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 Elena, did you file your MAT1 through your employer? If yes, did you ask your HR? Did you ask other employees if that’s the practice in your company? Ask your HR if their practice is to get the money from SSS and then give it to you. That’s not the SSS policy, but if it’s accepted there, then I think you just have to wait for your money from SSS after you give birth, and then consider finding a better company later on. Just make sure you get your benefit after SSS gives it to your company.

  2. Hi Elena, Philhealth only pays 2k to the OB and 3k to the hospital. In many hospitals, 5k is not enough payment for the doctor and the hospital, so they charge the patients. Most likely you pay more this year or next year for your delivery as prices have increased. Talk with your OB about her Philhealth package.

  3. Hi again Ns. Nora.regarding my sss maternity benefit. what if my employer did not give me my maternity cash before I took my leave? What should I do?

  4. hi po. im 8mos pregnant and I want to avail of philhealth maternity benefits. But my payment is only january-march from my employer. so april till now I have not paid. due date is nov. 2, 2015. If I pay, can I avail? tnx.

  5. Hi jean, sad to say, you need to pay for Sep, but the payment deadline for Sep has passed. You need to pay for Sep Oct and Nov. Ask others too. Take care

  6. hi ms nora. how about april-june? should I pay? should I change as self employed? Is it sure that I can use it if I pay

  7. Hi jean, sori, tulad ng nasabi ko na, hindi na puedeng bayaran ang Sep. Lalo nang di na puedeng bayaran ang Apr to June. If you give birth in Nov, dapat sana nabayaran mo ang Sep Oct and Nov. Puede pang bayaran ang Oct and Nov, pero ewan ko kung tatanggapin pa ng Philhealth ang bayad mo for Sep. kasi ang deadline to pay for Sep was Sep 30. You can go to Philhealth and ask. Or ask Bayad Center. Take care

  8. Hello. may I ask about my daughter who gave birth in Canada thru cs. last july 2014 she arrived in canada, last sept 10 she gave birth. Active member for 10 yrs and 200/mo contribution. filipino(immigrant). spouse is permanent resident. what should be done and how much can she get from philheatlh and my daughter is also an SSS member. hear from you soon! it’s my pleasure if you can contact me at 09983314731. God bless!

  9. Hi neonita, did your daughter pay Philhealth for any 3 months within Apr to Sep 2015? If yes, then you can file for Philhealth for her. Documents to file at Philhealth: premium payment receipt, MDR (get from Philhealth), claim form 1 (your daughter downloads from and sign), hospital billing statement and OR and medical certificate. File within 180 days from hospital discharge. CS reimbursement is 19k pesos. About SSS, did she pay for at least 3 months within April 2014 to March 2015? If yes, your can file for maternity benefit claim. Did she file MAT1 form before giving birth? If not, she fills up MAT1 form, with attached letter explaining why she was not able to file MAT1 before delivery. Documents to file with SSS: MAT1 form, letter, MAT2 form, operating room statement, medical certificate, birth certificate, authorization for you to file with SSS in her behalf, plus photocopies of her SSS ID and main passport page or Canadian ID. Bring also your IDs when filing. God bless too. Just comment again if there are further questions

  10. Hi po I’m a dependent of my husband and scheduled for repeat CS on oct.23. What was given to me by his employer is certification that they paid his philhealth contribution for july-sept.2015. 3 months only in the certification. Can I avail of maternity benefits from philhealth? tnx po

  11. Hi Leah, yes, only 3 recent contributions are needed. I hope you also have claim form 1 signed by the employer and your husband’s MDR where your name is written as dependent.

  12. i want to check if i have my refund. i gave birth last sept.30, 2015 thru cs in casimiro ynares hospital. i’m having a hard time in contacting philhealth thru phone.

  13. Hi jillian, didn’t the hospital deduct your Philhealth coverage from your hospital bill? That’s Philhealth’s deduction policy. If there’s a valid reason that it was not deducted, and it was the hospital that filed with Philhealth, wait for your benefit payment notice from Philhealth, then present that notice, plus your OR and bill to the hospital and request for your refund.

  14. My last payment contribution as employed is April 2013. I decided to continue my contribution as voluntary this oct 2015 (already paid until dec 2015). My question is can I avail my benefit if I will be confined next week due to miscarriage. Thank you.

  15. My last contribution as employed is April 2013. Then I continue to pay as voluntary this Oct 2015 (quarterly till Dec 2015). My question is can I avail of benefits if I will be confine this Nov 2015 due to miscarriage. Thank you.

  16. Hi Lian, sorry, I think not yet. You can use Philhealth in Dec or Jan or Feb. But ask the hospital or others too.

  17. Hi can I use my Philhealth for my delivery? When I worked, my Philhealth was paid for by my company from Nov 2014 to March 2014 then I resigned and became self employed and paid from April 2015 to December 2015. my due date is this Nov 2015. tnx po

  18. Hi Jessica, do you mean you have paid for August 2015 to Nov 2015? If yes, you can use Philhealth in Nov. Did you get your new MDR from Philhealth? Keep your receipts.

  19. hello po, I’m 5 months pregnant and have just paid Philhealth for 4th quarter Oct – dec. Will I be able to avail of benefits?

  20. my daughter gave birth to a baby girl in the hospital in Riyadh Saudi Arabia by Caesarian Operation. Can she then claim for refund of expenses from Philhealth?

  21. Hi Alfonso, if 180 days have not passed since her discharge from the hospital, she can file for refund. Her hospitalization dates should be within the validity dates of her Philhealth premium payment receipt. She can send you the documents and you file on her behalf. She should include operating room report indicating the performance of CS, so her refund will be CS coverage. Papers should be translated to English. Ask her to include an authorization letter and a copy of her ID. Does she have a bank account in the Phils? The check will be in her name. Here are the documents required:

  22. Hi good eve. My wife will give birth this december 2015 but we’re not married yet. So she will use her philhealth but after we inquired, we were told her previous company did not remit any payment. So we paid oct. To december 2015 in same account. Can we user her maternity benefit? Thank you..

  23. Hi henjhun, ues, your wife can use her Philhealth in Dec. If not yet done, she should update her data at Philhealth with her ID so she can get her updated MDR.

  24. hi can I use my husband’s philhealth? But it was not paid for a long time. It’s my due this dec. I plan to pay the full contribution. Can I avail of benefits if my due is around last week of dec? thanks.

  25. Hi khaye, go to Philhealth with your ID and register as Individual Payor, Informal Economy. Fill up form. Pay Oct to Dec. Get your MDR and card. Yes, you can use your Oct to Dec payment for your Dec delivery.

  26. hello and good day, as for my prenatal consultation, im using my insurance that our company provided so my prenatal consultation is free and the receipts are kept by my doctors secretary, can I still get my pre-natal care benefit?

  27. Hi jhelyn, yes, if the prenatal ORs are in your name. Include prenatal ORs when you present your Philhealth papers to the hospital.

  28. Tanong ko lng po sa public po kc ako n nnganak. So mababa lng ung byad sa hospital tpos ung gamot kmi po ang bumili.. so ano po makukuha ko sa philheath?? exact amount na 8000 or un lng bill nmin sa hospital?? Kc ung mga resibo po nsmin pa di po kinuha sa hospital..

  29. i have a cesarean delivery last sept. 26, 2015 my OB Charge me to 25,0000 for her professional fee how to claim my maternity benefits. Thanks and God bless,

  30. Ask ko lang po employed po aq since July 2013 until now ang employer q po naghuhulog sa philhealth pero nkaself employed po pla ang aking philhealth ngaun po nkakuha nmn po aq ng contribution of payments sa employer q since nung July 2013- Sept 2015.. Nkaleave po aq ngayon ang due date q po is Feb.6 2016 magagmt ko po ba ang philhealth ko since na last payment q us sept2015..

  31. Married po aq if ever po d q magagamit ang aking philhealth pwde q po ba mgamt ang philhealth ng asawa ko Feb.2015 po sya ngstart mghulog hangang ngaun po naghuhulog po sya employed po kc si mister..kso po need pa po nmn ausin philhealth nya dhl d pa po nya aq dependent how long it takes kng ippbgo po nmn ang knyang philhealth..aabot po kaya sa due date q tnx

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