What Pinoy workers can do if they get sick abroad

If an overseas Filipino worker (OFW) gets sick abroad, no need to worry, especially if he or she is a member of the Philippine Health Insurance Corporation (Philhealth), the state insurance company.

According to the Philhealth website, the amount spent for confinement or surgical operations abroad may be reimbursed by Philhealth members or their authorized representatives (i.e. a family member) in the Philippines.

The Philhealth member or representative must submit these documents in claiming the reimbursement:

- PhilHealth Claim Form 1 accomplished and signed by the member or his authorized representatives
- Photocopy of MDR (Member Data Record) or latest receipt
- Medical certificate with complete diagnosis, period of confinement and services rendered; and
- Statement of Account and/or official receipts with itemized charges; and other supporting documents

The member or representative must file the claim in the Philippines within six months after the hospitalization. All claims, except those under investigation, will be processed and paid within 60 working days, the website said.

The insurance provider noted that confinement of less than 24 hours would not be subjected for reimbursements.

Meanwhile, overseas workers who were provided with health insurance by their employers abroad may still file a separate reimbursement claim at Philhealth.

“The insurance was part of your benefit as an employee of your employer abroad. You may file your claim reimbursement at any PhilHealth office in the Philippines as long as the documentary requirements are complete and properly submitted,” Philhealth said.

Inpatient/Outpatient coverage

Philhealth's website section for overseas workers said the state insurer provides subsidy for room and board, drugs and medicines, laboratories, operating room and professional fees for confinements of not less than 24 hours.

Please click here to view the list of INPATIENT CARE BENEFITS.

Philhealth said overseas workers can also claim benefits for day surgeries, dialysis and cancer treatment procedures such as chemotherapy and radiotherapy in accredited hospitals and free-standing clinics.

Please click here for a list of OUTPATIENT BENEFIT PACKAGES.

Rates for overseas workers

According to Philhealth, the rates it gives overseas workers for the following medical cases and surgical procedures are:

Medical Cases
1. Dengue I (Dengue fever, DHF grades I&II) P8,000
2. Dengue II (DHF grades III & IV) P16,000
3. Pneumonia I ( moderate risk) P15,000
4. Pneumonia II (high risk) P32,000
5. Essential Hypertension P9,000
6. Cerebral Infarction (CVA-I) P28,000
7. Cerebral Hemorrhage (CVA-II) P38,000
8. Acute Gastroenteritis (AGE) P6,000
9. Asthma P9,000
10. Typhoid Fever P14,000
11. Newborn Care Package in Hospitals and Lying in Clinics P1,750

Surgical Cases
1. Radiotherapy P3,000
2. Hemodialysis P4,000
3. Maternity Care Package (MCP) P8,000
4. NSD Package in Level I Hospitals P8,000
5. NSD Package in Levels 2 to 4 Hospitals P6,500
6. Caesarean Section P19,000
7. Appendectomy P24,000
8. Cholecystectomy P31,000
9. Dilatation and Curettage P11,000
10. Thyroidectomy P31,000
11. Herniorrhaphy P21, 000
12. Mastectomy P22,000
13. Hysterectomy P30,000
14. Cataract Surgery P16,000

What cannot be reimbursed

The health cases not covered by Philhealth reimbursements are as follows:

- Fifth and subsequent normal birth delivery
- Non-prescription drugs & devices
- Alcohol abuse or dependency treatment
- Cosmetic Surgery
- Optometric Services

Special benefit packages

Philhealth said special benefit packages are available for OFWs infected with severe acute respiratory syndrome (SARS) and Avian Influenza.

Every Philhealth member undergoing SARS treatment is entitled to a P50,000 benefit while identified health care workers are given P100,000 reimbursable insurance.

Tuberculosis treatment, on the other hand, may be reimbursed by members provided that the health procedure was done in an accredited facility in the Philippines.

Source: GMA News