Now Reading [
Tutorials
] News

How to Claim Your PhilHealth Benefits Guidelines and Requirements


You and your family might not be sick right now but having a health insurance will come in handy when accidental crisis happen. When that happens, the most common problem is where you will find the money to pay for bills especially right now when hospitalization can cost 25,000 php and even more. Philippine Health Insurance Corporation or commonly known as PhilHealth is the leading health insurance company in the country.

How to Claim Your PhilHealth Benefits Guidelines and Requirements

As a member, you are given health care benefits which covers health and hospitalization subsidies not only for you but for any dependents you have enrolled.

To be eligible to claim your PhilHealth benefits you have to satisfy the following:

1. Conditions

You need to pay at least 3 months’ worth of premiums within the immediate 6 months of confinement. If it is a pregnancy case, you should avail the newborn care package, dialysis, chemotherapy, radiotherapy and selected surgical procedures on which you should pay at least 9 months’ worth in the last 12 months.

Moreover, the member must be confined in an accredited hospital due to illness or disease requiring hospitalization for 24 hours. The attending physician(s) must also be PhilHealth accredited. The claim is within the 45 days allowance for room and board.

2. Required documents

Before getting discharged from the hospital, you are required to submit the following documents to get deductions from the hospital bill.

A Clear, Updated copy of your Member Data Record (MDR). If you are dependent, make sure that you are listed in the MDR.

An original copy of PhilHealth Claim Form 1, which you can get at Philhealth, the hospital or your employer. Submit the original copy signed by your employer.

Receipt of Premium payments. Employees only need to submit the Certificate of Premium Payments with OR numbers.

Your PhilHealth ID and a valid ID.

For special cases wherein you are not able to submit the claim form personally, create an authorization letter and a valid ID for your representative.

3. Claimin and Post-Claims

As of 2014, there is no need for direct filing so you just have to submit the required documents before the end of your stay to automatically deduct the corresponding benefits from the hospital bill.

PhilHealth will then send a benefit payment notice to the address declared in your MDR. There you will be able to see the actual payments by the PhilHealth during your confinement.


It is important to remember to keep your PhilHealth membership up to date. Emergencies can happen in an instant and nothing warns you beforehand. It’ll be helpful not only for yourself but for any person who you declared as your dependent.

How to get PCSO Medical Assistance Easy Steps