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

1,136 Comments

Add a Comment
  1. hi again mrs nora, do I need to pay 6 months again if ever I decide to pay Philhealth on july 30?

  2. Hi Erika, will you give birth in October? If money is tight, you can pay for just one quarter — July Aug Sep (600 pesos) and you’ll be covered in Oct. But if you can, it’s good to pay July to Dec (1,200) for continued coverage for you and your baby.

  3. yes oct.8 po is my due. What about april-june? I can’t pay it next month? and do I get the same benefits if I pay only for 3 months for example? and is the newborn care package included?

  4. Hi Erika, you are no longer allowed to pay for April to June in July. Deadline is June 30. If you pay only for July to Sep, you will start to be covered only in Sep, and if you need coverage in July and August you will not yet be covered because you did not pay April to June. But if you pay also for Apr to June, you will be covered starting this June up to Sep. if you decide to pay only for July to Sep, you will be covered starting Sep up to Dec. Yes, benefits are the same. Newborn care is covered if the pediatrician is Philhealth-accredited.

  5. hi po my husband is a member. Is it automatic that I’m dependent po? or do we need to update? thanks

  6. Hi!po I gave birth just last may.29 and I submitted mdr,remittance and cf1. can I get a refund from philhealth? actually I’m dependent of my husband po

  7. Hi ysang, ask your husband to update his data at Philhealth so your name will be written as dependent on his new MDR. He brings his ID and your marriage certificate. If he is working, he can give you an authorization letter plus one of his IDs. Bring your ID.

  8. Hi Nelly, did you give birth at a government hospital? Why was your Philhealth coverage not deducted from your bill before discharge? Did you have an agreement with the hospital that you will claim a refund from them? Or did you give birth abroad?

  9. Hi khym, yes, you can pay for one year. Every paying member gets the same benefit amount for the same illness or treatment, whether they paid for 6 months or one year. The rule is the member should have paid at least 3 months within the 6-month period PRIOR to confinement.

  10. Hi. Good day Ms. Nora. I resigned in my previous work last April, they paid my contribution only until March. My due is on Oct.2, 2016. I just want to know what months should i pay to avail the maternity benefits? And what requirements will I be needing to present in the hospital? Thanks.

  11. Hi Jackie Lynne, you should pay for July to Sep. Docs: MDR, premium payment receipt, claim form 1 and your ID

  12. Hi Jackie, yes, if you pay July to Sep. To be sure, ask your hospital or clinic when you go there for your next check-up

  13. Hi just wanted to ask , where can i get assistance regarding my philhealth MDR. Im about to give birth this July 15, i obtained a copy of my MDR tru our company’s HR , however it showed that the most recent contribution posted was only until March2016. My midwife said that she would need an MDR that is updated up until the June2016 so that i can avail my philhealth benefit. So how should i deal with this, my paystub shows that, contributions are being deducted every month, and theres no missed payment, but its the posting that is quite late.

    Please advise. Thank you so much

  14. Hi Macrist, it has long been an SOP that hospitals/clinics accept a Certificate of Applicable Premium Payment from the employer as a supporting document to the MDR. The cert lists the months paid, amount paid and payment OR no. Your cert can list payments from Jan to June (if June is already paid). Ask your midwife if your employer’s cert with OR nos. is okay because Philhealth has not yet posted already-paid 2nd-quarter payments for employed members.

  15. Pwd po ba mag avail ng maternity benefits kahit sa bahay na nakaanak kasi di na makabot sa hospital.. Supposedly sa lying in ako manganak pero dahil tumaas bp ko one week bago ako nanganak kaya nirefer nila ako sa hospital.

  16. Hi Sheryl, sorry Philhealth pays the coverage only if you gave birth at an accredited hospital or accredited clinic with the help of an accredited OB-gyne or midwife.

  17. hi tanong ko lang po paano po ako makaavail ng maternity benefit?ofw po ako.ngaun po dito ako sa pinas at dto rin po ako manganganak.due date ko this coming 22.kailangan ko po ba hulugan philhealth for this year?

  18. Hi lhyn, yes, you need to pay July 2016 to July 2017 (2,400 pesos). Pay asap because you need to pay BEFORE confinement. Ask if you can pay half or 6 months (1,200). Bring your passport or any OFW ID to show you’re OFW

  19. Due date ko na po this july pero ang nahulugan lang is from november to devber 2016 , panu po kaya ko makaka avail ? ano po ung babayaran ko ?

  20. Hi po… magagamit ko po ba sa panganganak ngayong july ang philhealth? Bayad po sya from april 6 2016 to december 2016. And kailan po dapat ung susunod na payment?

  21. Hi mariz, yes, you can use it in July. You should pay for Jan to Mar 2017 or Jan to June 2017 in Dec 2016 or Jan 2017. If you’re OFW, pay before the expiration of your current receipt.

  22. Hi ms Nora, balak ko po mag hulog sa philhealth ko. Balak ko po bayaran na until December. Ano po mga requirements na kailngan ko dalin?

  23. Hi again ms Nora, meron na poba online na pwede kumuha ng mdr? My nabasa po kase ako online na pwede na daw kumuha. Hindi ko Lang po maalala yung site. Balak po kase ng husband ko na mag bayad nalang sa mga bayad center tapos online nalang kame kuha ng mdr para hassle free.

    And about po sa tanung ko kahapon, Hindi na poba kailngan ng ultrasound result ko.?

  24. nag register po ako online sa philhealth,chineck ko po yun premium contribution ko po and nakalagay po dun un last employer ko. which is nung oct.2014 pa po ako resign.
    wala po dun un lastyear na nag hulog ako voluntary ng 1200 sa 1st pregnancy ko. bat po ganun? kailngan poba mag register po ako ng panibago?

  25. Hello po ask ko lang po individual payer po ako ngaun sa Philhealth ko any nabyaran ko po Jan to march and April to June lang po due date ko po august 2 or end of July magagamit ko po ba philhealth ko? Or need ko pa po ba bayaran July to sept? Plz reply salamat po

  26. HI ms Nora, kailangan pa poba talaga ng PMRF pag si ba ang nag bayad ng philhealth ko. Kase po sa 1st pregnancy ko nun Hindi na po ako nag fill up ng bagong form.

  27. Hi po ask ko lang po if still i can use my philhealth benefits since 3years n po hndi ko nahuhulugan ung contribution ko,ano po dapat kung gawin sa oct.17,2016 n po kc duedate ko?tnx po

  28. hi ms nora my due date is dec 1. if i only pay august to october covered po ba yun? or i have to pay august to december? september 2015 po nag member si hubby pero di po sya nakapag work so first time po namin magbabayad sa august, ok lang po ba yun?

  29. Hello. Gusto ko lang po malaman ku maari ko pa din ba gamitin ang Philhealth ng dalawang beses? Nagamit ko po kasi yun dahil naconfine ako ng isang araw sa private hospital. Magagamit ko pa rin ba yung Philhealth ko sa panganganak ko sa susunod na buwan? 9months pa lang po yung nabayaran ko.

  30. Hi Dhes, yes, you can use it again, kasi your previous illness is different from giving birth. Ang 90-day rule ng Philhealth ay kapag the same illness within 90 days, isang confinement lang ang iko-cover.

  31. Hello ms Nora, ask ko Lang Po, mkaka avail Po din ba Ng benefits sa philhealth Khit live-in or single mom ang manganganak? (Self-employed Po ako andUpdated Po ang payments ko sa philhealth

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