Medical emergencies can happen anytime, and getting timely care matters.
PhilHealth has expanded its Facility-Based Emergency (FBE) benefit to cover outpatient emergency cases, helping members access treatment without needing hospital admission.
This benefit is available in all accredited Level 1 to Level 3 hospitals and applies to various emergency conditions.
There is no extra charge for members aside from their regular PhilHealth contributions.
If you or a loved one need urgent medical attention but are not admitted, this expanded coverage offers financial relief.
What is Covered?
PhilHealth’s FBE benefit provides financial support for patients needing emergency medical care in an outpatient setting.
It includes coverage for:
- Emergency consultations and treatments for health conditions such as burns, seizures, nontraumatic bleeding, severe headaches, vomiting, dizziness, and high blood pressure.
- Emergency mental health cases such as acute psychiatric distress or suicide attempts.
- Sexual assault cases, providing immediate medical intervention for survivors.
- Important diagnostic procedures such as X-rays, CT scans, laboratory work, and other necessary tests.
- Emergency medications and treatments, including nebulization, intubation, and intravenous fluids.
Which Hospitals Are Covered?
PhilHealth’s expanded coverage applies to all accredited Level 1 to Level 3 hospitals.
Patients do not need to be admitted to benefit from this coverage.
If a hospital has extension facilities, these must be registered with PhilHealth through their Regional Offices to qualify for benefits.
How to Avail
To claim the FBE benefit, follow these steps:
- Verify Your PhilHealth Membership
Check if your PhilHealth membership is active, and your contributions are up to date.
If your employer handles your contributions, confirm that payments are being made.
- Prepare the Required Documents
Bring the following:
- PhilHealth Identification Number (PIN)
- PhilHealth Benefit Eligibility Form (PBEF) (confirms eligibility)
- PhilHealth Claim Form 1 (required for claiming benefits)
- Valid ID for identity verification
- Go to an Accredited Hospital
Visit an accredited Level 1 to Level 3 hospital offering the Facility-Based Emergency (FBE) benefit.
Check the list of accredited hospitals on the PhilHealth website or ask directly at the hospital.
- Submit Your Documents
Provide your PIN, PBEF, Claim Form 1, and valid ID to the hospital’s billing or admissions office.
The hospital will process your request and apply the benefit to reduce your bill.
- Confirm Compliance for Extension Facilities
If the hospital has extension facilities, they must submit a certification to their respective PhilHealth Regional Office, stating the name and complete address of the extension facility.
PhilHealth Claim Form 1
This document, PhilHealth Claim Form 1, is a required form for members who need to avail of outpatient emergency benefits under the Facility-Based Emergency (FBE) benefit.
It serves as an official request for coverage, ensuring that eligible medical expenses are processed correctly.
Patients must complete this form and submit it, along with their PhilHealth Identification Number (PIN), Benefit Eligibility Form (PBEF), and a valid ID, to the hospital’s billing or admissions office.
The form can be downloaded directly from the PhilHealth website at PhilHealth Claim Form 1.
Make sure to fill out all required fields accurately to avoid processing delays. If you need help completing the form, you can ask assistance from the hospital’s PhilHealth desk or visit the nearest PhilHealth office for guidance.
Accreditation and Compliance
Hospitals do not need extra accreditation to provide FBE benefits, as it is already included in their existing accreditation with PhilHealth.
However, hospitals with extension facilities must submit a certification to their respective PhilHealth Regional Office to maintain coverage.
The certification should include:
- Name of the extension facility
- Complete address
This makes sure that patients treated at extension facilities still receive their entitled PhilHealth benefits.
Future Updates: Upcoming Coverage for Ambulance Services
PhilHealth has announced future expansions, including ambulance services under the Prehospital Emergency (PHE) benefit.
This will help patients needing emergency transport get financial support.
More details will be announced soon, so staying updated is a good idea.
Frequently Asked Questions
- Does the FBE benefit cover all types of outpatient emergencies?
Yes, it applies to many emergency medical conditions, including nontraumatic bleeding, severe headaches, dizziness, burns, seizures, and psychiatric emergencies.
However, non-emergency outpatient visits are not included.
- Can non-members avail of this benefit?
No. Only active PhilHealth members and their qualified dependents can claim this benefit.
If you are not yet a member, you must register and start contributing to qualify.
- Are there limits to how often I can use this benefit?
There are limits based on the case rate and fund allocation.
However, if your case qualifies as a genuine emergency, PhilHealth will cover the eligible expenses.
- Will this cover private hospitals?
Only PhilHealth-accredited Level 1 to Level 3 hospitals are covered.
Some private hospitals are accredited, so it is best to check directly with PhilHealth or the hospital.
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Conclusion
PhilHealth’s expanded outpatient emergency coverage is a huge help for many.
By covering outpatient emergency cases, patients can receive immediate care without stressing over hospital admission costs.
To maximize these benefits:
- Keep your PhilHealth membership active
- Visit an accredited hospital
- Prepare and submit the required documents
With future expansions, including ambulance service coverage, PhilHealth continues to improve healthcare support for members.
Stay informed and take full advantage of your benefits.