Cross-Border Terminal Illness & Advance Care Checklist: United States & Philippines

1. 1

   Organizing Palliative and Hospice Care and Cross-Border Healthcare Coverage

   In the United States, ask your family member's attending physician or hospital discharge team for a palliative care consultation, or request an evaluation for the Medicare Hospice Benefit under Medicare Part A (administered by the Centers for Medicare & Medicaid Services and explained via Medicare.gov at 1-800-633-4227) [1]. Hospice coverage applies when a hospice physician and the attending physician certify a life expectancy of six months or less if the illness runs its normal course and the person elects comfort-focused care rather than curative treatment [1]. It covers home or inpatient nursing, physician services, medical equipment, medications for pain and symptom control, and family respite care [1]. You can locate accredited providers and planning guides through CaringInfo, a program of the National Alliance for Care at Home (formerly the National Hospice and Palliative Care Organization, NHPCO) [2].

   If care takes place in the Philippines or the family is considering relocating the person there, check coverage early because U.S. Medicare generally does not pay for healthcare outside the United States [1]. In the Philippines, hospital palliative care units operate under the Department of Health National Integrated Cancer Control Act (NICCA) framework alongside organizations such as Hospice Philippines and the Philippine Society of Hospice and Palliative Medicine, while the Philippine Health Insurance Corporation (PhilHealth) provides Z-Benefits packages for qualifying catastrophic illnesses at contracted facilities (requiring pre-authorization through the hospital's PhilHealth liaison) [3]. Before any air travel, obtain formal fit-to-fly medical clearance and verify whether private medical evacuation insurance is required.

2. 2

   Executing Written Advance Directives in Both Countries While Capacity Remains

   Medical directives should be executed separately in each jurisdiction while your family member retains full decision-making capacity:

   • United States: Execute a state-specific Advance Directive combining a Living Will (stating preferences on life-sustaining treatment, artificial nutrition, and pain management) and a medical decision-making designation [2]. Free state-specific forms matching each state's witness or notarization rules are available from CaringInfo [2]. For someone with an advanced life-limiting condition, ask the treating physician or palliative team to complete a state-recognized Physician Orders for Life-Sustaining Treatment (POLST or MOLST) form so emergency medical personnel have actionable medical orders [2].
   • Philippines: Put a written Advance Healthcare Directive and any Do-Not-Resuscitate (DNR) or comfort-care instructions on file directly with the attending physician and the hospital ethics or palliative care committee in the Philippines, ensuring that informed consent and treatment limits are recorded in the patient's clinical chart.
3. 3

   Establishing Separate Financial and Healthcare Powers of Attorney

   A power of attorney drafted only for one country often faces delays or rejection by banks and land registries in the other. Establish separate instruments while your family member has full legal capacity:

   • United States: Execute a state-specific Durable Power of Attorney for Health Care (Health Care Proxy) and a Durable Financial Power of Attorney so the appointed agent can manage medical decisions, property, and financial institutions if capacity is lost [2]. For U.S. bank and brokerage accounts, setting up Payable-on-Death (POD) or Transfer-on-Death (TOD) designations directly with each financial institution allows funds to transfer outside state probate.
   • Philippines: Philippine banks, the Land Registration Authority, and government agencies normally require a specific, notarized Special Power of Attorney (SPA) naming the exact transactions authorized [4]. If signed in the Philippines, execute the SPA before a commissioned Philippine Notary Public. If signed in the United States, your family member can either appear in person to have the SPA consularized/notarized at the Embassy of the Philippines in Washington, D.C. (or the nearest Philippine Consulate General, inquiries via [email protected]) or sign before a local U.S. Notary Public and obtain a U.S. State Apostille from the relevant Secretary of State, which makes the document directly valid in the Philippines without consular legalization [4].
4. 4

   Claiming Fast-Track Terminal Illness Benefits and Caregiver Leave

   Both jurisdictions offer financial support and job-protected leave during serious illness:

   • United States: Eligible employees caring for a spouse, parent, or child with a serious health condition can request up to 12 workweeks of unpaid, job-protected leave under the federal Family and Medical Leave Act (FMLA), administered by the U.S. Department of Labor Wage and Hour Division (using medical certification Form WH-380-F), alongside applicable state Paid Family Leave programs [5]. For disability benefits, the Social Security Administration (SSA, reachable at 1-800-772-1213) operates the Compassionate Allowances (CAL) and Terminal Illness (TERI) programs to fast-track Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) medical reviews within weeks for qualifying diagnoses [6].
   • Philippines: If your family member has qualifying contributions to the Social Security System (SSS, hotline 1455, email [email protected]), file for the SSS Sickness Benefit (up to 120 days per calendar year) or Permanent Total/Partial Disability Benefit via the My.SSS portal or an SSS branch [7]. Combine this with PhilHealth catastrophic Z-Benefits [3] and medical assistance programs through the Philippine Charity Sweepstakes Office (PCSO) or the Department of Social Welfare and Development (DSWD).
5. 5

   Aligning Wills, Beneficiary Designations, and Post-Death Estate Procedures

   Reviewing wills, beneficiary records, and post-death filing deadlines across both countries prevents conflicting estate proceedings:

   • United States: Ensure any U.S. will complies with state execution rules for probate before the state Probate Court, verify life insurance and retirement beneficiaries, and review veterans benefits with the Department of Veterans Affairs (VA) if applicable. When a death occurs, report it promptly to the Social Security Administration (at 1-800-772-1213 or via the U.S. Embassy Federal Benefits Unit if residing in the Philippines) [6], and note that the estate representative must file a final federal income tax return (IRS Form 1040) with the Internal Revenue Service.
   • Philippines: Verify that beneficiary records are current with the Social Security System (which pays a separate SSS Funeral Benefit of PHP 12,000 to PHP 60,000 to whoever paid burial expenses, plus a monthly or lump-sum SSS Death Benefit to primary/secondary beneficiaries) [7], or with the Government Service Insurance System (GSIS), PhilHealth [3], the Pag-IBIG Fund, and the Overseas Workers Welfare Administration (OWWA) for eligible overseas workers. For property in the Philippines, note that the Bureau of Internal Revenue (BIR) requires filing the Estate Tax Return (BIR Form 1801, taxed at a flat 6% rate on the net taxable estate) within one year from the date of death to obtain the electronic Certificate Authorizing Registration (eCAR) needed to transfer titles, whether through probate or a notarized Extrajudicial Settlement of Estate [8].

Official Authorities & Verified Contacts

Official Sources Checked by Clarvia

1. [1]
   Hospice care coverage — Medicare.gov (Centers for Medicare & Medicaid Services)
2. [2]
   Advance Directives and State-Specific Forms — CaringInfo (National Alliance for Care at Home)
3. [3]
   Z Benefits Package for Catastrophic Illnesses — Philippine Health Insurance Corporation (PhilHealth)
4. [4]
   Notarials and Apostille of Private Documents (Special Power of Attorney) — Embassy of the Philippines in Washington, D.C.
5. [5]
   Family and Medical Leave Act (FMLA) — U.S. Department of Labor (Wage and Hour Division)
6. [6]
   Compassionate Allowances — Social Security Administration (SSA)
7. [7]
   Funeral, Death, Sickness, and Disability Benefits — Social Security System (SSS)
8. [8]
   Estate Tax Return (BIR Form 1801) Requirements and Guidelines — Bureau of Internal Revenue (BIR)