Philhealth Maternity Benefits

Updated December 2014:

Philhealth started implementing its Case Rates Payment system for maternity cases and other medical/surgical cases in September 1, 2011.

For Normal Spontaneous Delivery (NSD) in Level 1 hospitals and in lying-in facilities, maternity clinics, RHUs and birthing facilities, the total Philhealth benefit consists of 8,000 pesos (6,500 for the facility and health professional and 1,500 for prenatal care).

For NSD in Levels 2 to 4 hospitals, the total Philhealth payment consists of 6,500 pesos (5,000 for the facility and health professional and 1,500 for prenatal care).  Prenatal care ORs must be submitted to the hospital.

For Delivery by Caesarian Section (CS) in accredited Levels 2 to 4 hospitals and performed by accredited health professionals, Philhealth’s coverage is 19,000 pesos. 11,400 pesos is for hospital costs and 7,600 pesos is for the doctors. CS is not covered in level 1 hospitals or maternity clinics. There’s no prenatal care benefit for CS cases.

The Newborn Care Package (NCP) is worth 1,750 pesos. NCP includes physical examination, eye prophylaxis, Vitamin K administration, BCG vaccination, first dose of Hepatitis B immunization, newborn screening tests, and breastfeeding advice.


Based on recent Philhealth circulars and advisories, here are some bits of info about Philhealth maternity benefits:

Q: How much is the total maternity benefit for normal deliveries?
The total benefit is 6,500 pesos at Level 1 hospitals and in lying-in and maternity clinics.
It is 5,000 pesos at Levels 2 to 4 hospitals.

There’s an additional benefit of 1,500 pesos if you submit ORs of prenatal care services. Philhealth will refund this prenatal benefit. It will not be reflected or deducted from the hospital bill.

Many lying-in and maternity clinics require that prenatal care services are performed by them.

Q: Can I receive this maternity benefit for all my normal deliveries?
There was a plan to cover all normal deliveries. But as of now, only the first 4 births are covered under the normal delivery package.  Ask the hospital or clinic where you are giving birth.

Q: Can I automatically receive the total benefit of 6,500 pesos or 8,000 pesos for my normal delivery?

You do not always get the total benefit. The benefit of 8,000 pesos pays for the following:
– hospital costs
– for the attending doctor
– 1,500 pesos for prenatal care

For lying-in clinics or midwife-managed facilities:
6,500 pesos for midwife and facility services
1,500 pesos for prenatal care

For level 2 to 4 hospitals:
3,000 pesos for hospital costs
2,000 pesos for the doctor
1,500 pesos for prenatal care

So if you didn’t submit prenatal care receipts, you get only 5,000 pesos or 6,500 pesos. Your prenatal care refund amount also depends on the amount of ORs you submit.

Q: If I’m 1 month to 8 months pregnant now, can I apply for Philhealth membership so I can avail of the maternity benefits when I give birth?

Yes and No.
Yes, if you’re still within the deadline to be able to pay for 3 months within 6 months prior to delivery.

No, if it’s already too late to pay for 3 months prior to delivery.
But if you can accept possible denial, you can go to the nearest Philhealth and ask if you can avail if you pay for 1 year in advance. The rule about this has not yet been made very clear.

Yes, if you’re an OFW or an OFW dependent. You can avail of the benefit as long as your delivery date is within the validity dates written on your premium receipt.

The same condition for Sponsored Members. They also have validity dates, as reflected in their Sponsored ID cards.

For Employed Members, payment for 3 months of the 6 months prior to delivery are required.

Q. If the hospital or clinic is Philhealth-accredited, can I be sure that I get the maternity benefit?

No. You have to make sure that your doctor is also Philhealth-accredited.

Q: How do I get my pre-natal care benefit?
Keep your official receipts for paid prenatal consultation and care, and then submit them to your accredited hospital/clinic/lying-in/maternity facility, so the receipts will be included in the Philhealth claim. You will get your refund from Philhealth. The refund check will be in your name and will be sent to your address.  Many lying-in or maternity clinics require that your prenatal care services are done by them.

Q: When should I file my claims?

BEFORE discharge from the hospital or clinic.  Upon admission or during admission, ask the hospital about their Philhealth policies, so you have time to remedy if there are problems.

Direct filing by patients with Philhealth is no longer allowed, so submit your documents to your accredited health facility before discharge so that your maternity and newborn test cost benefits will be deducted from your hospital/clinic bill.

Now, only certain direct filing cases are allowed, such as filing for refund by overseas Filipinos giving birth abroad, by employees who are admitted and discharged during weekdays or holidays, and by patients who are asked by their government hospitals to buy medicines and supplies from pharmacies outside the hospitals.

Q. What are the documents needed to enjoy maternity benefits?

1. Updated Philhealth Member Data Record (MDR). Get this from any Philhealth branch. If you’re a dependent, your name should be written in the MDR form as a dependent.
2. Philhealth premium payment receipts.

If you’re Individual Payor, OFW or dependent, bring original and xerox copies.

If you’re employed, ask for a Certificate of Philhealth premium payments from your employer.

3. Philhealth Claim Form 1. You can ask for this form from your employer, the hospital or from any Philhealth branch. Ask for two copies, the other is for your baby’s newborn care package.

4. If you’re a dependent of your husband, bring your marriage certificate, in case the hospital asks.

6. If you have pre-natal care receipts, bring them to the hospital/clinic and attach them to the claim forms. Pre-natal care benefit is 1,500 pesos, if your ORs sum up to 1,500 pesos or more.

3. Philhealth ID or any valid photo ID, in case the hospital asks for identification.

Q. Are there other reasons why I can’t avail of Philhealth’s maternity benefits?

You CAN NOT avail of complicated maternity care in non-hospital facilities such as lying-in and maternity clinics. Avail of complicated maternity services in hospitals.

Here are exclusions (both hospital and non-hospital facilities):

– fifth normal delivery and subsequent deliveries
– normal delivery after 1 breech delivery and 3 normal deliveries
– normal delivery after 1 cesarean delivery and 3 normal deliveries
– normal delivery after 1 preterm delivery and 3 normal deliveries
– normal delivery after 1 stillbirth and 3 normal deliveries
– normal delivery after 1 normal delivery, 1 abortion and 3 normal deliveries
– normal delivery after 3 abortions and 4 normal deliveries

Exclusions in non-hospital facilities: (You should go to a hospital)
– you’re younger than 19
– you’re already 35 years old or older and this is your first time to give birth
– multiple pregnancy
– uterine or ovarian abnormalities, such as ovarian cysts and myoma uteri
– placental abnormality, such as placenta previa
– abnormal fetal presentation, such as breech
– history of 3 or more miscarriages or abortion
– history of 1 stillbirth
– history of cesarean section (CS), or uterine myomectomy, or other major gynecologic or obstetric operation

– history of hypertension, eclampsia, pre-eclampsia, diabetes, heart disease, asthma, epilepsy, bleeding disorders, renal diseases, thyroid disorder and morbid obesity

– risky conditions that may arise during pregnancy such as vaginal bleeding and premature contractions

CS will NOT be covered by Philhealth if it’s performed at a Level 1 hospital or maternity clinic.

Above exclusions are sourced from: Philhealth Circular signed by Philhealth President Rey Aquino on November 10, 2008.

Q: If my child is delivered via Cesarean Section (CS), will Philhealth cover my expenses?

Yes, as long as it is Indicated CS. Under the Philhealth Case Rate program, the coverage for CS is 19,000 pesos. This 19k is allocated as 11,400 pesos for hospital costs and 7,600 pesos for professional fees.

CS is covered only at Level 2 to 4 hospitals.

Q: What is the Newborn Care Benefit?

This is a Philhealth benefit worth 1,750 pesos for your newborn baby:
– 500 pesos for umbilical cord care, eye prophylaxis, thermal care, Vitamin K, BCG vaccine administration, and newborn resuscitation, 1st dose of hepatitis immunization

– 550 pesos for the newborn screening test
– 200 pesos for the newborn hearing screening test
– 500 pesos for the pediatrician

– Available for all normal deliveries, even for fifth and succeeding deliveries, and for CS deliveries.

Ask your doctor about it beforehand because the newborn tests must be performed within a certain number of hours after the baby’s birth in order for the tests to be paid by Philhealth. The pediatrician must be Philhealth-accredited.

Q: What’s the best way to get the maximum Philhealth maternity benefits?

Find an obstetrics-gynecologist who is Philhealth-accredited, who works in a Philhealth-accredited hospital, and who is willing to help you get the maximum benefit starting from prenatal care up to newborn care.

Or find a midwife’s clinic or a lying-in clinic which is Philhealth accredited and willing to help you get the maximum benefit starting from prenatal care, antenal care, maternity care and newborn care. Make sure that your midwife is also Philhealth-accredited.

Related articles:

Philhealth Requires Nine Months of Prior Payments

Philhealth Branches — Membership Reactivation


Add a Comment
  1. Hi Trexie, sorry di ko lahat ma-gets. Ang benefit for normal delivery ay 5000 (2000 for doctor at 3000 for hospital). For newborn care, ito ay 1750 (merong mga detailed costing). Kung 9250 ang hospital, 9250 minus 3000 = 6250 ang balance na babayaran mo. Kung 2810 ang doctor, 2810 minus 2000 = 810 ang balance na babayaran mo. Kung 1825 ang newborn care, 1825 – 1750 = 75 ang balance na babayaran mo, pero puedeng mas mataas pa ang balance mo, kasi yong kuentada sa newborn care ay naka-detail din kung saan dapat gagamitin yong 1750. So ang babayaran mo is 6250 plus 810 plus newborn care. Mag-comment na lang uli kung I did not get your question correctly

  2. Good morning po, nag start ako mag hulog September 2014 at ang huli kung hulog sa PHILHEALTH July 2016 and Due date ko na this coming December ma aavial ko po ba ung maternity benefits? Plz help me thanks

  3. Hi. Sa december po ako manganganak at pinapakuha ako ngayon ng ob ko ng philhealth. Unemployed ako at 8 months ng buntis. pwede pa ba ako kumuha ng philhealth para sa panganganak ko? Pwede po ba ako magadvance ng hulog?

  4. Hi Shenon Rose, props to your OB for reminding you to pay your Philhealth. Yes, go asap to the nearest Philhealth with your ID and register. Check Informal Economy – No income. Pay for Oct to Dec (600 pesos) or Oct to March 2017 (1,200 pesos). Your Oct to Dec receipt will qualify you to avail of Philhealth in December.

  5. Hi po! Dati po ako nghuhulog s philhealth kaso Na stop kasi nkapg abroad ako. Ngayong umuwi po ako nabuntis po ako. Continue KO LNG hulog KO as voluntary member. Nkapghulog ako nung july-september 2016 at ngayong oct- December 2016. Panu po yan mka avail pb aKO ng benefits kahit 6 months LNG hulog KO.ngayong january po due date KO. Tnx po

  6. Hi menchi, yes, maka-avail ka. Matagal nang na-reduced yong 9-month requirement. 3 months na lang ngayon. 3 months within the 6 months prior to hospitalization (kasama yong current month sa 6-month counting). So if you give birth in Jan2017, you will use yong Oct-Dec2016 receipt mo. I hope nakuha mo yong new MDR mo na Voluntary na yong status mo.

  7. Hello. Nanganak po ako tru CS last nov 2o14 at pinagbayad ako ng pang d whole yr kc kaaaply q lng dat month para makaavail ako,after d n aq nkapg hulog 4 d hul yr of 2o15 7mos q n po ngaun at dis coming dec ang duedate q 4 my 2nd child,ask po kung pwede pa po ako mkpgbyad para mgmit dis coming dec.?tnx po!

  8. Hi Zel, yes, pay ASAP for Oct to Dec if you’re Voluntary. You can use this for your December delivery.
    If you’re OFW, pay ASAP for 12 months — you’ll be covered in Dec.

  9. Hi Zel, yes, payment of 3 months within 6 months (past 5 months and current month) na lang ngayon ang requirement. Pero if you like, para continuous ang coverage mo, you can pay for Oct to Mar or Oct to Sep.

  10. ask q lng po .. last july kumuha po ng phlhealth kapatid q .. chineck q po ung contribution wala pong hulog, sabe nya hnd pa daw nahuhulugan ng dating employer nya kc daw d pa dw po sya under benefits nila,, this december manganganak n po sya ee.. pwd q po ba hulugan ung phlhealth nya ngaun para magamt nya prn??

  11. hi po employed po ako then bago ako nanganak inayos ko na lahat akala ko ok na ang binigay lang na receipt skin at cert of contribution ng employer ko ay hanggang july 2016 lng.. nakapanganak na po nong dec. 2 at di tinanggap ng lying in ung philhealth ko kc hanggang july lng pero ang kaltas skin ng employer hanggang nov 2016.. pinuntahan ng asawa ko agency pero ang reason nila di maihulog true online abonohan muna nmin ng 600 pesos.. wla n kaming pang abono non kaya sabi ng lying in di na daw marerefund at magagamit philhealth ko..:( antagal ko nagwork tas di ko magagamit s panganak ko

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