PhilHealth members abroad will still enjoy hospital benefits

CEBU - The Philippine Health Insurance Corporation announced that members can file a benefit claim for hospital admissions outside the country.

According to PhilHealth, if the member abroad or his/her dependent is confined for at least 24 hours for an illness or injury that requires hospitalization, the member can file a claim for refund.

The same can be applied if the member or his/her dependent undergoes a surgical procedure reimbursable by PhilHealth on an outpatient basis.

Benefit claims for overseas hospitalization must be filed in the PhilHealth Regional Office where the member locally resides as can be traced to its member data record.

Filing of claims by members or authorized representatives must be within 180 calendar days since the day the patient was discharged from the hospital.

According to PhilHealth, members should submit a duly accomplished and signed Claim Form 1 and a photocopy of the member data record. Other requirements include original medical certificate with complete diagnosis, period of confinement and medical services rendered, original statement of account and official receipts with itemized charges or any proof of hospital bills and professional fees payment.

PhilHealth clarified that even if the statement of account indicates that the total hospital bill was paid for by a private insurance company or by the employer, the claim may still be paid upon the presentation of the statement of account or certified true copy of the receipts.

If the member cannot personally file the claim, authorized representatives (legal spouse, children of legal age, parent, and siblings of legal age or duly authorized individuals) can accomplish and sign the claim forms.

PhilHealth said that the maximum allowable benefit given to members depends on the type of illness or injury using the international classification of diseases code relative to the value scale for medical procedures.

It will also depend on the maximum benefit for a third- or fourth- level hospital. — Jessica Ann R. Pareja/BRP (THE FREEMAN)