At a glance
- Office: Local Health Insurance Offices (LHIOs)
- Classification: Simple
- Who may apply: All PhilHealth Members who were NOT able to avail of the automatic deduction
- Total fees: None
- Total processing time: 1 hour and 10 minutes
Requirements
| Requirement | Where to get it |
|---|---|
| Properly filled-out Acknowledgement Receipt Form (1 original copy) | Public Assistance and Complaint Desk PhilHealth Website (www.philhealth.gov.ph/downloads) or in any PhilHealth Local Health Insurance Office (LHIO) |
| Properly filled-out PhilHealth Claim Form 1, 2, 3, & 4 and Claims Signature Form (CF1, CF2, CF3, CF4, CSF), as applicable (1 original copy) | Public Assistance and Complaint Desk PhilHealth Website (www.philhealth.gov.ph/downloads) or in any PhilHealth Local Health Insurance Office (LHIO) |
| Hospital and Doctor’s Waiver (1 original copy) | Health Care Institute (HCI) |
| Official Receipt/s showing full payment (1 original copy) | HCI |
| Official Receipts or Authenticated Photocopies** of the same by PhilHealth staff (original copies seen) for medicines bought outside the hospital or laboratory tests performed outside the hospital during confinement (1 original copy) | HCI, Pharmacy |
| Anesthesia, Surgical or Operative Record, as applicable (1 photocopy) | HCI |
| Hospital Statement of Account (SOA) duly signed by the hospital clerk or representative of the patient (1 photocopy) | HCI |
| Properly filled-out PhilHealth Benefit Eligibility Form (PBEF) (1 original copy) - For facilities with portal | HCI |
| Medical Certificate or Clinical Abstract indicating final diagnosis of patient, confinement period and services rendered written legibly and translated in English (1 photocopy) - For confinements abroad | HCI Abroad |
| Member’s Valid ID (1 photocopy) | Member |
| Certified True Copy of Birth Certificate of Newborn (CTC’ed by the Health Care Facility) (1 original copy) - For newborn and mother claim | Member |
| Valid ID with signature of the authorized representative (1 photocopy) - If thru a representative | Authorized Representative |
| Authorization letter signed by the Member (1 original copy) | Member |
| Valid ID of the Member (1 photocopy) | Member |
Steps
| What you do | What the office does | Fee | Time |
|---|---|---|---|
| Get queuing number at the PACD and wait for the number to be called | Issue queuing number and advise client to proceed to designated counter when the number is called (PACD Officer) | None | 1 hour *** |
| Submit duly accomplished acknowledgement receipt form and PhilHealth Claims form with supporting documents | Receive and screen claims documents as to completeness of documentary requirements (non-medical) If documents have deficiency/ies, Return the same and advise the client accordingly If documents are complete; Stamp “received” in the acknowledgement receipt form and give the client a receiving copy (Frontline Officer/Claims Receiving Officer Designate) | – | 6 minutes |
| Receive acknowledgement receipt or claim with deficiency | Log the Claims received in the logbook and let the member or representative signed for acknowledgement (Frontline Officer/Claims Receiving Officer Designate) | – | 1 minute |
| Advise client to receive Benefit Payment Notice (BPN) within 60 days (Frontline Officer/Claims Receiving Officer Designate) | – | 1 minute |
Source
Read from the office's Citizen's Charter by Muse Spark. Fees and steps change: check the PDF and the office before you go.