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

886 Comments

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  1. Hi yang, you should have received a payment notification from Philhealth so you can see how much Philhealth paid to the maternity clinic, so you have something to show to the clinic. Sorry I don’t really know what else to advise you, as this now depends on the clinic if they really filed the claim and received the 1,500 prenatal benefit.

  2. Hi Lyaine, sorry, there’s a deadline for filing — 60 days after discharge. And it should be the clinic that files the claim, not the patient. There are only few exceptions. Also, if the clinic is not accredited by Philhealth, then the clinic cannot file a claim.

  3. hi can I use my benefits if I apply for philhealth now and I’ll give birth in august. if yes what should I do. thanks.

  4. Hi kai, yes. Go to Philhealth asap with your ID, register and pay for May to August. Get your MDR and your card. At the clinic or hospital, present your MDR and receipt upon admission or before discharge

  5. gud am tanong ko lang po kung magkno pa huhulugan ko sa philhealth sa pagkakaalam ko po 7 monts ko lng nahulugan dahil bgo lang akong member march 2014-oct 2014 ang hulog ko..tapis ngaun po 7 monts na kong bunts at manganganak po ako sa august 2015..mgkano pa po kya ang ihuhulog ko.

  6. makakakuha poh b nq benefits qnq individual poh aqnq naqhuhuloq at nun Jan lnq anqqanq jun AQ naqhuloq next month n poh q manqanqank at qnq skalinq maccs poh AQ uli

  7. Im about to give birth by october, can i still apply for phil health membership, if paying the whole year can avail me

  8. Hi Jyc, yes. Go to Philhealth with your ID, fill up the PMRF form, pay for June to Sep, or June to Oct, or June to Dec, get your receipt, MDR and card.

  9. good evening po. I had PHILHEALTH NO. in the past. Have not paid for a long time. If I APPLY or register again, will I use the same Philhealth no.? I was single before and now I’m married. What should I do? Can I avail of the maternity benefit if I apply by october 2015 when I get back to PINAS? due date is jan 2016. (4 mos.before delivery ). thank you.

  10. Hi betty, yes, you can apply as individual payor when you get back here in Oct 2015. Apply at any Philhealth branch with your ID, pay for Oct to Dec 2015, or Oct 2015 to March 2016 (to lengthen your coverage), get your MDR and card. You can leave your Philhealth no. blank so they’ll give you a new no. Or you can write your old Philhealth no. but bring your Marriage certificate.
    If you want coverage now, you can authorize someone in the Phils to register and pay for you, scan your authorization letter and your IDs and email it to your representative, including your personal data (items asked in the Philhealth PMRF form).

  11. hello i’m previously employed. my remittance to philhealth up to feb only. Can I pay as voluntary from march until august so I can avail of the benefit? tnx po

  12. i’m 18 yrs old and 6mos pregnant. can I avail of maternity benefits if I apply for Philhealth membership tomorrow? and pay for june-sept. sept 29 is my due date.

  13. Hi deth, yes, pay asap. On June 29 or 30. You can pay for Apr to June only up to June 30. It’s better to go to Philhealth with your ID, fill up the PMRF form so you can get your MDR and card. You can pay for Jul to Aug or Jul to Sep in August. Or you can pay Apr to Aug or Apr to Sep this 29th or 30th.

  14. Hi roane, yes, you can be a member. Yes, you can avail in Sep if you pay for June to Sep. Go to Philhealth with your ID or barangay certificate or birth certificate. But it’s advisable if you pay for Apr to Sep, so you can be eligible even in June or July and up to Nov. If you want to pay for Apr to June, you need to apply on June 29 or 30. Payment deadline for a quarter (Apr to June, July to Sep, Oct to Dec) is the last day of the quarter.

  15. Ms. Nora i registered today as voluntary but didn’t pay contribution. i didn’t know there’s a deadline. what if i pay contribution tom. july-dec, can i avail benefits if my due date is last week of sept?

  16. Ms Nora, we went to the clinic and the midwife told us that an 18-yr old cannot use philhealth at a clinic. Should be at a hospital. It’s there at the clinic where I had my checkups. We’re planning to go to east ave. Will east ave accept me as I did not have my checkups there, and can I avail of maternity benefit?

  17. Hi roane, yes, it’s Philhealth’s policy that minors should give birth at a hospital if they want to use Philhealth. You can still go to East Avenue and explain your situation. It’s best if you go there to have your last checkups before giving birth.

  18. Hi ms. Nora, can I avail of my maternity benefit in 2012? I gave birth october 2012. I’m updated with my contributions.

  19. Hi Joyce, sorry, your claim will not be accepted. There’s a deadline for filing Philhealth claims. It should be within 60 days after discharge.

  20. hi ms.Nora can I avail of philhealth. I last paid january 2012 . I paid as voluntary this july to december 2015. I’ll give birth in january 2016. thank you po

  21. Hi im a philhealth member before and my contribution stops when I stop working.its been a year.im now 9 months pregnant,can I still pay for 1 year so I can have benifits when I give birth?

  22. Hi nova, this month, you can pay for July to Sep, but you can use it in Sept Oct Nov. You’re already late for paying for Apr May June. Ask others too.

  23. hi can i apply sss and phil health to get a maternity benefits? is it not too late to apply? thanks how much ? can u sum it up please.. thanks

  24. Hi kris, if you give birth in September or Oct or Nov or Dec, pay Philhealth for July to Sep so you can avail. Pay also for Oct to Dec, if your due is after Dec. About SSS, were you employed before? If not, register with SSS using RS1 form. Present proof that you have source of income. You can avail of SSS maternity benefit if your RS1 is approved, your delivery date is next year, and you pay for July to Sep or July to Dec.

  25. hi Ms. Nora,am i eligible to avail of Philhealth maternity benefits if i paid last Apr-June 2015 and yesterday i paid for July-sept. my due is 2nd week of August? Thank you.

  26. Hi khai, yes, you can avail. For newborn care, fill up 2 claim form 1 – one for you and one for your baby. Ask the pediatrician if you can use your Philhealth to help pay your newborn care costs.

  27. hi mrs nora can I avail of maternity benefits? due date is sept. 1. employed frm feb.2014 to march 2015 but employer paid only feb.-november 2014. Paid as voluntary/invidualy payor for apr.-june 2015. even if I don’t pay july august sept.2015, can I avail?
    regarding sss I have filed maternity notice last may 2015. If I file sss mat 2, do I need supporting documents from my employer? thanks in advance.

  28. Hi apple, yes, you can avail of Philhealth. But to be sure, pay also for July to Sep. About SSS, the gap between March 2015 and Sep 1 is less than 6 months, it’s most likely that SSS will require you to submit documents from your former employer. It’s wise to request cert of separation and cert of non-advancement of maternity benefit plus L501 document earlier.

  29. hi ms. nora can I use my benefits if I apply for philhealth now and I’ll give birth in end of December. if yes what should I do. thank you po

  30. hello, if a patient was discharged from the hospital without paying anything, can you still claim the 6,500 or 8,000 for maternity package?

  31. Hi maureen, you can no longer claim because the 6,500 or 8,000 from Philhealth will go to the hospital or clinic.

  32. Hi rose, yes, go to Philhealth with your ID and at least 600 pesos, fill up registration form, pay for July to Sep and get your MDR and card. In October, pay for Oct to Dec. Or you can pay July to Dec (1,200) when you register.

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