Philhealth Maternity Benefits

Updated June 2014:

Philhealth started implementing its Case Rates Payment system for maternity cases and certain other medical/surgical cases for patients admitted starting 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 payment 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).

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.

The Newborn Care Package (NCP) has been increased from 1,000 to 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 benefit has been increased to 6,500 pesos in Level 1 hospitals and in lying-in and maternity clinics. It remains at 5,000 pesos for normal deliveries 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.

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.

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

Not always. 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:
3,500 pesos for hospital costs
1,500 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.
For Voluntary Members or Individually Payors, pay at least 3 months of the 6 months prior to your month of delivery. If it’s already too late to pay for 3 months prior to delivery, pay for 1 year in advance so you can avail.

If you’re an OFW or an OFW dependent, yes, 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, 3 months of payments within the 6-month period prior to delivery are required.

Q. If the hospital 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.

Q: When should I file my claims?
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.

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.

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 Normal Maternity Care Package (NCP) of benefits?

You CAN NOT avail of complicated maternity care in non-hospital facilities such as lying-in and maternity clinics. Avail of these 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’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 is NOT covered if it’s performed in 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 CSdeliveries.

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.

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 up to newborn care. Make sure that your midwife is also Philhealth-accredited.

Related article:
Philhealth Requires Nine Months of Prior Payments

Philhealth Branches — Membership Reactivation

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  1. Hi Jannette, there was a plan before to extend the Philhealth benefit to all deliveries, but I think this plan was not followed up, because I can’t find a circular about it. You said 8 pregnancies — but how many deliveries? Are the 5 others miscarriages? If this is your 4th normal delivery, then you can avail. In SSS, its 4 pregnancies. With Philhealth, it’s 4 normal deliveries.

  2. Hi Kasei, sorry I cannot determine if there can be a second case. Call 441-7442 to ask if hematoma evacuation can be considered second case. Philhealth usually pays only one case; it considers 2 cases only in certain situations.

  3. Hi cykies, if you delivered Sep or Oct, you were eligible for Philhealth coverage, even if you didn’t pay for July to Dec. Besides, if you got a 5k deduction, that means you qualified. Was 5k pesos deducted from your bill? If you got a 5k deduction, then you already got your Philhealth benefit, and there’s nothing more to refund. At hospitals, the maternity benefit is only 5k.

  4. I had miscarriage and confine last saturday for D&C operation. I was discharge the next day (sunday) and was not able to use my philhealth since the required documents was not provided such as forms that need to be sign by our office and updated report of payment. Is it possible to still get my benefits even I paid my bill and check out of the hospital?

  5. Hi marlyn, yes, you can refund your coverage. Your case as Employed member is listed as one of the exemptions. File with Philhealth asap.

  6. Good day mam i gave birth at baguio gen hospital. i tried to file my prenatal receipts but they did not accept. can i file at philhealth Office?

  7. Hello Nora, I’m currently 22 weeks pregnant but i’m on medical leave from work until delivery due to complication of my pregnancy. Question, since i won’t be earning anything from september to february 2015 (my due date), i want to pay as a voluntary member to ensure coverage by philhealth. Will the hospital (philhealth accredited, level 3) automatically deduct my philhealth benefits? Because I’m still employed. On the claim form cf1 that I will fill up, do I need to have it signed by my employer as I already paid as voluntary? where can i get the certificate of contribution now that i’m paying as a voluntary member but still technically employed by my company? do i still get it from my employer as I’m already the one paying as voluntary until feb next year? thanks.

  8. Hi Clarisse, keep your premium receipt — that will be required by the hospital. Pay your next payment at Philhealth so you can get your MDR and Philhealth card. Bring a copy of your leave form; Philhealth might ask to see it. Employed members usually pay more than 200 pesos a month, so Philhealth sometimes ask for the leave form. You will sign your own claim form, as you’ll file as Individual Payor. Submit your Philhealth papers to the hospital while confined (before discharge) so you get the deduction. Direct filing with Philhealth is no longer allowed. http://www.healthphilippines.net/2014/06/philhealth-maternity-benefit-individual-payor/

  9. Hello Nora, my sister miscarried twice. The first one was ectopic pregnancy in 2012. this year, she miscarried at 5 months. She’s voluntary member of philhealth. is she covered? What are the requirements to avail ? She’s in PGH now. Really appreciate your reply. thank you

  10. Hi kat, if she paid for at least 3 months for the past 6 months, she can avail of the D&C coverage of 11k, if she had D&C (raspa). You must file papers before discharge.

  11. hi! is it true that under updated regulations, an employed member should have nine months consecutive contributions to avail of the maternity benefits? thank you so much!

  12. Hi juliefer, no, that’s not true. For employees, there has been no change — it’s still payment of at least 3 months of the 6 months before confinement.

  13. hi ms. nora, i am a philhealth member and an ofw here in UAE. I gave birth here in UAE on July 31, 2014. can i avail of maternity benefits? how much will it be? (is it same as for those who gave birth in phils?) what are the requirements and when is the deadline for submission? appreciate your reply on this. Thanks in advance.

  14. Hi Rachel, you have 180 days from date of discharge to file. Maternity benefit is 5k pesos plus 1750 pesos if you submit proof of newborn care. Yes, the benefit amount is fixed and the same for overseas or local confinements. Documents: MDR, premium payment receipt, medical discharge papers and baby’s birth certificate (if claiming newborn benefit), claim form 1 for you and claim form 1 for your baby.

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