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Answers to Common OFW Questions

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Can my family/beneficiaries in the Philippines use my Philhealth even if they can’t present an MDR (Members Data Record)?

Your dependents or beneficiaries in the Philippines can avail Philhealth benefits. If they can’t present a Members Data Record (MDR), they need to present the following documents as substitute:

  • E-Receipt as proof of applicable premium payment

  • Marriage Contract/Certificate for Spouse

  • Child/children - Birth Certificate – for children of OFW

  • Birth Certificate of Member and any proof of the parents' date of birth- for OFWs Parents

I want my husband/wife in the PH to claim my reimbursement cheque. What should I do to have the cheque transferred to his/her name?

 PhilHealth will issue a reimbursement cheque under the name of your spouse if you provide authorization letter. Your spouse also need to present clear copies of the following documents: your two valid IDs, two valid IDs of the spouse, and your marriage contract. A Special Power of Attorney (SPA) may also be issued to your wife.

I am currently overseas and would need to undergo a surgical operation. Can I avail my PhilHealth benefits for this confinement?

 PhilHealth covers hospital confinement due to sickness or surgical operation of an OFW abroad. The OFW needs to file a claim for reimbursement at the nearest Philhealth office within 6 months or 180 days after the confinement.

What are the documents that I need to submit in claiming Philhealth reimbursement?

 These are the documents that an OFW needs to submit:

a. PhilHealth Claim Form 1 accomplished and signed by the member or his authorized representatives;

b. Photocopy of MDR or latest receipt;

c. Medical certificate with complete diagnosis, period of confinement and services rendered;

d. Statement of Account and/or Official Receipts with itemized charges; and other supporting documents.

Note: Documents that are written in a foreign language should be translated in English

I also have a health insurance card courtesy of my employer abroad that covers hospital expense. Can I still use my Philhealth benefit in case of confinement?

Your PhilHealth benefits is not affected with the health benefits that you are entitled to receive as an overseas worker. You can still file for claim reimbursement as long as you submit the complete and proper documents within the allotted period.

What if my dependents or I gets hospitalized in the Philippines?

Your PhilHealth benefits can be automatically deducted from your total hospital bill. You just need to submit the following documents:

  • PhilHealth Claim Form 1 accomplished and signed by the member or its immediate family member
  • Photocopy of MDR or latest receipt and other supporting document if the patient is not reflected as dependent in the MDR.
After filing for a claim, how long should I have to wait?

PhilHealth will release the reimbursement claim within 60 working days from date of receipt, provided that it is not under investigation.

How to file for a claim if the hospital did not provide a copy of the bills official receipt and the physician’s professional fee?

 If an official receipt is not provided, you can submit a copy of your Statement of Account as substitute. This document should list down the breakdown of hospital charges for room and board, medical supplies, laboratory procedures, operating room fee and professional fees.

What do you mean by “single period of confinement” ?

This is confinement or series of confinements for the same illness with intervals of not more than three months or 90 days. Cases like these prohibit the member to avail benefits/allowances within the 90-day period.

They can only avail themselves of the unused portion of the benefits and room and board allowance until the 45 days allowance is exhausted. However, members can avail themselves of a new set of benefits if succeeding confinements are of different illnesses or conditions


 

I am currently working abroad? Who can sign in my behalf of my PhilHealth Claim Forms?

Migrant workers that are married can ask his or her spouse or children that are at least 18 years old to sign in their behalf. If the spouse or children are not available, their parents can also be the signatory.

Single OFW can ask their parents or any other authorized representative to sign for them. The representative should present an authorization letter from the member, a photocopy of his/her 2 valid IDs as and 2 valid IDs of the member.

I want to know the status of my Philhealth claim- what should I do?

You can inquire about your Philhealth claim by sending an email to owp@philhealth.gov.ph or calling (+63)09175129149. Be ready with the following info: 
Patient's Complete Name
Date of Confinement
Name of Hospital

What are the cases that are not covered by PhilHealth?
  •  Fifth and subsequent normal obstetrical deliveries
  • Non-prescription drugs & devices
  • Alcohol abuse or dependency treatment
  • Cosmetic Surgery
  • Optometric Services
  • Cost-ineffective procedures that shall be defined by PhilHealths
What is the basis when computing in-patient benefits?

Benefits are computed based on ward type accommodations only

Benefits have limits/ceilings

Based on hospital category and case/type of illness

Level 1 Hospitals (Primary)

Level 2 Hospitals (Secondary)

Level 3 & 4 Hospitals (Tertiary)

How Can I avail the Out-Patient Benefit Package (OPB) for OFWs?

Just present a photocopy of your Member Data Record (MDR) or latest receipts and supporting documents (for dependents who are not listed in the MDR) to any of the 42 participating DOH hospitals in the Philippines.

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