayag/ Corporate Secretary.
Here are the PhilHealth numbers to take note:
- TBOS – 012000036388
- ASOC – 012000026558
- YAMES – 012090001621
5. The finance department then forwards the hard copy of the PhilHealth Claim Form 1 to the immediate head/team leader of the employee concerned or directly to the employee’s guardian.
6. Upon receiving, the employee is tasked to fill out and complete the CF-1 Form by providing the details for the following: Part 1 – member information, Part 2 – patient information (only for the dependent) and Part 111 – member certification.
7. The employee will have to obtain a copy of his/her MDR or his/her Member Data Record from PhilHealth online. (This is not required if the hospital has a My PhilHealth Portal account)
There are two ways in acquiring the MDR, either online or in person via walk-in application.
The steps in how to get PhilHealth MDR (Member Data Record) online are the following:
- Go to the official PhilHealth website. You can access the official PhilHealth website through this link: https://www.philhealth.gov.ph/..
- Once there, click the online services button on the main menu.
- Look for membership portal button on the portal under the membership choices. Click register or log in.
The Membership Portal is where you can check your PhilHealth contributions and the accuracy of your membership details. This is also where you can find and print the latest copy of your PhilHealth Member Data Record (MDR).
- Log in to your account using your PhilHealth Identification Number and password.
- Enter the captcha code provided after inputting your PhilHealth ID number and password and then click the log in button.
- If you don’t have an updated account with PhilHealth yet, click the create account button on the lower right corner to register.
- Fill out the registration form with your personal details such as name, birth day, phone number, email address, PhilHealth number, and password.
- Click the link sent to your email address to activate your account. Afterwards, you can finally log in to your account using your PhilHealth Identification Number (PIN) and password.
- Review your membership information.
- Upon logging in, you’ll land on the member information page where you can see details of your membership including:
- Your 12-digit PhilHealth Identification Number (PIN)
- Complete name
- Gender
- Birth date
- Contact information
- Address
- Membership category
- Profession
- Monthly income
- List of dependent/s
As of currently, there’s no option to update or change your membership information online.
If there’s any information you want to change, correct, or update, you are required to submit a duly-accomplished PhilHealth Member Registration Form (PMRF) together with the required documents to the nearest PhilHealth office and not online.
- From there, click the print MDR button found on top of the member Information page.
- A PDF file of your MDR will appear on your browser. Hover the mouse over the upper right corner of the page.
- Click the corresponding icon for saving or printing the MDR.
If the online method doesn’t work due to a technical issue (which is common among government websites), the only other way to get your MDR is to personally request it at any PhilHealth branch.
Here’s how to get your PhilHealth MDR personally at the nearest PhilHealth office:
- In your nearest PhilHealth branch, get a PhilHealth request form and fill it out with your name, PhilHealth number, birthdate, and address.
- Check the member data record (MDR) box.
- Submit your accomplished form and present your valid ID to the PhilHealth officer. In just a few minutes, your MDR will be printed and issued to you.
8. Upon the acquisition of the MDR form, the employee must then submit the listed requirements below to the hospital where the employee or the dependent is confined:
- CF-1 Form
- MDR ((Not required if the hospital has a My PhilHealth Portal account)
- Proof of contribution payments such as official receipts (If the information is not indicated on the MDR)
9. The hospital staff shall review the submitted requirements and grant the benefit to the employee or the dependent of the employee.