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PHILHEALTH CLAIM — DEADLINE AND DOCUMENT CHECKLIST
For a claim you file yourself (direct filing / reimbursement)
Patient [FULL NAME OF PATIENT]
PhilHealth member and PIN [FULL NAME OF MEMBER] · PIN [12-DIGIT PHILHEALTH IDENTIFICATION NUMBER]
Relationship of patient to member [SELF/SPOUSE/CHILD/PARENT]
Hospital or clinic [NAME AND ADDRESS OF HEALTH CARE INSTITUTION] · [ACCREDITED/NOT ACCREDITED/ABROAD]
Admitted · Discharged [DATE OF ADMISSION] · [DATE OF DISCHARGE]
LAST DAY TO FILE [DATE OF DISCHARGE + 60 CALENDAR DAYS] — confinement abroad: [DATE OF DISCHARGE + 180 DAYS]
Filed on · received by [DATE FILED] · [PHILHEALTH OFFICE, NAME OF RECEIVING OFFICER, RECEIVING STAMP]
Claim / transmittal number [NUMBER ON THE RECEIVING COPY]
1. Should you file it yourself?
Usually the hospital files the claim with PhilHealth and deducts your PhilHealth benefit from the bill before you pay. You file directly ("direct filing", for reimbursement) only where PhilHealth allows it, for example:
• confinement abroad (180 days from discharge);
• emergency confinement in a hospital not accredited by PhilHealth (60 days);
• an employed member confined over a weekend or holiday who could not get the employer’s certification before discharge (60 days);
• other cases listed by PhilHealth (Circular No. 20, s. 2014, such as peritoneal dialysis and the Animal Bite Package). Some newer benefit packages allow direct filing only for confinement abroad.
Before you pay the full bill, ask the hospital billing office whether it will deduct PhilHealth. If you file directly, PhilHealth pays the case rate to you, not the whole bill.
2. Documents
✓ Document Who prepares it Notes
☐ PhilHealth Claim Form 1 (CF1) Member, with the hospital’s help Latest version from philhealth.gov.ph or the PhilHealth office
☐ Claim Form 2 (CF2) Hospital Diagnosis with ICD-10 / RVS codes and charges
☐ Claim Form 3 (CF3) or Claim Form 4 (CF4) Hospital and attending doctor Clinical record. Circular 20 s.2014 accepts a photocopy of the chart or a clinical abstract instead of CF3
☐ Claim Signature Form (CSF) Member or patient, hospital, doctors If the hospital or PhilHealth office asks for it
☐ Waiver for directly filed claims Hospital States that you paid in full and no PhilHealth deduction was made (Annex 1 of Circular 20 s.2014)
☐ Statement of Account (SOA) Hospital billing Itemized and signed
☐ Official receipts (originals) Hospital, doctors, pharmacy, laboratory Hospital bill, professional fees, medicines and tests bought outside
☐ Operative and anesthesia record Hospital Only for surgery or procedures
☐ Proof of contributions Member If asked — for example self-paying, voluntary or OFW members
☐ Confinement abroad Foreign hospital, member Itemized bill and official receipts, medical certificate or clinical abstract, English translation if needed, passport pages with travel dates. Ask PhilHealth for the current list
☐ Authorization letter and IDs Member and representative Only if someone files for you
☐ Copies of everything You Keep the receiving copy with the date stamp — it proves you filed on time
3. Why claims are denied or returned
• Filed late — after 60 days from discharge (180 days if abroad). PhilHealth has said this is the main reason for denied claims.
• Incomplete or unsigned forms; missing ICD-10 or RVS codes. These are usually returned to the sender for correction — a refiled claim that still does not fix the deficiency is denied.
• The member was not eligible on the date of admission, or the condition is not covered by the case rates.
• The same confinement claimed twice, or dates on the forms that do not match.
If the claim is denied, you may file a motion for reconsideration — see the separate template “PhilHealth Motion for Reconsideration”.
[DATE]
The Head
[LOCAL HEALTH INSURANCE OFFICE / PHILHEALTH REGIONAL OFFICE [NUMBER]]
Philippine Health Insurance Corporation
[ADDRESS]
Subject: Direct filing of claim for reimbursement — [FULL NAME OF PATIENT], confined [DATE OF ADMISSION] to [DATE OF DISCHARGE], PIN [NUMBER]
Dear Sir/Madam:
I respectfully submit my claim for reimbursement of PhilHealth benefits for the confinement of [FULL NAME OF PATIENT], my [RELATIONSHIP / “myself”], at [NAME OF HOSPITAL], [CITY/COUNTRY], from [DATE OF ADMISSION] to [DATE OF DISCHARGE].
I am filing this claim directly because [CHOOSE ONE: the confinement was abroad / it was an emergency confinement in a non-accredited facility / I was confined over a [WEEKEND/HOLIDAY] and could not obtain my employer’s certification before discharge / OTHER REASON]. The hospital did not deduct PhilHealth benefits from my bill, as shown in the enclosed waiver and statement of account.
This claim is filed on [DATE], within [SIXTY (60) / ONE HUNDRED EIGHTY (180)] days from the date of discharge.
Enclosed are the following:
1. PhilHealth Claim Form 1 (CF1);
2. Claim Form 2 (CF2) and [CF3/CF4/CLINICAL ABSTRACT];
3. Waiver for directly filed claims;
4. Statement of Account;
5. Official receipts — [NUMBER] pieces, total PHP [AMOUNT];
6. [OTHER DOCUMENTS].
Kindly send any notice about this claim to [ADDRESS], [E-MAIL] or [MOBILE NUMBER]. If any document is missing, I would appreciate being informed so that I can complete it promptly.
Thank you.
Respectfully,
______________________________ [FULL NAME OF MEMBER OR AUTHORIZED REPRESENTATIVE] PIN [NUMBER] · [RELATIONSHIP TO PATIENT] [MOBILE NUMBER] · [E-MAIL]
RECEIVED BY (PhilHealth): ____________________ Date and time: __________
NOTES — delete this page before filing
• Deadline: directly filed claims must be submitted within 60 days after the date of discharge; confinement abroad within 180 days (PhilHealth Circular No. 20, s. 2014, Part III, items 7–9). Count calendar days, starting the day after discharge. File early — do not rely on a weekend or holiday extension.
• Who may file directly and which documents are mandatory: Circular No. 20, s. 2014, Parts II–III. Newer benefit packages may restrict direct filing (for example PhilHealth Circular No. 2026-0008 allows it only for confinement abroad). Ask the PhilHealth office for the current rule for your case.
• Calamities: PhilHealth has granted longer filing periods to areas hit by natural calamities by separate circulars. Check whether one applies to your place and dates.
• Forms change: always download CF1, CF2, CSF and CF4 from philhealth.gov.ph or get them at the PhilHealth office.
Field labels in [SQUARE BRACKETS, CAPITALS] must be completed or deleted. Alternatives are separated by a slash. © Layers (layers.md), licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Template and deadlines for information only — check your own case with the agency or insurer, and have documents with legal effect reviewed by a lawyer. Not legal advice.
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Template — check your case with the agency; review by a lawyer. Not legal advice. © Layers (layers.md) · CC BY 4.0