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

589 Comments

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  1. Hi po! I just want to ask, I’m about to give birth this 1st week of august and nagapply po ako ng philhealth ng june 30. Ang binayaran kopo is april-dec 2014. Will philhealth cover my maternity? Sabi kasi ng ob ko malaki possibility na ma CS ako. Thank you so much!

  2. Hi nicole, yes, you’re eligible. But in case your hospital’s policy is not yet updated, tell them that Philhealth’s requirement for Individual Payors has been reduced to payment of 3 months within 6 months immediately prior to delivery.

  3. Hi, my wife just gave birth last week, june 25. And was discharged last June 28. We weren’t able to avail the philhealth during our stay in the hospital because we were not informed ahead. Can we still avail the benefit since all documents are already completed? Where can we file it? In the hospital? Or directly to philhealth? Thanks!

  4. hi po.ilang buwan ba para makuha yung refund ko sa panganganak ko?palagi n kasi akung tumatawag sa inyo.sabi nyo kasi 2-3 months lang makuha na.peru 4months na.wala paring dumating na refund.tsaka kailan ba talaga? nung last na tumatawag ako sa inyo sabi nyo mag antay ako mga last week of june meron na.peru july na kasi wala parin .ano ba talaga?kailangan ko kasi pam pa inject ko sa baby ko..

  5. Hi Earl, ask the hospital if they can file your claim for you…because there’s no more direct filing with Philhealth, and you need some docs from the hospital. If the hospital refuses to file, you can try filing or making an appeal with Philhealth.

  6. Hi ria, sorry this is not Philhealth’s website. Really frustrating, but processing really takes many months.

  7. Hi mam nora ask ko lng my wife is currently 7 months pregnant wala po xa hulog sa philhealth this year since maselan po ang pgbubuntis pnatigil xa sa work ng doctor how much po kaya ang months na dapt bayaran pr mkclaim ng maternity benefits?? Thanks po sa response mam nora more power po

  8. Thanks for the your reply mam nora..

    I will follow up on this and will post the result here to help the readers as well..

    Also when is the cut off date for philhealth contributions?? is it every end of the month

    More power po mam nora..

  9. Hi Gene, yes, every end of the month, or last day of the quarter (for those paying quarterly). Thanks for planning to share helpful info

  10. Hi ms.Nora, I’m confused po kasi regarding sa maternity benefit, 8k po kasama na prenatal expenses, Yung about sa newborn package po na 1750 di pa po b kasama yun sa 8k na mkukuha?
    Sa novaliches district hospital po kasi, Yung gamit sa panganganak na gamot s labas ipapabili , then ung new born package(NBP) di kasama Sknla. Sa Tatay dw po n philhealth macre2dit Yung NBP, Yung s nanay ng bata gastos LNG s ospital.
    Question po Yung mga nagastos s pagbili ng gamot s labas pra s delivery at Yung NBP Pwede po b mrefund yun? And hiwalay po b ang pg bayad s NBP?

    Thank you.
    More power !

  11. Hi Duday, maternity coverage is 6500 — this should be deducted from hospital bill. Prenatal coverage is 1500, and will be refunded by Philhealth by mail to member if member submits prenatal care ORs worth at least 1500 to the hospital. NBP coverage is 1750 if pediatrician is Philhealth-accredited. You will submit 2 claim form 1 (one for you and one for your baby). You are the mother so your baby can use your Philhealth. The hospital’s birth certificate will be used. No need for the father to file (but if the hospital insists that it should be the father, then the father should submit his Philhealth papers before discharge). You can refund later on your expenses for meds bought outside if your Philhealth deduction is lower than 6500. 1750 NBP should also be deducted from your newborn care bill. Submit your Philhealth papers upon admission.

  12. Hi , ask ko LNG po ule, panu malalaman Kung anung level nung hospital ? Kung kasama b xa s level 1 o 2-4 ? Thanks po

  13. gud am po ask ko lang po kung pwede ko na ma-avail ung maternity benefits gayong last july 7 lang po ako nagfile ng membership sa philhealth. sa Auhust 31 po ang due date ng delivery ko pwede ko na po ba maavail un? and kung hindi pa po pwede iavail un after delivery ko, pwede ko pa rin ba maavail un after 3 months of delivery saka ko lang po iaapply sa philhealth ang maternity benifits ko? at gaano po katagal dapat makuha ung benifits upon delivery.

  14. Hi Eliza, if you were not able to pay May June July, I think you cannot yet avail. The requirement is payment of 3 of 6 months before delivery. No, you cannot file your claim 3 months after delivery. Ask Philhealth if you can avail if you pay 1 year in advance

  15. hello po mam nora ask ko lang po kasi naguguluhan po talaga ako nkapag apply na po ako ng philhealth bali pang apat na anak ko na po ngaun tong pinagbubuntis ko ngaun sa september pa po ang anak ko my nagsabi po kasi sakin na hindi ko daw magagamit ang philhealth ko kasi pang apat na panganganak ko na po ito pero ngaun pa lang po ako gagamit ng philhealth..anu po ba hindi ko po kasi alam kung sinu papaniwalaan ko

  16. hi mam..nagvoluntary member yong friend ko last may 21, 2014 lang,,,nagbayad na siya ng good for 4 months lang…makaka avail naba siya ng benefits?

  17. Hi mam. Matagal na po akong nagpamember sa philhealth, siguro mga 2012 pa. Pero this last april 2014 ko lang hinulugan at kinuha yung i.d ko. So bale ang hinulugan ko is april-july, quarterly ata yun. May due date is august 9, 2014. Makaka-avail po ba ako? Kung hindi, pwede pa po ba maghulog ngayon para maka-avail before my due date? Kelan po ko pwede maghulog ulit? Thanks.

  18. Pwede ko ba ma avail yung philhealth ko since may anim akung buwan na Hindi nababayaran,.ngpa member po ako last sept. 2013..Bali po July -sept.2013 ang na bayaran ko tapos oct-March Hindi ako nkabayad then nag bayad po ako uli April-dec 2014,.my due date kasi sa panganganak ko is sept..pwede ko na ba magamit..tnx po

  19. Helo po ask ko lng po sana if totoo yung sinasabi ng friend ko na pag 35 yrs old kna at first baby mo pa lang pinanganak mo di ka raw makakapag-avail ng maternity benefits?

  20. Good day! Just wanna ask po if I can still avail this s my 5th pregnancy 1 normal delivery, 1 Cs and 2 mscariage then this will my last coz plan ko po mg pa ligate. Doc told me na cs din DAw ako. Husband’s dependent Lang po ako sa philhealth. I’m not sure if I can avail. Pls advice me.

  21. hi ms.nora..ask ku lng po if maka2avail p po b ku ng phil maternity benifits??ectopic po. ku.phil health lng po ng aswa ku ang ngamit s hospital ng madischarged po ku.thanks po..pwede po b s facebook ku nlng po kau mgrply.thankz po uli.

  22. Hi ms.Nora!
    Iccs po ako this july 21 and yung husband ko po is nasa saudi yung philhealth nya po is nakapremium payment may 13-2014 to may 12-2014 maaavail ko po kaya ung maternity benefits as ofw dependent?thank you in advance

  23. Hi judy, you cannot avail if you deliver at a maternity clinic or primary hospital. To avail, go to a bigger hospital (level 2 to 4), but consider also the cost.

  24. Hi Jennifer, if you mean May 2014 to May 2015, yes, you can avail. Make sure your ob and hospital are Philhealth-accredited.

  25. hi po good day, ask ko lang po kasi ngaung july palang po ako maghuhulog sa philhealth, employer ko po maghuhulog, ask ko lang kasi by oct last wik or first wik of nov ako manganganak kung magagamit ko po ba philhealth ko kht 3 months lang mahuhulugan pa? salamat po

  26. Hi Ms. Nora,i recently paid april-june 2014 as voluntary member and my expected delivery is on Sept 7, 2014. If ever hindi ko mabayaran ung July-Sept payment, coverred pa rin ba ko ng Philealth maternity benefits pag nanganak ako ng Sept 7? Medyo tambak na kze ang gastusin ko. TIA! God Bless po.

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