If you paid for care that PhilCare covers, you can ask PhilCare to pay you back. Send your claim within 60 days of your outpatient consultation or treatment, or within 60 days of leaving hospital after a hospital stay. This article is for employees in the Philippines with PhilCare, for the plan year 1 July 2026 to 30 June 2027.
Important: Send your claim within 60 days. If PhilCare asks for more documents, send them within 30 days.
When you can claim
You can claim a reimbursement from PhilCare when you paid for covered care in these cases:
Emergency at a hospital not affiliated with PhilCare: you got emergency care at a hospital that does not work with PhilCare.
Emergency outside the Philippines: PhilCare pays no more than it would pay at a PhilCare-affiliated hospital in the Philippines.
No PhilCare hospital nearby: there was no PhilCare-affiliated hospital or clinic within 50 km of the emergency.
Emergency without an LOA: at a PhilCare-affiliated hospital, no Letter of Authorization (LOA) was issued, or a doctor not affiliated with PhilCare treated you.
No PhilCare doctor available: there was no PhilCare-affiliated doctor in your area for a covered procedure, or you needed a type of specialist that the PhilCare network does not have, and you were treated at a PhilCare-affiliated hospital or clinic.
Covered costs not taken off your bill: you paid for covered care that PhilCare should have paid.
PhilCare pays at PhilCare rates. You pay any amount above PhilCare rates. PhilCare also takes off the amount PhilHealth covers. If you are a PhilHealth member, give your PhilHealth documents to the hospital before you leave, so you do not pay that amount yourself.
Documents you need
PhilCare needs the original documents. Send these:
Claim form: a completed PhilCare Claim Reimbursement Form
Hospital receipts: the original official receipts for all hospital bills
Doctors' receipts: the original receipts for the doctors' fees
Statement of Account: from the hospital or clinic that treated you
Charges: the original charge slips, or an itemised list of charges
For an emergency: the Attending Physician's Report, or a medical certificate from the emergency room doctor
For a hospital stay: the Admitting History Report from the hospital's Medical Records Section, the Clinical Abstract, the Admitting History and the Medical Certificate
If you had surgery: the Histopath or Surgical Report
For an accident or a medico-legal case: a Police Report
How to send your claim
Collect the documents above. Keep a copy of each one.
Send your claim and the original documents to PhilCare within 60 days.
If PhilCare asks for more documents, send them within 30 days.
Follow the steps exactly. PhilCare can refuse a claim if the steps and documents are not complete. A late claim is not refused or reduced if it was not reasonably possible to send it on time.
How PhilCare pays you
PhilCare processes your claim within 30 days of receiving all your documents. PhilCare pays in Philippine pesos (PHP), by cheque in your name, unless you ask for another way or PhilCare chooses another way.
If PhilCare refuses or reduces your claim
Write to PhilCare's head office within 10 days of receiving the decision. Give all your reasons. If you do not write within 10 days, the claim is treated as settled. PhilCare's decision on your request is final.
Who to contact
Claims, documents and payment: PhilCare, 24/7 on (02) 8462-1800, or email [email protected] (7am to 7pm every day).
Your cover or your dependents: your HR Manager.
This article is general information about your PhilCare plan for 1 July 2026 to 30 June 2027. It is not the full terms. You can see your benefits in the HeyPhil app or the PhilCare Member Gateway. For the full terms of your PhilCare cover, ask your HR Manager.