FAQ: PhilHealth Unclaimed Refunds

WMSI Updates

ph_logo1DOLE recently announced updates on the services and guidelines of PhilHealth that directly benefits our OFWs, including seafarers who might have unclaimed refunds. If you think you are entitled to a refund, go through the details below and don’t forget to check your name on the list in FAQ #4.

1. What Is An Unclaimed Refund?

An unclaimed refund refers to a benefit payment made by PhilHealth to a member through a healthcare institution (HCI), that the member had not been able to collect from. It usually results from an under-deduction by the HCI of the actual cost of hospitalization reimbursable to PhilHealth. HCIs with unclaimed refunds returned the funds to PhilHealth. As a result, PhilHealth endeavors to ensure that what it reimbursed for a member indeed reaches the member.

2. Who Are Entitled To The Refund?

Not all members have a refund. Similarly, not all HCIs have refundable amounts to members. Only those members with which HCIs have declared unclaimed refunds are entitled to it.

3. How Much Is The Refund?

The amount of refund varies per member, based on the lists reported by the HCIs. The lowest amount that can be refunded is one hundred pesos (P100).

4. How Will I Know If I Have An Unclaimed Refund?

Access www.philhealth.gov.ph/unclaimedrefunds. Click the tab showing the list of members’ and patients’ names. If your name is not on the list but you think you might have a refund from a previous hospitalization, kindly check with the HCI where you were admitted to.

5. How Do I Collect My Refund?

If your name is in the list, proceed to the nearest PhilHealth office and present at least two (2) valid government-issued identification cards.

6. If Member Is Not Available, Who May Claim The Refund?

If the member is not available for reasons such as overseas worker, disability, etc., a representative may file the claim in his/her behalf. The claimant must bring the following documents:

a. Photocopy of valid ID card/passport of member
b. valid ID card of representative
c. authorization letter duly signed by the member
d. special power of attorney

7. If A Member Is Deceased, Who May Claim The Refund?

The next of kin or heir may claim the refund. He/she must prove his/her relationship to the deceased. The following documents may be relevant to prove relationship:

a. valid ID card of member
b. death certificate
c. valid ID card of claimant
d. birth certificate
e. marriage contract
f. waiver letter from surviving heir.

8. Why Are Some Member Names Missing In The List?

Some of the lists forwarded by HCIs to PhilHealth only contain patients’ names. Under this circumstance, it is assumed that the patient will be the claimant.

9. After I File For Payment Of My Refund, How Long Will It Take Before I Receive The Refund?

All processing of payment for unclaimed refunds will be done at PhilHealth regional offices. Hence, if you file at a distant service office, processing time may be longer than if you filed at the regional office. However, the claimant may also opt to either personally pick up the refund, or have it mailed to his/her residence.

Source/Credits: PhilHealth