PhilHealth membership is mandatory for all overseas Filipino workers (OFWs) so they would sure be interested to know about the benefits that they are entitled to if ever they or their dependents would need medical care here in the Philippines or abroad.

Read the FAQs on PhilHealth Membership.

Listed below are the answers to the most frequently asked questions about PhilHealth benefits and availment:

FAQs on PhilHealth Benefits and Availment

1. 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 an 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

2. 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.

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

PhilHealth covers hospital confinement due to sickness or 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.

4. What are the documents that I need to submit in claiming 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

5. 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.

6. What if my dependent or me 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

7. After filing for a claim, how long should I have to wait

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

8. My hospital confinement did not provide a copy of the bills official receipt and the physician’s professional fee. Can I submit other documents in filing for a claim?

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 fee.

9. 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

10. 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.

11. Is their a way for me to know the status of my claim?

You can inquire about your claim by sending an email at owp@philhealth.gov.ph or call (+63)09175129149. Be ready with the following information that will be needed:

• Patient's Complete Name
• Date of Confinement
• Name of Hospital

12. 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

13. 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)

14. I want to avail the Out-Patient Benefit Package (OPB) for OFWs? How can I do this?

You just need to 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.