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Employed module as of jan 2012

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The document outlines PhilHealth benefit availment and reimbursement procedures. It provides details on: 1) Inpatient and outpatient care benefits including allowances for room and board, medicines, procedures, and professional fees. Confinements less than 24 hours do not qualify except in emergency cases. 2) Requirements to avail benefits including a minimum of 3 monthly contributions within the last 6 months or 9 monthly contributions within the last 12 months. 3) Reimbursement procedures which include automatic deduction or direct filing, and different processes for local and foreign confinements.

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BENEFIT AVAILMENT
What are my Benefits? A. In-Patient Care Allowance for: Room and Board Drugs and Medicines X-Ray and Laboratories Operating Room Fees Professional Fees Confinement of less than 24 hours will not be paid except for the ff: 2. Case is Emergency 3. Patient is Transferred to another Hospital 4. Patient Expired
What are my Benefits? B. Out-Patient Care Allowance for: Procedures must be Drugs and Medicines performed in Philhealth X-ray and Laboratories Accredited Health Care Providers Operating Room Fees Professional Fees confinement / admission in a non-accredited SAMPLE CASES: Health Care Providers can be paid if the case is Day surgeries emergency and the facility has DOH License Dialysis Cancer treatment procedures such as: chemotherapy radiotherapy
Exclusions / Non-Compensable Procedures: Fifth and subsequent normal obstetrical deliveries Non-prescription drugs and devices Alcohol abuse and dependency treatment Cosmetic surgery Optometric services Other cost ineffective procedures as defined by PhilHealth
New Inpatient PhilHealth Benefits Schedule For all PHIC Members and their Dependents Admissions starting April 05, 2009 (Circular 09, s. 2009) Levels 3 & 4 Hospitals (Tertiary) Benefit Item Case Type A B C D Room & Board P500 P500 P800 P1,100 (maximum of 45 days/year) Drugs and Medicines P4,200 P14,000 P28,000 P40,000 (per single period of confinement) X-ray, Lab & Others P3,200 P10,500 P21,000 P30,000 (per single period of confinement) For procedures with RVU 30 and below = 1,200 Operating Room For procedures with RVU 31 to 80 = 1,500 For procedures with RVU 80 to 600: RVU x PCF 20 (minimum = 3,500)
New Inpatient PhilHealth Benefits Schedule Admissions starting April 05, 2009 (Circular 09, s. 2009) Levels 3 & 4 Hospitals (Tertiary) Professional Fees Case Type A B C D A. Daily Visits Gen. Practitioner (Groups 1, 5 and 6) Per day P300 P400 P500 P600 Maximum per confinement P1,200 P2,400 P4,000 P6,000 Specialist (Groups 2, 3 & 4) Per day P500 P600 P700 P800 Maximum per confinement P2,000 P3,600 P5,600 P8,000 B. Surgery For RVU 500 and below For RVU 501 and above Surgeon Anesthesiologist Surgeon Anesthesiologist Gen. Practitioner (1st Tier Group 1) RVU x PCF 40 = PF1 40% of surgeons fee RVU x PCF 40 = 40% of surgeons (PF1) PF1 fee (PF1) With Training (2nd Tier Group 5 & 6) RVU x PCF 48 = PF2 48% of surgeons fee RVU x PCF 48 = 48% of surgeons (PF1) PF2 fee (PF1) Diplomate / Fellow (3rd Tier Group RVU x PCF 56 = PF3 56% of surgeons fee RVU x PCF 80 = 40% of surgeons (PF1) PF4 fee (PF4) 2, 3, 4)
New Inpatient PhilHealth Benefits Schedule For all PHIC Members and their Dependents Admissions starting April 05, 2009 (Circular 09, s. 2009) Level 2 Hospitals (Secondary) Benefit Item Case Type A B C Room & Board 400 400 600 (maximum of 45 days/year) Drugs and Medicines 3,360 11,200 22,400 (per single period of confinement) X-ray, Lab & Others 2,240 7,350 14,700 (per single period of confinement) For procedures with RVU 30 and below = 750 Operating Room For procedures with RVU 31 to 80 = 1,200 For procedures with RVU 81 to 600: RVU x PCF 15 (minimum = 2,200)
New Inpatient PhilHealth Benefits Schedule Admissions starting April 05, 2009 (Circular 09, s. 2009) Level 2 Hospitals (Secondary) Professional Fees Case Type A B C A. Daily Visits Gen. Practitioner (Groups 1, 5 and 6) Per day P300 P400 P500 Maximum per confinement P1,200 P2,400 P4,000 Specialist (Groups 2, 3 & 4) Per day P500 P600 P700 Maximum per confinement P2,000 P3,600 P5,600 B. Surgery (For Case Types A, B, and C) Surgeon Anesthesiologist Gen. Practitioner (1st Tier Group 1) RVU x PCF 40 = PF1 40% of surgeons fee (PF1) With Training (2nd Tier Group 5 & 6) RVU x PCF 48 = PF2 48% of surgeons fee (PF1) Diplomate / Fellow (3rd Tier Group RVU x PCF 56 = PF3 56% of surgeons fee (PF1) 2, 3, 4)
New Inpatient PhilHealth Benefits Schedule For all PHIC Members and their Dependents Admissions starting April 05, 2009 (Circular 09, s. 2009) Level 1 Hospital (Primary) Benefit Item Case Type A B Room & Board 300 300 (maximum of 45 days/year) Drugs and Medicines 2,700 9,000 (per single period of confinement) X-ray, Lab & Others 1,600 5,000 (per single period of confinement) Operating Room 500
New Inpatient PhilHealth Benefits Schedule Admissions starting April 05, 2009 (Circular 09, s. 2009) Level 1 Hospitals (Primary) Professional Fees Case Type A B A. Daily Visits Gen. Practitioner (Groups 1, 5 and 6) Per day P300 P400 Maximum per confinement P1,200 P2,400 Specialist (Groups 2, 3 & 4) Per day P500 P600 Maximum per confinement P2,000 P3,600 B. Surgery (For Case Types A and B) Surgeon Anesthesiologist Gen. Practitioner (1st Tier Group 1) RVU x PCF 40 = PF1 40% of surgeons fee (PF1) With Training (2nd Tier Group 5 & 6) RVU x PCF 48 = PF2 48% of surgeons fee (PF1) Diplomate / Fellow (3rd Tier Group RVU x PCF 56 = PF3 56% of surgeons fee (PF1) 2, 3, 4) Maximum of 2,000 per Maximum fee computed as confinement percentage of 2,000
**What is Single Period of Confinement & *45 Days Allowance? 45 DAYS 45 DAYS for one (1) for one (1) calendar year calendar year FOR THE MEMBER TO BE SHARED BY THE DEPENDENTS single period of confinement refers to a series of confinements/ procedures of the same illness within 90 DAYS
Illustration of single period of confinement: CASE: CHEMOTHERAPY (case type C) Level 4 Hospital Tertiary Hosp: Max. Drugs & Meds. 28,000 / XLO 21,000 / Operating Room 1,200 (RVU10) JAN FEB MAR APR admitted / admitted / admitted / admitted / availed availed availed availed shall receive shall receive only shall receive only shall receive maximum the remaining the remaining another computation of benefits from the benefits from the maximum benefits based on initial computation initial computation computation if 45 the benefit based on benefit based on benefit days allowance is schedule schedule schedule not yet exhausted Drugs & Meds P20,000 Drugs & Meds P8,000 Drugs & Meds 0 (exhausted) Drugs & Meds P28,000 XLO P15,000 XLO P6,000 XLO 0 (exhausted) XLO P21,000 OR Fee P1,200 OR Fee P1,200 OR Fee P1,200 OR Fee P1,200
How to avail or file for reimbursement: For confinements within the country A. FOR AUTOMATIC DEDUCTION (PhilHealth Benefits deducted from Hospital Charges) Member submit the following to the Billing Section of the Hosp upon discharge: Accomplished Claim Form 1 Copy of MDR or Supporting Documents in its absence Proof of Eligibility / Employers Certification (if needed) Official Receipts of Medicines bought outside, if any* *(for reimbursement to member, if benefits still not exhausted, upon submission of hosp to PHIC)
How to avail or file for reimbursement: For confinements within the country B. FOR DIRECT FILING (member paid the hospital charges in full) Submit the following to PHIC within 60 DAYS from the date of discharge: Accomplished Claim Form 1 Copy of MDR or Supporting Documents in its absence Proof of Eligibility / Employers Certification (if needed) *Accomplished Claim Form 2 (accomplished by the hosp & doctors) *Waiver from the Hospital and Doctors OR Official Receipts *Operative Record, if with operation *Claim Form 3, if necessary
How to avail or file for Reimbursement: For confinements abroad DIRECT REIMBURSEMENT ONLY Submit the following to any PHIC Office within 180 days from the date of discharge: Accomplished Claim Form 1 Statement of Account with itemized charges and/or OR Medical Certificate/abstract with final diagnosis, period of confinement & services rendered (with English translation) MDR 180 Proof of Contribution (xerox of latest Official Receipt or MI5) days
Am I eligible to avail the Benefits? MUST HAVE CONTRIBUTED AT LEAST 3 MONTHLY PREMIUM CONTRIBUTIONS WITHIN THE IMMEDIATE 6 MONTHS PRIOR THE MONTH OF AVAILMENT JAN FEB MAR APR MAY JUN JUL x x x month of x x x availment x x x
PhilHealth Circular 25, s-2010 Nine (9) Months Contribution as a Requirement for Benefit Availment The Corporation shall now require Nine (9) months of Contribution within (12) Twelve months prior to the month of availment for all confinements including availment of outpatient benefit This requirement shall be for all types of members except those under the Sponsored Program, Lifetime Member Program and the Overseas Workers Program The policy shall be effective for all reimbursements with admission / treatment (out-patient) date starting JULY 01, 2011
PhilHealth Circular 25, s-2010 Nine (9) Months Contribution as a Requirement for Benefit Availment Illustration: JULY 2011 availment JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL 2010 2010 2010 2010 2010 2010 2011 2011 2011 2011 2011 2011 2011 12 11 10 9 8 7 6 5 4 3 2 1 X X X X X X X X X
PhilHealth Circular 25, s-2010 Nine (9) Months Contribution as a Requirement for Benefit Availment Illustration: JULY 2011 availment (for Individually Paying Members IPP) AVAIL 3RD QUARTER 4TH QUARTER 1ST QUARTER 2ND QUARTER MENT JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL 2010 2010 2010 2010 2010 2010 2011 2011 2011 2011 2011 2011 2011 12 11 10 9 8 7 6 5 4 3 2 1 X X X X X X
PhilHealth Circular 25, s-2010 Nine (9) Months Contribution as a Requirement for Benefit Availment Illustration: SEPT 2011 availment (for Individually Paying Members IPP) 3RD QUARTER 4TH QUARTER 1ST QUARTER 2ND QUARTER 3RD QUARTER JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP 2010 2010 2010 2010 2010 2010 2011 2011 2011 2011 2011 2011 2011 2011 2011 Jul & August 2011 shall only be counted in the 9/12 if the premium shall be paid prior to confinement Any contribution payment paid within the confinement shall no longer be considered for the present confinement but for future / prospective ones
PhilHealth Circular 25, s-2010 Nine (9) Months Contribution as a Requirement for Benefit Availment Example: Date of confinement: September 3, 2011 Date of payment (3rd Quarter 2011) September 3, 2011 3RD QUARTER 4TH QUARTER 1ST QUARTER 2ND QUARTER 3RD QUARTER JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP 2010 2010 2010 2010 2010 2010 2011 2011 2011 2011 2011 2011 2011 2011 2011 12 11 10 9 8 7 6 5 4 3 2 1 x x
Eligibility to use: former OFW, Indigent or IPM* (shifting of membership category) Certification from MDR current Employer OF W (eligibility is + reflected) or Photocopy of applicable RF-1 and ME-5 Proof of d contribution sore Indigent ID on ber (eligibility is from previous Sp em category M reflected) (within the immediate 6 months) Latest Official M Receipt or MI-5 IP * Members eligibility is divided into 2 different membership classification
How long does it take to process a claim? The rule provides 60 DAYS upon filing to process a claim Check payments will be sent to the member / hospital through registered mail or over the counter / pick-up Members will receive a Benefits Payment Notice upon issuance of reimbursement
What is Benefit Payment Notice? BPN written notice sent to members who availed the benefits shows the details of the benefits computed (i.e. benefits received by the member, hospital, doctors)
ENHANCED CLAIM FORMS Implementation: September 01, 2010
ENHANCED CLAIM FORMS Implementation: September 01, 2010
ENHANCED CLAIM FORMS Implementation: September 01, 2010
PHILHEALTH CALL CENTER
our website .... NCR Central Info ..

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Employed module as of jan 2012

  • 2. What are my Benefits? A. In-Patient Care Allowance for: Room and Board Drugs and Medicines X-Ray and Laboratories Operating Room Fees Professional Fees Confinement of less than 24 hours will not be paid except for the ff: 2. Case is Emergency 3. Patient is Transferred to another Hospital 4. Patient Expired
  • 3. What are my Benefits? B. Out-Patient Care Allowance for: Procedures must be Drugs and Medicines performed in Philhealth X-ray and Laboratories Accredited Health Care Providers Operating Room Fees Professional Fees confinement / admission in a non-accredited SAMPLE CASES: Health Care Providers can be paid if the case is Day surgeries emergency and the facility has DOH License Dialysis Cancer treatment procedures such as: chemotherapy radiotherapy
  • 4. Exclusions / Non-Compensable Procedures: Fifth and subsequent normal obstetrical deliveries Non-prescription drugs and devices Alcohol abuse and dependency treatment Cosmetic surgery Optometric services Other cost ineffective procedures as defined by PhilHealth
  • 5. New Inpatient PhilHealth Benefits Schedule For all PHIC Members and their Dependents Admissions starting April 05, 2009 (Circular 09, s. 2009) Levels 3 & 4 Hospitals (Tertiary) Benefit Item Case Type A B C D Room & Board P500 P500 P800 P1,100 (maximum of 45 days/year) Drugs and Medicines P4,200 P14,000 P28,000 P40,000 (per single period of confinement) X-ray, Lab & Others P3,200 P10,500 P21,000 P30,000 (per single period of confinement) For procedures with RVU 30 and below = 1,200 Operating Room For procedures with RVU 31 to 80 = 1,500 For procedures with RVU 80 to 600: RVU x PCF 20 (minimum = 3,500)
  • 6. New Inpatient PhilHealth Benefits Schedule Admissions starting April 05, 2009 (Circular 09, s. 2009) Levels 3 & 4 Hospitals (Tertiary) Professional Fees Case Type A B C D A. Daily Visits Gen. Practitioner (Groups 1, 5 and 6) Per day P300 P400 P500 P600 Maximum per confinement P1,200 P2,400 P4,000 P6,000 Specialist (Groups 2, 3 & 4) Per day P500 P600 P700 P800 Maximum per confinement P2,000 P3,600 P5,600 P8,000 B. Surgery For RVU 500 and below For RVU 501 and above Surgeon Anesthesiologist Surgeon Anesthesiologist Gen. Practitioner (1st Tier Group 1) RVU x PCF 40 = PF1 40% of surgeons fee RVU x PCF 40 = 40% of surgeons (PF1) PF1 fee (PF1) With Training (2nd Tier Group 5 & 6) RVU x PCF 48 = PF2 48% of surgeons fee RVU x PCF 48 = 48% of surgeons (PF1) PF2 fee (PF1) Diplomate / Fellow (3rd Tier Group RVU x PCF 56 = PF3 56% of surgeons fee RVU x PCF 80 = 40% of surgeons (PF1) PF4 fee (PF4) 2, 3, 4)
  • 7. New Inpatient PhilHealth Benefits Schedule For all PHIC Members and their Dependents Admissions starting April 05, 2009 (Circular 09, s. 2009) Level 2 Hospitals (Secondary) Benefit Item Case Type A B C Room & Board 400 400 600 (maximum of 45 days/year) Drugs and Medicines 3,360 11,200 22,400 (per single period of confinement) X-ray, Lab & Others 2,240 7,350 14,700 (per single period of confinement) For procedures with RVU 30 and below = 750 Operating Room For procedures with RVU 31 to 80 = 1,200 For procedures with RVU 81 to 600: RVU x PCF 15 (minimum = 2,200)
  • 8. New Inpatient PhilHealth Benefits Schedule Admissions starting April 05, 2009 (Circular 09, s. 2009) Level 2 Hospitals (Secondary) Professional Fees Case Type A B C A. Daily Visits Gen. Practitioner (Groups 1, 5 and 6) Per day P300 P400 P500 Maximum per confinement P1,200 P2,400 P4,000 Specialist (Groups 2, 3 & 4) Per day P500 P600 P700 Maximum per confinement P2,000 P3,600 P5,600 B. Surgery (For Case Types A, B, and C) Surgeon Anesthesiologist Gen. Practitioner (1st Tier Group 1) RVU x PCF 40 = PF1 40% of surgeons fee (PF1) With Training (2nd Tier Group 5 & 6) RVU x PCF 48 = PF2 48% of surgeons fee (PF1) Diplomate / Fellow (3rd Tier Group RVU x PCF 56 = PF3 56% of surgeons fee (PF1) 2, 3, 4)
  • 9. New Inpatient PhilHealth Benefits Schedule For all PHIC Members and their Dependents Admissions starting April 05, 2009 (Circular 09, s. 2009) Level 1 Hospital (Primary) Benefit Item Case Type A B Room & Board 300 300 (maximum of 45 days/year) Drugs and Medicines 2,700 9,000 (per single period of confinement) X-ray, Lab & Others 1,600 5,000 (per single period of confinement) Operating Room 500
  • 10. New Inpatient PhilHealth Benefits Schedule Admissions starting April 05, 2009 (Circular 09, s. 2009) Level 1 Hospitals (Primary) Professional Fees Case Type A B A. Daily Visits Gen. Practitioner (Groups 1, 5 and 6) Per day P300 P400 Maximum per confinement P1,200 P2,400 Specialist (Groups 2, 3 & 4) Per day P500 P600 Maximum per confinement P2,000 P3,600 B. Surgery (For Case Types A and B) Surgeon Anesthesiologist Gen. Practitioner (1st Tier Group 1) RVU x PCF 40 = PF1 40% of surgeons fee (PF1) With Training (2nd Tier Group 5 & 6) RVU x PCF 48 = PF2 48% of surgeons fee (PF1) Diplomate / Fellow (3rd Tier Group RVU x PCF 56 = PF3 56% of surgeons fee (PF1) 2, 3, 4) Maximum of 2,000 per Maximum fee computed as confinement percentage of 2,000
  • 11. **What is Single Period of Confinement & *45 Days Allowance? 45 DAYS 45 DAYS for one (1) for one (1) calendar year calendar year FOR THE MEMBER TO BE SHARED BY THE DEPENDENTS single period of confinement refers to a series of confinements/ procedures of the same illness within 90 DAYS
  • 12. Illustration of single period of confinement: CASE: CHEMOTHERAPY (case type C) Level 4 Hospital Tertiary Hosp: Max. Drugs & Meds. 28,000 / XLO 21,000 / Operating Room 1,200 (RVU10) JAN FEB MAR APR admitted / admitted / admitted / admitted / availed availed availed availed shall receive shall receive only shall receive only shall receive maximum the remaining the remaining another computation of benefits from the benefits from the maximum benefits based on initial computation initial computation computation if 45 the benefit based on benefit based on benefit days allowance is schedule schedule schedule not yet exhausted Drugs & Meds P20,000 Drugs & Meds P8,000 Drugs & Meds 0 (exhausted) Drugs & Meds P28,000 XLO P15,000 XLO P6,000 XLO 0 (exhausted) XLO P21,000 OR Fee P1,200 OR Fee P1,200 OR Fee P1,200 OR Fee P1,200
  • 13. How to avail or file for reimbursement: For confinements within the country A. FOR AUTOMATIC DEDUCTION (PhilHealth Benefits deducted from Hospital Charges) Member submit the following to the Billing Section of the Hosp upon discharge: Accomplished Claim Form 1 Copy of MDR or Supporting Documents in its absence Proof of Eligibility / Employers Certification (if needed) Official Receipts of Medicines bought outside, if any* *(for reimbursement to member, if benefits still not exhausted, upon submission of hosp to PHIC)
  • 14. How to avail or file for reimbursement: For confinements within the country B. FOR DIRECT FILING (member paid the hospital charges in full) Submit the following to PHIC within 60 DAYS from the date of discharge: Accomplished Claim Form 1 Copy of MDR or Supporting Documents in its absence Proof of Eligibility / Employers Certification (if needed) *Accomplished Claim Form 2 (accomplished by the hosp & doctors) *Waiver from the Hospital and Doctors OR Official Receipts *Operative Record, if with operation *Claim Form 3, if necessary
  • 15. How to avail or file for Reimbursement: For confinements abroad DIRECT REIMBURSEMENT ONLY Submit the following to any PHIC Office within 180 days from the date of discharge: Accomplished Claim Form 1 Statement of Account with itemized charges and/or OR Medical Certificate/abstract with final diagnosis, period of confinement & services rendered (with English translation) MDR 180 Proof of Contribution (xerox of latest Official Receipt or MI5) days
  • 16. Am I eligible to avail the Benefits? MUST HAVE CONTRIBUTED AT LEAST 3 MONTHLY PREMIUM CONTRIBUTIONS WITHIN THE IMMEDIATE 6 MONTHS PRIOR THE MONTH OF AVAILMENT JAN FEB MAR APR MAY JUN JUL x x x month of x x x availment x x x
  • 17. PhilHealth Circular 25, s-2010 Nine (9) Months Contribution as a Requirement for Benefit Availment The Corporation shall now require Nine (9) months of Contribution within (12) Twelve months prior to the month of availment for all confinements including availment of outpatient benefit This requirement shall be for all types of members except those under the Sponsored Program, Lifetime Member Program and the Overseas Workers Program The policy shall be effective for all reimbursements with admission / treatment (out-patient) date starting JULY 01, 2011
  • 18. PhilHealth Circular 25, s-2010 Nine (9) Months Contribution as a Requirement for Benefit Availment Illustration: JULY 2011 availment JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL 2010 2010 2010 2010 2010 2010 2011 2011 2011 2011 2011 2011 2011 12 11 10 9 8 7 6 5 4 3 2 1 X X X X X X X X X
  • 19. PhilHealth Circular 25, s-2010 Nine (9) Months Contribution as a Requirement for Benefit Availment Illustration: JULY 2011 availment (for Individually Paying Members IPP) AVAIL 3RD QUARTER 4TH QUARTER 1ST QUARTER 2ND QUARTER MENT JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL 2010 2010 2010 2010 2010 2010 2011 2011 2011 2011 2011 2011 2011 12 11 10 9 8 7 6 5 4 3 2 1 X X X X X X
  • 20. PhilHealth Circular 25, s-2010 Nine (9) Months Contribution as a Requirement for Benefit Availment Illustration: SEPT 2011 availment (for Individually Paying Members IPP) 3RD QUARTER 4TH QUARTER 1ST QUARTER 2ND QUARTER 3RD QUARTER JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP 2010 2010 2010 2010 2010 2010 2011 2011 2011 2011 2011 2011 2011 2011 2011 Jul & August 2011 shall only be counted in the 9/12 if the premium shall be paid prior to confinement Any contribution payment paid within the confinement shall no longer be considered for the present confinement but for future / prospective ones
  • 21. PhilHealth Circular 25, s-2010 Nine (9) Months Contribution as a Requirement for Benefit Availment Example: Date of confinement: September 3, 2011 Date of payment (3rd Quarter 2011) September 3, 2011 3RD QUARTER 4TH QUARTER 1ST QUARTER 2ND QUARTER 3RD QUARTER JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP 2010 2010 2010 2010 2010 2010 2011 2011 2011 2011 2011 2011 2011 2011 2011 12 11 10 9 8 7 6 5 4 3 2 1 x x
  • 22. Eligibility to use: former OFW, Indigent or IPM* (shifting of membership category) Certification from MDR current Employer OF W (eligibility is + reflected) or Photocopy of applicable RF-1 and ME-5 Proof of d contribution sore Indigent ID on ber (eligibility is from previous Sp em category M reflected) (within the immediate 6 months) Latest Official M Receipt or MI-5 IP * Members eligibility is divided into 2 different membership classification
  • 23. How long does it take to process a claim? The rule provides 60 DAYS upon filing to process a claim Check payments will be sent to the member / hospital through registered mail or over the counter / pick-up Members will receive a Benefits Payment Notice upon issuance of reimbursement
  • 24. What is Benefit Payment Notice? BPN written notice sent to members who availed the benefits shows the details of the benefits computed (i.e. benefits received by the member, hospital, doctors)
  • 25. ENHANCED CLAIM FORMS Implementation: September 01, 2010
  • 26. ENHANCED CLAIM FORMS Implementation: September 01, 2010
  • 27. ENHANCED CLAIM FORMS Implementation: September 01, 2010
  • 28. PHILHEALTH CALL CENTER
  • 29. our website .... NCR Central Info ..