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

1,085 Comments

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  1. can i update at another branch of philhealth? where is the nearest branch of philhealth branch here in commonwealth qc? tnx

  2. Hi maricel, yes, you need to update your Philhealth record. The nearest Philhealth is at F.R. Estuar Bldg., 880 Quezon Avenue. Bring your ID and marriage certificate (orig and xerox). Fill up registration form. Check FOR UPDATING. Get your new MDR. Your premium payment receipt should also be in your new surname.

  3. Hi Reuth, yes, she can avail of Philhealth as your dependent. Her name should be written in your MDR as your dependent. If not yet written, update your record at Philhealth with your ID and marriage certificate (orig and xerox).

  4. Hi janeth, pay for Jan to June 2016 at Philhealth branch so you can get your MDR. If you pay Jan to June this month, you’re covered by Philhealth starting from the next day after payment till July or Aug. Bring your ID

  5. Hi! I was advised that the father of my child can use his philhealth for the baby, is it okay if the baby is under my name?

  6. Hi Jessica, if you have your own Philhealth, it’s easier to use your Philhealth to cover both your maternity and your baby’s newborn care. File 2 claim forms, for you and your baby.

  7. Hi Nora, im four months pregnant now and my contibution in philhealth are from july2015 up to now since im still working. Am i eligible for this philhealth benefits? And do you also have an idea about the sss maternity benefits? Sorry for a lot of question . I just wanted to know the details. Thank you ????

  8. Hi Nora, im four months pregnant now and my contibution in philhealth are from july2015 up to now since im still working. Am i eligible for this philhealth benefits? And do you also have an idea about the sss maternity benefits? Sorry for a lot of question . I just wanted to know the details. Thank you ????

  9. Hi Nora, im four months pregnant now and my contibution in philhealth are from july2015 up to now since im still working. Am i eligible for this philhealth benefits? And do you also have an idea about the sss maternity benefits? Sorry for a lot of question . I just wanted to know the details. Thank you ????

  10. Hi Nora, im four months pregnant now and my contibution in philhealth are from july2015 up to now since im still working. Am i eligible for this philhealth benefits? And do you also have an idea about the sss maternity benefits? Sorry for a lot of question . I just wanted to know the details. Thank you ????

  11. Hi Ghaille, yes, as long as your employer is remitting your Philhealth payments to Philhealth, you will be covered. Make sure that your April to June premiums are paid. Note also that the Philhealth coverage for normal delivery is only 5,000 (3k for hospital cost and 2k for PF), regardless of whether the hospital is affordable or expensive. About SSS, file your maternity notification asap. File through your employer. Here are the documents required for your maternity benefit claim

  12. Good day! I’m 8months pregnant my duedate on May 4….. can I still avail the maternity benifits if I will pay the 1st quarter contribution on March31 and 2nd quarter on April 11……

  13. Good day maam.ask ko lng august 30 2011.na cs akoh pero d ako nacover ng philhealth kahit kompleto ang hulog ko from january 2011 to december 2011.khit kompleto daw hulog or advance kelangan 9 months daw.ganun poh ba un? Nagbayad ako sa hospital ng 29k.

  14. good day . i got hispitalized due to miscarriage at exactly 1week from now . can i file this to philhealth and have my refund ? tnx and hoping for the quick responce

  15. Hello po! I’m an OFW and my mother in the Philippines received my maternity benefits check. I emailed her my authorization to encash it, she has my valid IDs but the 4 banks where she’d been to, refused to encash the check since it has a stamp “For Payees Account only”. My 2 bank accounts were closed recently. Is there any other way for my mother to encash my check?

  16. Hi Tifany, Philhealth’s rule is for the patient to file Philhealth with the hospital before discharge, and it’s the hospital that should file with Philhealth. You can file directly with Philhealth if they accept your reason for not filing with the hospital, like you were hospitalized abroad.

  17. Hello po Mrs Nora! I’m an OFW and my mother in the Philippines received my maternity benefits check. I emailed her my authorization to encash it, she has my valid IDs but the 4 banks where she’d been to, refused to encash the check since it has a stamp “For Payees Account only”. My 2 bank accounts were closed recently. Is there any other way for my mother to encash my check?

  18. Hi Anna, sorry I can’t think of any other sure way. I wish your mother lives in the province where she knows the rural bank manager, so the manager can remedy it. She can also ask around for a money changer or pawnshop or loan company that encashes government cheques. Your mother can also go to Philhealth and ask how you can request Philhealth to replace the check and issue it to your mother — is authorization enough? or will it be SPA?

  19. Hi Anna, wow, that’s nice. It’s always nice to hear something good about Philhealth. Thank you for taking the time to update us.

  20. My husband’s contribution is Jan to March 2016and I’m 8months pregnant and I’m his dependant can we still avail in philhealth

  21. Hi sherryann, yes, you can avail. Your name should be written in your husband’s MDR as dependent. It’s good if you also pay for Apr to June asap so your coverage is continuous.

  22. Hi Ms. Nora! I have been unemployed since December 18 2015..i was not able to continue my philhealth as individual payor and my husband’s MDR has not yet been updated to list me as his dependent. Im due probably last week of April or firat week of May..if i pay for 2016 2nd qtr or my husband updates his record, can i still avail of the maternity benefits? If yes, how do i go about filing and claiming? Thank you!!

  23. Hi Abi, I’ve replied to you in your other post. Anyway, if you pay, you’ll not be able to use it immediately, so ask your husband to update his Philhealth records by going to Philhealth asap with your marriage certificate (xerox and orig) and your letter asking Philhealth to cancel your Philhealth membership as you are now unemployed and to register you as dependent of your husband. Your husband will fill up the registration form (check FOR UPDATING). You should file your Philhealth papers upon admission or days before discharge. Coverage for normal delivery at a hospital is only 5k.

  24. Hi Abi, it’s okay. Fill up 2 claim forms, one for you and one for your baby (newborn care of up to 1,750 pesos, depending on available procedures). Attach also at least 1,500 pesos worth of prenatal care receipts in your name so Philhealth will refund you 1,500.

  25. Hello. Are there any differences regarding with the benefits if I am to deliver twins? Please reply. Thanks!

  26. Hi Red, the benefit amount is still the same, whether single birth or twin birth. If normal, it’s 5k, and if CS, it’s 19k.

  27. Hi I just want to ask if I can still avail for maternity benefits, my due date is this coming july and my last contribution was 2014 .

  28. Hi Jessa, yes, pay at Philhealth so you can get your MDR and card. Pay for Apr to June, or Apr to Sep. Bring your ID. Fill up the registration form. Check FOR UPDATING.

  29. Hi Trina, yes, be ready with your MDR and premium receipt. You should have paid at least 3 of the 6 months prior to your delivery.

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