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How to Avail PhilHealth Benefits When You Get Sick Abroad

Along with perseverance and lots of sacrifices for the betterment of loved ones back home, overseas Filipino workers may sometimes fall ill. Unwanted circumstances like this may be emotionally and financially devastating for both OFWs and their families in the Philippines. To somehow lessen undesired burdens like this, OFWs may avail their PhilHealth benefit even while abroad.
 
According to PhilHealth's official website, confinement due to sickness or for an operation while abroad is still covered by member's compensation. Reimbursement may be filed within a grace period of 180 days or 6 months at any PhilHealth local office through the member's authorized representative.
 
Documents needed to claim the reimbursement are the following:
  • Fully accomplished PhilHealth Claim Form 1 duly signed by the member or his authorized representative;
  • Photocopy of MDR or latest receipt;
  • Medical certificate with complete diagnosis, period of confinement and services rendered; (should be in English)
  • Statement of Account and/or Official Receipts with itemized charges; and other supporting documents (should be in English).
 
But aside from filing for the reimbursement, an OFW PhilHealth member may avail his benefit through outright/automatic deduction from hospital bills. During the confinement, submit the following documents to the hospital:
  •  PhilHealth Claim Form 1 accomplished and signed by the member or its immediate family member;
  • Photocopy of MDR or latest receipt and other supporting document if the patient is not yet reflected as dependent in the MDR.
A copy of your Statement of Account may be submitted should an official receipt for the payment made for the hospital bill and professional fee is not provided by the hospital. The Statement of Account must contain the breakdown of charges for room and board, medical supplies, laboratory procedures, operating room fee and professional fee.

Authorized representative who can sign the forms and claim reimbursement in behalf of the member:
  • If married - his/her spouse or his/her children with legal age or the parents in the absence of spouse and children;
  • If single - his/her parents or any authorized representative with authorization letter from the member and a photocopy of representative's 2 valid IDs as well as 2 valid IDs of the member.
 
There are, however, cases that are considered not compensatory by the state insurance company. These events are as follows:
 
  • Fifth and subsequent normal obstetrical deliveries
  • Non-prescription drugs & devices
  • Alcohol abuse or dependency treatment
  • Cosmetic Surgery
  • Optometric Services
  • Cost-ineffective procedures that shall be defined by PhilHealths

 
On the other hand, Out-Patient Benefit Package (OPB) may also be availed by OFW member. Just provide a photocopy of your Member Data Record (MDR) or latest receipts and supporting documents to any accredited hospitals in the Philippines.