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DUTIES and RESPONSIBILITIES of a PHILHEALTH MEMBER

As a PhilHealth member, there are certain things you must do to enjoy your benefits to the fullest:

On Membership
Have in possession at all times your PhilHealth Number Card or Identification Card. Update your Member Data Record (MDR) for any change in personal information such as change in civil status or addition of a new dependent. Request for a replacement in case of loss of PhilHealth Number Card or Identification Card.

On Contributions
Ensure that you promptly and regularly pay your contributions (for Individually Paying Members and Overseas Workers Program Members) to avoid suspension of benefits. For Employed Sector Members: For newly hired employees, check if your name is reported by your employer to PhilHealth in the Er2 Form (Report of Employee - Members). Ensure that your monthly PhilHealth contributions are deducted from your salary and promptly remitted and reported by your employer to PhilHealth. Report to PhilHealth at once an employer who does not remit premium payments. Ensure that you have sufficient qualifying contributions to avail of PhilHealth benefits anytime.

On Benefit Availment
Secure an updated list of PhilHealth-accredited facilities from any PhilHealth office wherein you can avail of benefits.

Submit a properly and completely filled-up PhilHealth Claim Form 1 to the hospital and ensure that all the information you stated in the said form are true and factual. Ensure that you properly and completely submit all the necessary documents to the hospital including a copy of your Member Data Record (MDR) to avail of PhilHealth benefits. Clarify with providers (hospital/doctor), the appropriate and final benefits deducted upon settlement of bills and charges. Ask for a copy of your Statement of Account/Billing Statement from the hospital upon discharge. Ask for an Official Receipt (OR) and Waiver from the hospital and doctor for payments made in full. Ensure that your claim, if you opt for direct filing, is filed at PhilHealth within sixty (60) days from the date of discharge for local confinements, and within one hundred eighty (180) days for confinements abroad.

What else you must do . . .


Be aware of amendments and updates on PhilHealth policies and benefits schedule. Seek clarification from any PhilHealth office on any unclear policy or guideline. Report at once to PhilHealth any hospital that fails, without valid reason, to accommodate a PhilHealth member who wishes to avail of benefits. Report at once to PhilHealth any fraudulent transaction that you know about. Observe and comply with PhilHealth rules and regulations as there are offenses in its Implementing Rules and Regulations that a member may be held liable for.

Email us: info@philhealth.gov.ph Download your forms: www.philhealth.gov.ph

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