OFWs and Their Dependents Can Enjoy PhilHealth Benefits

As an Overseas Filipino Worker, it is important that you are prepared for any emergencies. Not only because your family is not suffering from anything today does it mean that you should not be prepared.

You need to have a health insurance that you can lean on in times of emergencies, not only for you but also for your family in the Philippines.

In the country, PhilHealth from the government is the most common healthcare insurance program. As an OFW, you are highly encouraged to be an active member for you to fully enjoy the benefits from the program.

Who Are Covered by PhilHealth?

1. Land-based OFWs
2. Seafarers or Sea-based Filipino Workers. Any person who is employed or engaged in any activity on board a seagoing ship navigating foreign seas other than a government ship used for military or non-commercial purposes.
3. Filipinos with Dual Citizenship.

What Are the Advantages of Being a PhilHealth Member?

1. You or your dependents may avail of PhilHealth benefits for hospital confinement or out-patient surgeries in any accredited healthcare institutions in the Philippines. Confinement of OFWs overseas may be reimbursed.
2. OFW confinement is entitled to PhilHealth benefits through claim reimbursements. Members have 180 days upon discharge to submit all their claim documents at any PhilHealth offices in the Philippines.
3. Dependents are entitled the same set of benefits as the principal members. This means reduced worries and stress for the OFW to think about his or her family member’s health care needs while working abroad. Should a dependent gets hospitalized in the Philippines, the same set of benefits should be available for the dependent. PhilHealth also supports inpatient care through the All Case Rate Payment Scheme for most illnesses and surgical procedures.
4. OFWs are entitled to Lifetime membership. If an OFW has reached the age of retirement and has paid at least 120 months of contribution, he or she is automatically a Lifetime member of PhilHealth.
5. Availment for the OFW and the qualified dependent is easy and readily accessible. Should hospitalization become necessary, there is no need to worry about numerous documents and paperwork to submit since most accredited healthcare institutions are connected to the Health Care Institution Portal.
6. PhilHealth covers more than 4,600 medical and surgical procedures which include cancer cases and other dreaded diseases.

PhilHealth Benefits

Inpatient Benefits

These benefits are paid to the accredited Health Care Institution (HCI) through All Case Rates.

The case rate amount shall be deducted by the HCI from the member’s total bill, which shall include professional fees of attending physicians, prior to discharge

The case rate amount is inclusive of hospital charges and professional fees of attending physician

Availment Condition

Member must have at least three (3) months’ premium contributions within the immediate six (6) months prior to the month of availment.

Documents needed

A copy of Member Data Record or PhilHealth Benefit Eligibility Form (PBEF) 

duly accomplished PhilHealth Claim Form 1

Outpatient Benefits

1. Day Surgeries (Ambulatory Or Outpatient Surgeries) Are Services That Include Elective (Non-Emergency) Surgical Procedures Ranging From Minor To Major Operations, Where Patients Are Safely Sent Home Within The Same Day For Post-Operative Care
2. Radiotherapy
3. Hemodialysis
4. Outpatient Blood Transfusion 
5. Primary Care Benefits

Availment Condition

Member must have at least three (3) months’ premium contributions within the immediate six (6) months prior to the month of availment

Documents Needed

Copy of Member Data Record and duly accomplished PhilHealth Claim Form 1

Z Benefits

1. Acute Lymphocytic / Lymphoblastic Leukemia (standard risk) P210,000
2. Breast Cancer (stage 0 to IIIA) P100,000
3. Prostate Cancer (low to intermediate risk) P100,000
4. End-state renal disease eligible for requiring kidney transplantation (low risk) P600,000
5. Coronary Artery Bypass Graft Surgery (standard risk) P550,000
6. Surgery for Tetralogy of Fallot in Children (P320,000)
7. Surgery for Ventricular Septal Defect in Children (P250,000)

Cervical Cancer

1. Chemoradiation with Cobalt and Brachytherapy (low dose) or Primary surgery for Stage IA1, IA2 – IIA1 P120,000
2. Chemoradiation with Cobalt and Brachytherapy (low dose) or Primary surgery for Stage IA1, IA2 – IIA1 P120,000
3. Chemoradiation with Linear Accelerator and Brachytherapy (high dose) P175,000

Z MORPH 

(Mobility,  Orthosis, Rehabilitation, Prosthesis Help)

• first right and/or left below the knee P15,000
• both limbs P30,000

Selected Orthopedic Implants

Implants for Hip Arthroplasty

• Implants Hip Prosthesis, cemented*P103,400
• Total Hip Prosthesis, cementless**P169,400
• Partial Hip Prosthesis, bipolar P73,180
• *cemented: 66 years old and above 
• ** cementless: 65 years and 364 days old and below

Implants for Hip Fixation

• Multiple screw fixation (MSF)*** 6.5mm cannulated cancellous screws with washer – P61,500 
• ***59 years and 364 days old and below (both displaced and undisplaced fracture); 60 years old and above (undisplaced fracture)

Implants for Pertrochanteric Fracture

• Compression Hip Screw Set (CHS) – P69,000
• Proximal Femoral Locked Plate (PFLP) – P71,000

Implants for Femoral Shaft Fracture

• Intramedullary Nail with Interlocking Screws – P48,740
• Locked Compression Plate (LCP) – Broad / Metaphyseal / Distal Femoral LC – P50,740
• “PD First” – for End-Stage Renal Disease Requiring Peritoneal Dialysis P270,000 per year

Colon and Rectum Cancer Colon Cancer

• Stage I-II (low risk) – P150,000
• Stage II (high risk) – III – P300,00

Rectum Cancer

Stage I (clinical and pathologic) – P150,000

• Pre-operative clinical stage I but with post-operative pathologic stage II-III
• Using linear accelerator as mode of radiotherapy) – P400,000
• Using cobalt as mode of radiotherapy – P320,000

Clinical Stage II-III

• Using linear accelerator as mode of radiotherapy) – P400,000
• Using cobalt as mode of radiotherapy -P320,000

MDG-Related Benefits

Benefits Package and Amount of Benefit

• Outpatient Malaria Package – P600.00
• Outpatient HIV-AIDS Package – P30,000.00 per year (P7,500/quarter)
• Outpatient Anti-Tuberculosis Treatment through Directly-Observed Treatment Short-course (DOTS) Package P4,000
• P2,500 – Intensive phase
• P1,500 – Maintenance Phase
• Voluntary Surgical Contraception Procedures – P4,000.00
• Animal Bite Treatment Package – P3,000.00

Filing a Claim for Overseas Confinement

If an OFW is confined abroad, the following documents must be sent either via overseas courier or through electronic mail to the PhilHealth Regional Office or the Local Health Insurance Office nearest to the OFW’s Philippine address within 180 days from the date of discharge.

1. Medical abstract or medical record written in English or copy of Medical Certificate indicating the final diagnosis, confinement period and medical services rendered;
2. Copy of the operative record written in English, if an operation was performed
3. Statement of account
4. Official Receipt issued by the hospital and doctor
5. Properly filled out PhilHealth Claim Form 1

If an OFW or a qualified dependent is confined in the Philippines, a properly filled out PhilHealth Claim Form 1 must be submitted to the accredited hospital’s Billing Section before discharge.

How To Be a PhilHealth Member

If you are currently in the Philippines for vacation, you can register personally.

1. Go to the nearest Local Health Insurance Office or PhilHealth Express outlet.
2. Fill out two PMRF copies.
3. Submit your accomplished and signed forms.
4. Wait for the PhilHealth Member Data Record (MDR) and ID card to be issued to you.
5. Using your PhilHealth ID number (PIN), pay your premium contribution to the cashier.

However, if you are already abroad, there are three options for membership registration.

1. Applying at any branch of PhilHealth-accredited collecting partners iRemit and Ventaja Corporation.
2. Using the PhilHealth online registration facility.
3. Downloading and printing the PMRF, filling it out, and sending it to ofp@philhealth.gov.ph.

Whichever method you choose, you need to pay the annual PhilHealth contribution of P2,400 to any PhilHealth office, collecting agents or the PhilHealth Operations Center at the POEA Central Office.