PhilHealth expands conditions in filing claim

Due to the clamor of some of its members, the Philippine Health Insurance Corporation has expanded the conditions allowed for in the direct filing of claims.

As a general rule, PhilHealth-accredited health care institutions or HCIs are expected to deduct the entire amount of the benefit from the total hospital/ facility bill as members submit the necessary claim documents upon discharge.

In cases where maximum benefits were availed, the members no longer have to wait for reimbursement.

In addition to the cases enumerated in Circular 35-2013, PhilHealth clarifies through Circular 20-2014 that direct filing of claims shall be allowed when a member is unable to secure the required documents when the confinement falls on a weekend or on a declared holiday.

PhilHealth also allows direct filing of claims for peritoneal dialysis, animal bite package and other circumstances as determined by the Corporation.

In a statement, PhilHealth said that the deadline of submission of directly filed claims ( except for confinements abroad and emergency confinements in non- accredited HCIs) shall be 60 days after the date of discharge from the HCI.

When availing of benefits, PhilHealth members shall submit a duly accomplished Claim Form 1 (CF1), together with a copy of the Member Data Record (MDR), to the HCI. Aside from the member’s signature, employed individuals need to have the CF1 signed by their employer.

To facilitate hassle- free and outright availing of benefits, PhilHealth encourages members to always provide accurate information and submit all required documents to the hospital/ facility on time.