Guide on PhilHealth Inpatient Benefits Coverage & Claims
PHILHEALTH OUTPATIENT BENEFIT FOR SURGERY CASES – Here are the guidelines and the coverage under this PhilHealth benefit.
Millions of Filipinos are members of PhilHealth or the Philippine Health Insurance Corporation. It is a state-run health insurance agency that provides benefits or assistance for both in-patient and outpatient hospitalizations of members.
With regards to the outpatient benefits for PhilHealth members, one of it is the benefit for surgeries. It covers elective or non-emergency surgical procedures ranging from minor to major operations “where patients are safely sent home within the same day for post-operative care”. The procedures must be done at hospitals and Health Care Institutions (HCI) accredited to PhilHealth.
How to Process your Claim for PhilHealth Assistance?
- Step 1 – There are documents that you need to prepare and it is a case-to-case basis depending on the type of benefit you need to claim (inpatient, outpatient, or Z benefits). In the case of claiming a PhilHealth Inpatient Benefits, you should prepare the following:
- Step 2 – Present your document to the billing office of the accredited hospital or Health Care Institution (HCI) where you got confined or operated. The case rate amount will be deducted by the HCI from your total bill. The deduction includes both the case rate and the charges or professional fees of the attending physician(s).
- Step 3 – Pay for the remaining hospital bill.
It is important to keep your PhilHealth account updated to secure a turn to in times of medical emergencies and even on non-emergency situations relating to health. It does not only benefit the account holder but as well as the beneficiaries – the spouse, children, parents of the account owner.
You can apply for PhilHealth membership online. To check on the online application process, you may visit – How To Apply for PhilHealth Membership Online & the Requirements to Submit.
