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

778 Comments

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  1. Morning, is there a chance I can’t get my prenatal package? Was not under my name, but under the name of the lying-in. I haven’t filed for prenatal; the receipts are with me. But when they asked me to sign, they filed for PP. Can I get the refund? Is there a chance?

  2. hi Daryl, coverage for raspa or D&C is 11k. If you have paid for 3 of the past 6 months (3 months within May to Oct), yes, you’re eligible for Philhealth coverage.

  3. Hi Darr, yes, the deduction can increase if they write 2 cases (2 illnesses or treatments) in the claim. But the deduction are fixed for each type of illness or treatment. Ask for discounts from the doctors, and ask help from PCSO, if you decide so.

  4. Hi Duday, the prenatal check is usually given by Philhealth to the member/patient. But since they filed receipts that are not in your name, the clinic might not give it to you. I’m puzzled you did not ask them about it.

  5. Can I get my prenatal care benefit even if I was already discharged and my prenatal receipts were not included in the Philhealth forms. Thanks

  6. Hi nessa, you should have submitted your prenatal receipts together with the maternity papers. Direct filing with Philhealth is no longer allowed. You can ask the hospital if they have not filed yet your forms so you can submit your prenatal receipts.

  7. good day. My due is dec. I’ve paid my contribution this year from july-dec (6mos). Am I entitled to maternity benefits of philhealth? I plan to deliver in a private hospital. thanks!

  8. Hi kiray, yes, you’re eligible. Remember that the coverage is only 5k pesos (sometimes the deduction is only 3k because the 2k goes to the doctor too), so ask your hospital the total cost.

  9. Hi Ms. Nora, I gave birth last February 2014 thru CS delivery. I never avail my maternity thru PHILHEALTH and SSS,is it possbile that I can still FILE my claim?

  10. Hi jenny, for Philhealth, you can no longer file your claim. For SSS maternity benefit, you can file if you have paid at least 3 SSS contributions within Oct 2012 to Sep 2013. Include a letter explaining why you did not file your MAT1 form before delivery (some are approved, some are not).

  11. Hi erma, did you file your Philhealth papers before discharge? Philhealth no longer allows direct filing by Philhealth. If the claim 1 form is the problem, late filing is allowed if you were admitted Friday and discharged on Sat or Sun or early Monday

  12. Hi ms. Nors, may I ask if I can request for a solo bed at the government hospital here in our place. In one bed, 4 new mothers are using it. Only the babies are on the bed and the new mothers are seating. I wish to rest well. I’m an active philhealth member. Thanks

  13. Hi Rubie, is the government hospital in your place offering only charity services? Maybe the 4-in-a-bed situation is under the charity program. Ask if they have a paying-patient program. But the Philhealth maternity benefit is only 3k for hospital costs and 2k for PF. If you choose the paying-patient option, prepare to pay the extra hospital cost and extra PF. In government hospitals, the PFs of doctors treating charity patients are free, but doctors of paying patients can ask for separate PF in addition to the regular PF. Ask also around if that government hospital usually asks patients to buy medicines outside the hospital. Note also that the Philhealth benefit should be deducted before discharge, and if you are asked to buy meds outside, the ORs should be in your name.

  14. Good morning Miss Nora, how about the O.Rs from mercury drug, it’s there where my wife and I bought meds including ferous sulfate, calcium lactate, and antibiotic for her U.T.I treatment. Can we reimburse these even if my wife’s name is not on the O.Rs from Mercury Drug?

  15. Hi Reno, if you’re referring to the prenatal care package worth 1500, yes, the ORs should be in your wife’s name. I’ve seen Mercury Drug giving written ORs to customers requesting beforehand. But if you’ve already accumulated other prenatal ORs in your wife’s name worth 1500 or more, then these will be enough to claim your wife’s prenatal care benefit. Submit them together with your Philhealth papers before discharge.

  16. Good morning can you help me because my fiancee will be giving birth early this coming week and the lying-in says that she cannot use her philhealth because we are not married yet. please reply.

    Thank you

  17. Hi Aldrian, who is the Philhealth member? you or your fiancee? If you are the Philhealth member, your fiancee cannot use your Philhealth. If your fiancee is the Philhealth member, she can use her Philhealth whether she’s married or single. Maybe there’s another reason.

  18. Good am ms Nors, my wife (as my dependent) is giving birth this dec and it is our 6th child, can i still avail NSD, NCP and prenatal care benefit? What does question: “Are there other reasons why I can’t avail of Philhealth’s Normal Maternity Care Package (NCP) of benefits?” means? the answer here seems like it no longer covers the 5th and above delivery, but other items says..”Q: Can I receive this maternity benefit for all my normal deliveries? Previously, only the first 4 births are covered under the normal delivery package. Now, under the new national health law, all births are covered.” THanks!

  19. Good Day! I’m an employed Philhealth member. I have Mercury drug receipts for my prenatal vitamins,and U.T.I. medicines and I didn’t know that it is possible to reimburse them. Can I ask the Mercury Drug for written receipts when I show them my O.R. ? How many ultrasound receipts will be reimburse? I got three ultrasound tests and I’m due on February 2015.
    I have an SSS but the last payment I had before my current employer is September 2013. And I started with my current employer last September 2014. Am I still eligible for SSS Maternity Reimbursement?

  20. Hi Christina, about Mercury ORs, try asking if they can write ORs for your machine receipts. You can submit those 3 ultrasound ORs. But Philhealth will refund only up to 1500 pesos for prenatal care. About SSS: Sorry you might not qualify for SSS maternity benefit. Your semester of contingency is Oct 2014 to Mar 2015, so SSS will look for at least 3 contributions within Oct 2013 to Sep 2014. Ask others too. http://sssphilippinesnotes.blogspot.com/2013/07/sss-maternity-benefit-eligible.html

  21. Hi Franz, sorry I missed deleting that line about the new national health law — I have deleted the same line in my other posts. The long-standing rule of excluding the 5th and subsequent normal births from Philhealth benefits was removed from the New National Health Law of 2013, and it was also announced that they were going to cover all deliveries, but apparently, they went back on that, including special considerations for non-member pregnant women. I was searching for the news article where the Philhealth CEO talked about it, but can no longer find it.
    To be sure, you can ask the hospital/clinic where your wife will be giving birth.

  22. Hi ms.nora, i need to update my employment record in my Philhealth MDR, i’d like to know if it takes months for updating. My due date is on feb 7 2015. My previous employer is shown on my MDR. Needed for lying in. Thanks.

  23. Hi erica, you can get your updated MDR at Philhealth maybe in an hour or two. Fill up the PMRF form, then present your ID and your form at the counter when your number is called. Bring your marriage cert or any other relevant doc if you’re also updating dependents.

  24. Hi ms.nora. our clinic needs community tax or sedula. is it necessary? my wife is giving birth this December. we are both philhealth members. thanks

  25. Hi ryan, Philhealth does not require that, but if the clinic requires it, then submit it. Get your cedula from your city hall or barangay hall — maybe your city/town has rules about cedula for clinics and other businesses in your city/town.

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