The Philippine Health Insurance Corporation (PhilHealth) is a vital government institution that ensures Filipinos have access to affordable healthcare services. If you’re a member or a dependent in need of medical assistance, you will likely encounter the PhilHealth Claim Form (CSF) as part of the process of availing benefits.

To help you navigate this document, we’ve put together a simple guide on how to properly fill out the form and what to keep in mind to avoid delays in claim processing.

Understanding the PhilHealth Claim Form

The Claim Form (CSF) is used to apply for PhilHealth benefits after a medical confinement. It collects essential details about the member, patient, employer (if applicable), healthcare provider, and consent for processing medical records.

Before filling out the form, keep these important reminders in mind:

✅ Use capital letters and check the appropriate boxes.
✅ Ensure that all required information is complete and accurate.
✅ Providing false or incorrect information may result in legal consequences, including criminal, civil, or administrative liabilities.

CLICK HERE TO DOWNLOAD CLAIM SIGNATURE FORM (CSF)

Step-by-Step Guide to Filling Out the PhilHealth Claim Form

📌 PART I - MEMBER AND PATIENT INFORMATION

This section contains the personal details of the PhilHealth member and the patient receiving medical care.

1️⃣ PhilHealth Identification Number (PIN) of Member – A 12-digit number assigned to registered PhilHealth members.
2️⃣ Member’s Name and Date of Birth – Provide complete personal details of the registered member.
3️⃣ PhilHealth Identification Number (PIN) of Dependent – If the patient is a dependent (spouse, child, or parent), their PIN should be included.
4️⃣ Name of Patient & Relationship to Member – Indicate the patient’s name and their relationship to the PhilHealth member (child, spouse, or parent).
5️⃣ Confinement Period – Specify the date admitted and date discharged.
6️⃣ Patient’s Date of Birth – This helps verify eligibility for benefits.

🖊 Certification: The member (or their representative) must sign this section, confirming that the details provided are true and accurate. If the member is unable to sign, a right thumbmark is required, and an authorized representative must assist.

📌 PART II - EMPLOYER’S CERTIFICATION (For Employed Members Only)

If you are an employed member, your employer must complete this section to confirm that your PhilHealth contributions have been regularly paid.

1️⃣ PhilHealth Employer Number (PEN) & Contact Number – Provided by the employer.
2️⃣ Business Name of Employer – The official company or business name.
3️⃣ Certification by Employer – The employer certifies that the member has met the required 3/6 monthly premium contributions and that the provided details match their records.

✅ Employer’s Signature & Official Designation are required for validation.

📌 PART III - CONSENT TO ACCESS PATIENT RECORDS

By signing this section, the member/patient authorizes PhilHealth to review medical records to verify the claim.

Important Notes:
🔹 The patient or authorized representative must sign this section.
🔹 If the patient is unable to sign, a thumbmark can be used, and an HCI (Health Care Institution) representative must assist.

📌 PART IV - HEALTHCARE PROFESSIONAL INFORMATION

The attending doctor(s) must provide their PhilHealth Accreditation Number and signature to certify that the medical services provided are legitimate and accurately recorded.

📌 PART V - PROVIDER INFORMATION AND CERTIFICATION

This section is completed by the Health Care Institution (HCI) (hospital, clinic, or facility) where the patient received treatment.

1️⃣ PhilHealth Benefits & Case Rates – The assigned ICD-10 or RVS codes for the illness or procedure should be provided.
2️⃣ Certification by Authorized HCI Representative – The hospital/clinic representative must confirm that the information is correct and that the services were properly recorded.

📌 Reminder: This form is not for sale and may be reproduced for processing claims.

Final Tips for a Smooth PhilHealth Claim Process

✔ Check all required fields before submitting the form to avoid delays.
✔ Ensure your PhilHealth contributions are updated, especially if you're employed.
✔ If you have dependents, ensure they are properly registered under your PhilHealth account.
✔ Submit the form to PhilHealth-accredited healthcare institutions to ensure eligibility for claims.

By carefully following these steps, you can maximize your PhilHealth benefits and avoid common pitfalls in processing claims. If you have any concerns, you can contact PhilHealth through their official hotline (02) 441-7442 or visit www.philhealth.gov.ph.

Let’s make healthcare more accessible for all Filipinos! 🇵🇭💙