PhilHealth Inpatient Benefits: What You Need to Know

Navigating healthcare costs can be overwhelming, but understanding your PhilHealth inpatient benefits can significantly ease the burden. PhilHealth, the national health insurance program of the Philippines, offers comprehensive coverage for various inpatient services.

This guide simplifies everything you need to know about PhilHealth inpatient benefits, helping you maximize your coverage and minimize out-of-pocket expenses. Discover the key benefits, eligibility requirements, and step-by-step processes to ensure you’re fully prepared for any hospital stay.

Read on to make the most of your PhilHealth membership and safeguard your health and finances.

What are PhilHealth’s Inpatient Benefits?

PhilHealth’s Inpatient Benefits cover the cost of hospitalization for both inpatient and outpatient care. This includes room and board, meals, medical supplies, and laboratory tests. The specific benefits that are covered vary depending on the member’s PhilHealth status.

Benefits of PhilHealth Inpatient Benefits

For instance, members with at least 36 months of continuous premium payments are entitled to the full range of PhilHealth inpatient benefits. These benefits include:

  • Room and board
  • Meals
  • Medical supplies
  • Laboratory tests
  • Diagnostic procedures
  • Therapeutic procedures
  • Operating room fees
  • Anesthesia fees
  • Professional fees

Members with less than 36 months of continuous premium payments may still be entitled to some inpatient benefits, but the coverage may be less.

To be eligible for PhilHealth inpatient benefits, members must be confined in a PhilHealth-accredited hospital. The hospital must also be classified as a Level 1, 2, 3, or 4 hospital. The level of the hospital determines the amount of PhilHealth coverage that is available.

For example, a member who is confined in a Level 1 hospital will receive a lower level of PhilHealth coverage than a member who is confined in a Level 4 hospital.

How to Claim PhilHealth Inpatient Benefits

To file a claim for PhilHealth inpatient benefits, members must submit a claim form to their local PhilHealth office. The claim form must be accompanied by the following documents:

  • Hospital discharge summary
  • PhilHealth member ID card
  • Proof of payment of PhilHealth premiums

Once the claim is processed, PhilHealth will reimburse the member for the cost of the covered services.

Here are some additional information about PhilHealth Inpatient Benefits:

  • The maximum number of days of coverage for inpatient care is 90 days per year.
  • The maximum amount of reimbursement for inpatient care is based on the member’s PhilHealth status and the level of the hospital.
  • PhilHealth also covers the cost of certain inpatient procedures, such as caesarean deliveries and organ transplants.

For any concerns or inquiries regarding your PhilHealth matters, you can easily reach out for assistance. You can send an email to [email protected] or you can check our guide in other ways to contact Philhealth.