How to Use PhilHealth in a Hospital

PhilHealth, or the Philippine Health Insurance Corporation, is a government agency that provides health insurance coverage to Filipinos. Utilizing PhilHealth benefits effectively can significantly reduce your medical expenses during hospitalization. Here’s a detailed guide on how to use PhilHealth in a hospital, including eligibility requirements, coverage details, and the process to claim benefits.

Steps to Use PhilHealth in a Hospital

1. Inform the Hospital: When you arrive at the Emergency Room or are admitted to the hospital, inform the staff that you are a PhilHealth member. Present your PhilHealth ID and let them know you intend to use your benefits for the hospitalization. If you’re wondering, “Can I use PhilHealth immediately?” the answer is yes, as long as your contributions are up to date and you meet the eligibility criteria​ ​.
2. Prepare Required Documents: Ensure you have the following documents ready:
   • PhilHealth Member Data Record (MDR): This should be updated and can be downloaded online or obtained from a PhilHealth office.
   • PhilHealth Claim Form 1: This form is available at PhilHealth offices, hospitals, or from your employer and must be filled out and signed.
   • PhilHealth ID and a valid government-issued ID​.
3. Submission of Documents: Before discharge, submit the PhilHealth Claim Form 1, MDR, and IDs to the hospital’s billing section. The hospital will process the documents and deduct the PhilHealth coverage from your total bill. This step ensures your PhilHealth deduction on the hospital bill is correctly applied​ .

Eligibility Requirements

To be eligible for PhilHealth hospitalization benefits, you must meet the following conditions:

• Premium Contributions: You should have paid at least three months’ worth of premiums within the immediate six months before confinement. For certain conditions like pregnancy, chemotherapy, dialysis, etc., nine months of contributions in the last 12 months are required​ .
• Hospital Confinement: You must be confined in the hospital for at least 24 hours.
• Accredited Hospital: The hospital must be accredited by PhilHealth​​.

Coverage and Benefits

PhilHealth covers various expenses during hospitalization, including:

• Room and Board: A portion of the cost for your room and board is covered.
• Professional Fees: Fees for the attending physicians are included.
• Laboratory Tests and Medicines: Necessary laboratory tests and medications are subsidized.
• Operating Room and Surgical Expenses: Costs associated with surgery and the use of the operating room are also covered​.

If you’re wondering “how much percentage is covered by PhilHealth in private hospitals,” it typically depends on the case rate for the specific treatment or procedure. For example, major surgeries might have higher coverage amounts.

Frequency of Use

PhilHealth benefits can be availed multiple times within a month, provided the eligibility criteria are met each time. So, if you’re asking, “Can I use PhilHealth twice a month?” the answer is yes, as long as you meet the necessary conditions. However, there is a maximum confinement duration of 45 days per calendar year for the member, with an additional 45 days to be shared among dependents​​.

Applying for PhilHealth Z Package

The Z Benefits package is designed for serious and prolonged illnesses. Here’s how to apply:

1. Ensure that the hospital is a contracted Z Benefit facility.
2. Submit the necessary documents, including a treatment plan from a specialist.
3. The Z Benefits Coordinator at the hospital will assist in processing your application​​.

Key Considerations and Tips

• Regular Premium Payments: Maintain regular premium payments to ensure continuous eligibility for benefits.
• Accredited Hospitals: Always check if the hospital is accredited by PhilHealth for the specific program you need before admission.
• Document Preparation: Keep your PhilHealth documents updated and easily accessible to avoid delays during emergency situations​​.

PhilHealth Coverage for Surgery

If you’re curious about “how much is covered by PhilHealth for surgery,” it depends on the specific surgical procedure. PhilHealth assigns different case rates for various surgeries, which can significantly offset your hospital expenses. For instance, complex surgeries might have higher coverage limits compared to minor procedures.

Final Thoughts

Understanding and utilizing PhilHealth benefits can provide substantial financial relief during medical emergencies. By being prepared with the necessary documents and knowing the process, you can ensure a smoother experience when claiming your benefits. For the most accurate and updated information, refer to the official PhilHealth website or contact their customer service​