How to Use Philhealth in Hospitals

PhilHealth provides a significant safety net for Filipinos during medical emergencies, especially when utilizing services from accredited hospitals. These hospitals are not just recognized for their quality care but are also directly coordinated with the agency, ensuring that members can significantly reduce their out-of-pocket expenses. The program is designed for PhilHealth members in need of hospitalization due to various medical conditions. Members can expect to enjoy benefits such as subsidies for room and board, laboratory fees, medications, and surgical expenses. To maximize these benefits, members should ensure their hospital of choice is accredited by the agency, which can be confirmed via the PhilHealth website, mobile app, or direct hospital inquiry. This setup aims to streamline the claims process, offering peace of mind and reducing financial burdens for patients during critical times.

philhealth in hospitals

Using PhilHealth in Accredited Hospitals

PhilHealth benefits truly shine in its accredited hospitals. These hospitals not only provide quality care but also work directly with the agency to significantly reduce your out-of-pocket expenses.  They handle the claims process for you, offering peace of mind and streamlined care during a medical emergency.

How to Find Accredited Hospitals

  • PhilHealth Website: Access the regularly updated list of accredited hospitals and clinics on the PhilHealth website. Search by region, province, city, or facility type.
  • PhilHealth Mobile App: Download the PhilHealth mobile app for convenient access to the list of accredited hospitals and other resources.
  • Hospital Inquiry: Check hospital websites or brochures for their PhilHealth accreditation status. Alternatively, contact the hospital administration directly.

Remember: Always confirm if the hospital is accredited for your specific program before admission. This ensures maximum utilization of your benefits. Using PhilHealth in accredited hospitals can provide a smoother healthcare journey and minimize financial burdens during emergencies.

Legal Basis

PhilHealth operates under the Republic Act No. 7875 as amended by Republic Act No. 10606, which mandates universal health coverage in the Philippines. This law ensures that every Filipino has access to comprehensive health care services, promoting equity in health.


PhilHealth members enjoy a variety of benefits, particularly in times of need such as hospitalization due to certain medical conditions. Here are some highlighted benefits:

  • Subsidy for room and board
  • Laboratory fees coverage
  • Medication subsidy
  • Operating room and surgical expenses assistance

Eligibility / Qualifications

To qualify for hospitalization benefits, members must meet the following criteria:

  • Paid at least three months’ worth of premiums within the immediate six months of confinement.
  • For pregnancies, newborn care package, radiotherapy, dialysis, chemotherapy, and certain surgical procedures, nine months’ worth of contributions in the last 12 months are required.
  • Must be confined in the hospital for at least 24 hours due to an illness or disease requiring hospitalization.
  • The claim must be within the 45-day allowance for room and board.


Before availing of the hospitalization benefits, ensure you have the following documents:

  • A clear, updated copy of your Member Data Record (MDR). Dependents must be listed in the MDR.
  • The original copy of PhilHealth Claim Form 1, obtainable at PhilHealth, the hospital, or your employer. This must be signed by your employer.
  • Receipt of premium payments or Certificate of Premium Payments with OR numbers for employees.
  • PhilHealth ID and a valid ID.

Step-by-Step Guide on How to Use PhilHealth for Hospitalization

  1. Ensure Membership and Up-to-date Payments: Register as a member and maintain regular premium contributions.
  2. Check Eligibility and Prepare Documents: Before hospitalization, prepare and check the documents mentioned above to ensure eligibility.
  3. Hospital Admission: Upon admission, inform the hospital you’re a PhilHealth member and provide your MDR and valid IDs.
  4. Submission of Documents: Before discharge, submit all required documents to the hospital’s billing section.
  5. Benefit Deduction: The hospital will automatically deduct your PhilHealth benefits from the total bill.

Recent Updates

PhilHealth Enhances Coverage for Pertussis Patients, Ensuring Accessible Health Care

To support individuals affected by pertussis (whooping cough), the Philippine Health Insurance Corporation has increased its claim amount for hospitalized patients up to P90,000. This enhanced coverage aims to alleviate financial burdens and ensure equitable access to quality health care. PhilHealth’s commitment to universal health care is further demonstrated through its Konsultasyong Sulit at Tama (Konsulta) package, providing free consultation, screening, diagnostic tests, and prescribed medications for symptomatic patients. Vaccination remains essential in preventing pertussis, as the country experiences a surge in cases, particularly among unvaccinated children. PhilHealth’s proactive measures signify their dedication to improving services and making them more accessible to all Filipinos. (Inquirer)

PhilHealth Raises Breast Cancer Benefit to P1.4 Million, Expands Coverage

PhilHealth has increased its benefit package for breast cancer to P1.4 million, a 1,400-percent increase from the previous package of P100,000. The enhanced Z Benefit Package now covers Stages 0 to 4 of breast cancer and has expanded eligibility qualifications, even covering patients already undergoing treatment. This comprehensive package includes diagnostic tests, management, and surveillance for early signs of relapse, providing a holistic approach to breast cancer treatment. Members can contact the Z Benefits Coordinator of contracted health facilities for guidance on availing the enhanced benefit. (Manila Standard)

Heading: PhilHealth Records Accessible 24/7 Through eGovPH Super App

PhilHealth members now have round-the-clock access to their health insurance information via the eGovPH Super App. This digitalization initiative, in collaboration with the Department of Information and Communications Technology (DICT), allows members to conveniently view their membership profile, contribution history, and registration status with Konsulta providers. The user-friendly app also offers additional features like online registration, amendment, and the use of QR codes for verification, making quality and affordable healthcare services more accessible to millions of Filipinos. (PIA)

PhilHealth Member Portal Now Accessible on eGovPH Super App

The Philippine Health Insurance Corp. has partnered with the Department of Information and Communications Technology (DICT) to integrate the PhilHealth Member Portal into the eGovPH Super App. This collaboration aims to provide hassle-free and accessible health insurance information for members, both locally and abroad. By downloading the eGovPH mobile app, members can conveniently access their membership profile, contribution history, and registered Konsulta provider, with more services such as online registration and amendment to be added in the future. (Philstar)

Video: How to File Philhealth Claim

In this straightforward video guide, discover the step-by-step process to file a Philhealth claim. From gathering the necessary documents to submitting your claim, this video provides practical tips and insights to help you navigate the process smoothly. Take advantage of the detailed instructions and key points outlined in this guide to ensure a successful  claim submission.



Understanding your rights and responsibilities as a PhilHealth member is essential for leveraging the healthcare system in the Philippines. By following this guide, you can ensure that during times of medical need, the process of availing hospitalization benefits is as smooth and stress-free as possible. Remember, preparation is key, and being informed is your best tool in navigating healthcare benefits.

error: Content is protected !!