Philhealth Benefits: When Is A Member Eligible to Claim?

Philhealth Benefits

Are you a Philhealth member?  Do you regularly check if your contributions are posted on your account?  What could be the reasons why a paying member may not be able to use his Philhealth benefits?

Regular remittance of premium contributions must be maintained in order for a Philhealth member to avail of the benefits seamlessly.  Philhealth does not accept retroactive payments such that, if the member missed paying a certain period, he may not be able to use his Philhealth benefits.

Below is a summary of Philhealth’s Eligibility Requirements, based on the paying member’s type of membership:

Sponsored Membership Date of hospitalization / availment must be within the effectivity period indicated in the member’s ID and MDR.
Individually Paying Members (IPM)
  1. There are certain confinement cases wherein three months’ worth of premium within the last six months (3/6) prior to confinement is acceptable.
  2. For pregnancy-related cases, dialysis, chemotherapy, radiotherapy, and other selected surgical procedures, the member must have paid nine months worth of premium within the last twelve months (9/12) prior to confinement.
Lifetime Member The member just has to show their Lifetime ID card; no need to pay premium anymore.
Employed Members Three months worth of premium within the last six months (3/6) prior to hospitalization.
Overseas Workers (OWP)
Date of hospitalization / availment must be within the coverage period specified in themember’s MDR.

How to maintain member’s eligibility?

The secret is simple: pay your premiums on time.  Any discrepancies or gaps in your premium contributions will definitely affect your eligibility to claim benefits.  Here are some tips to help you secure your Philhealth benefits:

a. Sponsored Members:

  • Member’s card must be kept updated all the time.  If card is about to or has expired already, Sponsored Member must proactively ask his Sponsor if his membership will still be renewed.
  • If Sponsor will no longer renew the Sponsored Member’s membership, the latter has the option to register as an Individually Paying Member.

b. Individually Paying Member (IPM)

  • He must make sure that each quarter of the year has been paid (and all payments are posted in his account).
  • You have the option to pay your premiums yearly (advance payments) for security and convenience.

c. Overseas Workers Program Member (OWP)

  • All premiums must be remitted and posted on member’s account before membership expires.
  • In cases when contract abroad has been terminated, inform Philhealth to process shifting of membership category from OWP to IPM (or other applicable categories).  Pay the corresponding premiums right away to avoid gaps in your contributions.

d. Employed Members

  • If you are an employed member and you will be taking a Leave Without Pay, you may pay your monthly contributions at any nearest Philhealth office under the IPM category.
  • Remember to bring a copy of your RF-1 issued by your employer (to attest to the fact that you are indeed on Leave without Pay status).
  • In case you resign or get separated from work, you have to shift your membership category to IPM.

Remember that Philhealth does not have a “grace period” for missing your monthly contributions.  Once a month is left unpaid, the member can no longer make a retroactive payment.  These gaps will impact your and your dependents’ benefit claims, so make sure your payments are properly posted and your account is consistently updated.

Source: https://www.scribd.com/doc/115987403/Phil-Health-FAQs

Published by MasterCitizen

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56 thoughts on “Philhealth Benefits: When Is A Member Eligible to Claim?

  1. hai po, due ko po this month, since December-March nahuhulugan ko po yung philhealth ko through employer ko then nag resign na po ako so di ko nabayaran ang April-June pero nag self employed ako July-September nabayaran ko. pwede ko na bang hindi bayaran ang October-December na contribution? magagamit ko po ba yung philhealth ko this month if manganganak na ako?

  2. Magagamit ko po ba ang philhealth benefit ko? 6 months pregnant po ako then duedate ko is on January. Pero first time ko pa lang nahulugan ang philhealth ko coverage is from Oct 2017- Dec 2017.

  3. Hi.. tanong ko lang wat if nitong araw palang nabayaran yung 3rd quarter tapos ngayong araw din naadmit yung patient makaka avail po ba?

  4. Last contribution ko po since 2013… unfortunately i had to undergo surgery last May… pwede pa ba ako mag claim?
    Thanks for your attention.

  5. kung mula po ng naghulog ako since 2014 up to now updated po pero hindi pa po nagagamit khit minsan,pano na po mga nai contribute ko hulog,ano na po ang value nya pag hindi pa nagagamit,naiipon po ba un?

    1. Hi Dolor,

      The Philippine Health Insurance Corporation, or Philhealth, was created in 1995 to employ affordable health insurance coverage for all Filipinos. It is a government owned and controlled corporation, attached to the Department of Health, and serves as a means for the healthy to help pay for the care of the sick and subsidize medical assistance for those who cannot afford medical help.

      Nagcocontribute ka sa Philhealth para masigurong covered ka ng benefits kahit na anong oras ka mangailangan dahil sapagkaka sakit. Ang perang ibinabayad mo, kasama ang budget ng gobyerno ay siya ring ginagamit sa pagpapahospital ng mga miyembrong mahihirap at walang pambayad. Ganun ang prinsipyo ng Philhealth.

      MC

  6. Kailangan ko pa ba magbayad pag 60 years old na ako next month at ito pa rin philhealth no. ko gagamitin ko pag senior citizen na ako ?

  7. gud day po..tnung ko lng po knuha ko po ang nanay ko ng philhealth kc po sinior nxa last 2 yirs na po ata.,ngaun dkuna po nabalikan yun id po nia.any time po ba pwd kong kunin.anu po ba ibig svhin ng NDR? Salamat po

  8. Employed member po ako. Manganganak po ako this august 1, 2017. yung latest na 3 buwang hulog ko is feb, march, april 2017. Di ba po nakalagay sa philhealth na para makaavail ng benefit at least 3 months na hulog within 6 months prior to the date of confinement mabayaran. Does it mean po ba eligible ako or need pa rin update yung sa may, june and july 2017?

  9. Member po ako ng philhealth for a year palang. Kakatapos lang din ng contract ko sa second job ko. I am 5months pregnant at due date ko po is 3rd week of August. Required po ang philhealth sa paanakan, paano ko po magagamit ang philhealth ko gayong wala na po akong trabaho ngayon. Ano po ba dapat kong gawin ? Salamat po.

  10. Chineck ko ung Contribution ko online, nakita ko na wala sa record ung July Aug Sept 2016 pero merong April, May june 2016 tapos October Nov Dec 2016. Magkakaroon ba ng conflict kung gagamitin ko Philhealth ko sa May kasi maooperahan ako? Babayaran ko na ngaun ang January to June 2017

  11. Hinulugan ko ang philhealth ko nuon feb..ito po ba pdi na magamit ng aking asawa sa sept .pag sya ay nanganak..isa po akong ofw

  12. Helo po,OFW po ako dati.nag umpisa po ako nung 2011 till 2013 paid po lhat yun.2014 d po ko nkabayad.then abroad uli ako 2014 month of Nov.till Nov.2017.d ko pa po pina follow up till now.tanong ko po wat if d na ako babalik sa abroad pwede kb ichange yung OFW ko sa voluntary nalang?if incasa ok how much contfibution per month?

  13. Hello po, MasterCitizen! Tanong ko lang po, ofw po ako at ang nabayaran ko lang po sa philhealth ay from Dec. 28, 2015 to December 27, 2016 po. tapos naconfine ung family member ko po na beneficiary ko this month at d pa ako nakapagbayad for the Month of January 2017. cover po ba ako at beneficiary ko sa Philhealth benefits o hindi na po? Salamat!

  14. cover po ba ako ng philhealth sa scheduled cs ko this coming feb 16 kahit na ngkaroon ng gap ang payments ko from sept- oct 2016 tapos nong nov na ulit ako nagbayad ng 12 months pagdating namin kac ofw po ako.

  15. Hello po. Due po ng sister ko this january 28, pero hindi po sya nakapagbayad ng contri since june 2016. Makaka avail po ba sya ng maternity benefits? Thanks

      1. Un nga po eh d dn namin kse alam 😦 okey na po ung sss tinanggap nmn po ung MAT1, ung s phil health po kase d ako sure kung mkkaavail ba sya since wala sya hulog 6mos prior ng expected confinement date.. 😦

  16. Dati naka member ako sa philhealth sponsored ng mayor namin but since napalitan na sya 6 yrs ago nawala na din,ask ko lang kung pwede ko ipagpatuloy now or apply na lang ako ng bago..un employed pala ako and 47 years old…

  17. Hi..is the membership still active even if i wasn’t able to pay from the moment i applied?..i only paid 3 months contribution then so i could be a member..and how will i know my membership #..i lost my record of my application..

  18. tanung ko poh isa aq o.f.w dito sa doah qatar may philheath aq paano ko malalaman kung hinulugan ng agency ko yung akin

  19. Ofw ako,,22 years ako nagtrabaho sa ibang bansa,in every vacation ko,,kuha ako ng balik mangagawa kasama rin philhealth,,kasalukoyan dito na ako sa pinas 2 years na ako dito,,tanong ko apply ba ako ulit sa philhealth 53 years old na ako.

  20. I have been a Philhealth member. I turned 61 years old last month. Am I still suppose to pay my monthly membership fee? I am already a senior citizen and I want to know if it’s true that all senior citizen are automatically members of Philhealth and no need for monthly payments? thanks

  21. Meron akong six months contributions sa philhealth, nag start ako maghulog since april-june and then yung pnka latest july- sept. 30 2016. Eight months pregnant ako at ang due date ko is first week of sept. magagamit ko pa rin ba yung mga benefits ng philhealth or need ko talaga makpag contribute ng 9 months? Pwede ko ba iadvance kung saka sakali? Tnx 🙂

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