PhilHealth coverage

PhilHealth generally pays the accredited provider under the applicable benefit package. It does not promise to reimburse every expense or pay the whole bill.

Cost / amount:

• Benefit amount depends on diagnosis, procedure and the applicable package
• Ask for an itemized estimate showing the PhilHealth deduction and remaining patient charges

Processing time:

• Have eligibility and the package checked before admission or the planned procedure
• The hospital submits the claim; ask its PhilHealth desk about missing records before discharge

How to start:

• Contact the accredited hospital’s PhilHealth / billing desk

What to bring

• PIN / Member Data Record and patient identity
• Dependent relationship record, if relevant

  If the patient is a dependent not correctly reflected in the record, bring the marriage / birth document and request an update.

• Clinical and claim documents requested by the hospital

  The hospital prepares clinical claim records. Complete patient signatures and any eligibility forms it requires; keep your statement of account.

How to apply

1. 1
   Check the provider and treatment package

   Confirm that the facility and procedure are accredited / covered. Different inpatient, outpatient, Z and primary-care benefits have different rules.

   Open the official service

2. 2
   Have the hospital verify the member record

   Give the PIN and patient details. Resolve a wrong name or dependent entry with PhilHealth rather than using a different member’s identity.

3. 3
   Review the deduction and final bill

   Ask the billing desk to explain the benefit applied, any exclusions and the remaining patient charges. Keep copies for follow-up.