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Filing a critical illness insurance claim in the Philippines doesn’t have to be a hassle. This step-by-step guide shows Filipino policyholders how to quickly access benefits when they need them most. Plus, we’ll dive into why having coverage is more crucial than ever with the rise in cancer, stroke, and heart disease cases across the country.
Critical illnesses like cancer, stroke, and heart disease are hitting more Filipino families every year—and not just with emotional and physical stress, but major financial strain, too.
According to the Philippine Statistics Authority (PSA), these life-threatening conditions top the list of causes of death in the country:
Illness |
Ranking as Cause of Death |
% of Total Deaths |
|---|---|---|
Heart Disease |
#1 |
17% |
Stroke |
#2 |
11% |
Cancer |
#3 |
10% |
Source: PSA Report via MyOona Guide to Critical Illness
Treatment for these serious illnesses can take months or even years—and without critical illness insurance, the costs can wipe out your savings. Having the right financial protection makes all the difference when the unexpected happens.
That’s where critical illness insurance steps in—offering a lump-sum cash payout as soon as you’re diagnosed with a covered condition, so you can worry less about money and focus more on treatment and recovery.
Filing a critical illness insurance claim may feel overwhelming—especially when you’re also dealing with the emotional, physical, and financial impact of a serious diagnosis like cancer, stroke, or heart disease. But it doesn’t have to be.
This guide breaks down each step of the claims process so you can navigate it with confidence, avoid common delays, and get the financial support you need as soon as possible. Because when it comes to a critical illness, every moment—and every peso—matters.
Start by reviewing your critical illness insurance policy to confirm that your condition is among the covered illnesses. Most plans—including Oona’s—typically cover major conditions like cancer, heart attack, and stroke. However, some policies may have different inclusions or require a certain stage or severity before you can make a claim.
Pro Tip: Many insurers require that the diagnosis come from a board-certified specialist and be supported by specific lab tests, imaging, or medical reports. These requirements are usually detailed in the fine print of your policy.
Once you've confirmed that your condition is covered, the next step is to notify your insurer and begin the claims process.
As soon as you’re diagnosed with a critical illness, reach out to your insurance provider—don’t wait. Early notification is key to kickstarting your critical illness insurance claim and avoiding delays in receiving your benefit.
Most insurers (like Oona Insurance) make it easy to report your claim through multiple channels:
Phone call
Online customer portal
Even if you’re still gathering the required documents, notifying your provider early gets the process moving and gives you access to guidance on what to prepare next.
Up next: compiling the necessary medical and policy documents to support your claim.
To process your critical illness insurance claim, your insurer will need several key documents. While exact requirements may vary slightly depending on your provider, here’s a standard checklist to help you get started:
Document |
Purpose |
|---|---|
Accomplished Claim Form |
Basic details about the policyholder and the condition |
Medical Certificate/Diagnosis Report |
Confirms the illness from a licensed physician |
Diagnostic Test Results (CT, biopsy, ECG) |
Proof of the condition's severity or stage |
Government-Issued ID |
Identity verification |
Policy Contract |
Verifies coverage terms and eligibility |
Tip: Always keep both digital and physical copies of every document—even after submission—in case you’re asked to resubmit or provide updates later.
Once your documents are complete and organized, you’re ready to submit your claim.
Once you’ve gathered all the required documents, it’s time to submit your critical illness insurance claim. Submission options vary depending on your insurer, but most offer multiple convenient channels, including:
🌐 Online portals
📧 Email
📦 Drop-off or courier delivery to a physical branch
With Oona, you can submit your claim 100% digitally—perfect if you're undergoing treatment and need a quick, paperless process from home or the hospital.
📌 Once submitted, here’s what happens next.
Once your critical illness insurance claim is submitted, your insurer will begin the review process. This usually takes anywhere from 10 to 30 working days, depending on a few key factors:
Are your documents complete?
Does your claim require a detailed medical review?
What are the insurer’s internal timelines?
During this period, your insurer may reach out for clarifications or request additional documents—so stay alert.
Pro Tip: Follow up every 5 to 7 business days using your claim reference number. It’s the best way to ensure your claim is moving along and to address any potential issues early.
Once your critical illness insurance claim is approved, you’ll receive a one-time, tax-free lump sum payout—no strings attached. Unlike HMO reimbursements or PhilHealth, this money isn’t tied to specific treatments or receipts. It’s yours to use however you need:
For ongoing treatment or recovery
To cover lost income or unpaid leave
To support your family while you’re out of work
Or to pay off unexpected medical expenses
This flexibility is what makes critical illness insurance an essential addition to your traditional health coverage—providing the financial freedom to focus on getting better, without the added stress of mounting bills.
Now that you’re familiar with the entire process, let’s wrap things up with a quick recap and a handy FAQ section to address any lingering questions or concerns.
A critical illness diagnosis is life-altering—but it doesn’t have to ruin you financially. If you or a loved one are covered by critical illness insurance, filing your claim correctly and on time can give you the financial breathing room you need to focus on healing.
By understanding your policy, gathering documents early, and staying in communication with your insurer, you’re setting yourself up for a smooth and efficient claims process.
Not insured yet? Or perhaps your current policy doesn’t fully cover your health risks? It’s never too late to explore your options. Oona Critical Illness Insurance offers accessible, affordable coverage for Filipinos, with lump-sum benefits and no medical exam required. Unsure if this type of insurance is right for you? Check out our guide on why critical illness insurance is worth it to help you make an informed decision.
