Navigating healthcare abroad can be complex, but for Overseas Filipino Workers (OFWs), PhilHealth provides a structured process to file claims outside the Philippines. By ensuring active membership and following a straightforward documentation procedure, OFWs can claim reimbursements for medical treatments received internationally. This service is part of the broader Universal Health Care program, aimed at reducing the financial healthcare burdens for Filipinos globally.
The eligibility criteria, requirements, and a step-by-step guide are laid out to aid OFWs in utilizing their benefits, reinforcing the institution’s commitment to supporting Filipino workers, no matter where they are.
Understanding PhilHealth Claims Abroad
PhilHealth’s commitment to supporting Filipinos extends beyond the country’s borders, allowing OFWs to file claims for hospitalizations and medical treatments received abroad. This provision ensures that the financial burden of healthcare can be alleviated, regardless of your location.
Legal Framework and Benefits
PhilHealth has adapted its policies to better serve Overseas Filipino Workers (OFWs) during the COVID-19 crisis, with former President Duterte declaring voluntary membership for them and suspending increased premiums. Originally, OFWs faced mandatory contributions up to 5% of their income by 2024 under the Universal Healthcare Law. Now, OFWs benefit from the Medical Care Program, which includes hospitalization and other healthcare services, accessible both domestically and overseas. Enrollment in the National Health Insurance Program is required, utilizing documents like employment contracts or income declarations. Locally, the All Case Rate payment scheme facilitates service access using a PhilHealth ID and updated Member Data Record at accredited institutions. The adjustments aim to ensure OFWs and their dependents maintain essential healthcare coverage no matter where they are.
The benefits include:
- Reimbursement for hospitalization expenses, subject to PhilHealth policies.
- Coverage for a range of medical and surgical conditions, ensuring broad support for various healthcare needs.
Who Can Avail?
To be eligible, you must be:
- An active PhilHealth member at the time of hospitalization.
- Hospitalized for a condition covered by PhilHealth.
- Within the 45-day annual limit for room and board allowance.
Requirements
Filing a claim requires the following documents:
- Medical Abstract or record in English detailing diagnosis and treatment.
- Operative Record (if surgery was performed).
- Statement of Account (SOA) showing a detailed breakdown of expenses.
- PhilHealth Claim Form 1, available for download online.
Step-by-Step Guide to Filing Your Claim
- Gather Necessary Documents: Ensure you have all the required documents mentioned above. Preparation is key to a smooth claim process.
- Verify Membership Status: Check that your membership is active and that you’re filing within the valid period for OFWs.
- Mail Documents: Send the compiled documents to the organization within 180 days after hospital discharge. Timing is important to ensure your claim is considered.
- Await Reimbursement: After submission, the agency will process your claim based on the documents provided and reimburse the applicable amount.
Enrollment as a Prerequisite
To access these benefits, enrollment in the NHIP as a self-paying member is mandatory. This involves completing enrollment forms and submitting necessary documents like your overseas employment contract or an affidavit of income declaration.
Recent Updates
Ejercito Pushes for Revision of PhilHealth Rates
In a bid to address the financial burden faced by direct contributors to the Philippine Health Insurance Corp., Senator Joseph Victor “JV” Ejercito has sponsored Senate Bill 2620. The bill aims to amend the Universal Healthcare Act, allowing for the revision of premium rates. This move is seen as necessary to adapt to pressing circumstances, such as the ongoing Covid-19 pandemic. (Manila Times)
Bong Go champions amendments to the Universal Health Care Act to ease PhilHealth premium burdens on daily wage earners, poor
In a co-sponsorship speech, Senator Christopher “Bong” Go expressed his strong support for proposed amendments to the Universal Health Care (UHC) Act, specifically focusing on revising the Philippine Health Insurance Corporation premium contributions. The aim is to alleviate the financial strain on Filipinos, particularly in the aftermath of the pandemic. The proposed amendments include reducing premiums from 2024 to 2027 and requiring the national government to cover fifty percent of the premium contributions for migrant workers. (Manila Times)
Senator Bong Go Supports Opening of Super Health Center in Arayat, Pampanga
Senator Christopher “Bong” Go joined the inauguration and blessing of a new Super Health Center in Arayat, Pampanga. The Super Health Center aims to alleviate the burden on overcrowded hospitals, provide primary care services, and enable early detection of diseases. Senator Go emphasized the importance of the center in decongesting hospitals and providing essential healthcare services to the community. (The Inquirer)
PhilHealth Registration for OFWs: Ensuring Access to Benefits
Overseas Filipino Workers must submit completed PhilHealth Member Registration Forms (PMRF), valid identification, and supporting documents for dependents to any PhilHealth office for registration. Upon confirmation of eligibility through the PhilHealth Portal, OFWs can promptly utilize benefits; if ineligible, additional documentation may be required. For medical incidents abroad, submission of detailed medical records in English, operative records if surgery occurred, and the completed PhilHealth Claim Form 1 within 180 days post-discharge is necessary to process claims.
PhilHealth assures its members that lapsed contributions do not hinder access to healthcare benefits. Under Universal Health Care (UHC), every Filipino is entitled to utilize PhilHealth benefits for medical treatment anytime and anywhere. PhilHealth stands ready to support its members, emphasizing the importance of immediate and accessible health coverage.
Video: Former DMW Secretary Ople on PhilHealth mandatory contribution for OFWs
DMW Sec. Susan Ople has expressed the need to revise the provisions of the Universal Health Care Act regarding PhilHealth’s mandatory contributions for Overseas Filipino Workers (OFWs). Ople believes that this requirement is burdensome and unjustified, particularly for low-paying jobs like domestic work, in response to concerns raised by migrant workers.