Philhealth

Global Care Medical Center of Laguna recognizes the fact that hospitalization cost is always a concern for most patients. Fortunately, GCMCL is one of the PhilHealth-accredited hospitals which exert maximum effort to provide best care and assistance to all PhilHealth members towards the attainment of their benefits. 

PHILHEALTH REQUIREMENTS

1. Philhealth member or the patient’s representative will go to the Benefit Section along with the fully-accomplished Philhealth Eligibility Form provided by our institution and given by our admitting staff to the Philhealth member/patient representative.
2. Benefit staff will input the data supplied on the Philhealth Eligibility Form and will check if the member/patient is eligible to avail the Philhealth benefits.
3. Advised Philhealth member/representative regarding the data provided by the portal. If the member/ patient is eligible, the benefit staff will advise them to fill out the Claim Signature Form (CSF) thoroughly. If the member/patient is not eligible, we will advise him/her on the corresponding documents needed and will advise them to accomplish or submit the needed requirements before the patient is discharged.

The usual requirements needed if the Portal says “NO”.

  Case 1: No qualifying contributions

• • For voluntary members, they should submit a photocopy of the official receipt (Philhealth contributions) and had nine (9) months within the twelve (12) month-period prior to the first day of confinement.
• • For employed members, they should submit the fully accomplished Claim Signature Form (CSf) duly signed by the employer’s authorized representative (CSF Part II- Employer Certification) or a certification of their Philhealth contributions testifying that their employee had nine (9) months within the twelve (12) months qualifying contributions prior to the first day of confinement.
• • For OFW/OWWA-sponsored members, they should submit the updated Member Data Record (MDR) and the confinement of the patient should be within the validity period indicated on the MDR.

  Case 2: Discrepancies on Birthdate/ Spelling of the Names of Patient and/or Member

• • Member should fill out the Philhealth Member Registration Form (PMRF) along with the supporting documents with regard to the discrepancies (Birth Certificate or any two government issued ID’s) and will submit to the nearest Philhealth office for correction.

1. In case that the Philhealth Member cannot sign the Claim Signature Form (CSF), we need a document that will prove the relationship of the authorized representative to the Philhealth member. Below are the list of attachment/documents:
   a.) Spouse – a copy of marriage contract or an updated MDR indicating the name and the relationship to the member.
   b.) Child – a copy of Birth certificate or an updated MDR indicating the name and the relationship to the member (Child should be at the legal age).
   c.) Parent – a copy of Birth certificate of the member or an updated MDR indicating the name and the relationship to the member.

*If the supporting documents are not available, an authorization letter coming from the member authorizing his/her representative to sign in behalf of him/her with an attachment of government issued ID’s of the member and his/her representative will do.