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

678 Comments

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  1. hi ms nora can i get any maternity benefit if i already resigned from work this june and im going to give birth on oct?

  2. Hi Jean, sorry the lying-in should be Philhealth accredited. If not accredited, you cannot use Philhealth. Ask others too

  3. Hi mam! Ask ko po kumuha kc ako ng PH nung feb then hndi ko xa nhulugan ngaun lng ako nghulog for month of jul-sept .. Pwede ko n b xa mgmit duedate ko n kc nxtmonth .. Thnks po klangan ko tlga man

  4. Hi mam! may i Ask I got PH feb then I wasn’t able to pay. it’s only now that ipaid for month of jul-sept .. can i use it for my due date next month .. thanks need to know

  5. Hi nadine, you can still pay for July to Sep as Voluntary so you can avail without going back to your employer to get cert of premium payments plus copy of payment receipt. Besides, your employer might not have made your June payment, so pay as Voluntary at Philhealth to be sure, and then get your updated MDR and Philhealth card.

  6. Hi Ms Nora ask ko lang po kung kanino po mapupunta yung prenatal care na 1500 sakin po ba o sa lying-in sila po kc daw mag aasikaso ng papers ko.Sabi po kc nila wala na daw po ako babayaran kung member daw po ako ng philhealth daw po kc covered nun.Thank you po.

  7. Hi Ma’am,

    Is it necessary ba talaga na Philhealth ID yung ipresent when claiming philhealth claims/ benifit? I don’ have philhealth ID but I do have MDR. I am employed naman po.

    Thank you.

  8. Hi remy, your updated MDR, your premium payment receipt (cert of premium payment with OR nos., if employed) and employer-signed claim form 1 are more important. If you don’t have your Philhealth ID, present any valid ID.

  9. Hi Ms. Nora May i ask if it’s true that philhealth no longer refunds? It was what they said at the lying where I’m having my check ups. may i ask if the doctor’s fee is really separate? They said that pf is 6k if i choose a doctor to help me deliver. according to them, that’s in addition to what they get from philhealth. No other person to ask.
    Please help me.Thank you.

  10. Hi Kim, did you give the your prenatal ORs to your lying-in? Your prenatal check should be sent to your address by Philhealth.

  11. Hi kim, yes it’s true that Philhealth no longer allows direct filing by patients at Philhealth. If that’s the policy of the lying-in, that you pay an additional fee to the doctor, sadly, that is allowed, because all lying-ins can dictate their price. There are cheaper lying-ins, and there are more expensive lying-ins. There are doctors that charge less, and there are doctors that charge more. The Philhealth coverage for maternity at lying-ins is 6500. Submit prenatal care ORs worth 1500 or more to the lying-in so Philhealth will refund you 1500.

  12. Hi Ms Nora. Ask ko lang po kung naayos ko po mga requirements before ako lumabas ng hospital mababawas po ba sa bill ko ung sa philhealth? after ko po manganak ngpasa po ako mga resibo ng mga gamot. Tumwag ako sa philhealth my cheke dw po ako nasa hospital na. Dec 2011 po ako nanganak 2012 pa nandun cheke ko. last week ko lang po kc natanung. Posible po kaya na ung 11thou plus po yun? or yung sa gamot lang po? CS po ako at sa jose reyes nanganak nasa pay ward po ako my bnayaran din ako sa hospital nasa 5thou kc ung ob ko at anes walang bayad dhil boss ko ung ob. tnx po

  13. Hi rachel, you should be able to get back the 5k that you paid the hospital, and the cost of the meds that you bought outside. Hospital cost benefit is 11,400, but your refund will not exceed what you actually spent.

  14. Thank you. What if the check is already stale? Was issued 2012. Would I return it to philhealth and would I wait for check replacement? thank you so much

  15. Hi rachel, go to Philhealth with your ID and ask for check replacement. Include a letter to Philhealth asking for check replacement and explaining why you were not able to encash your check on time. Yes, you will wait for check replacement.

  16. Hi rachel, if you’re claiming your refund from the hospital, and if the hospital has already processed your refund, it would either be in cash or a check issued by the hospital, and that should not be stale. When I answered your question about stale check, I thought you’re holding a stale check from Philhealth. Bring your ID, your ORs, hospital bill and benefit payment notice (xerox and orig) if already received.

  17. Hi Ms. Nora. Ask ko lng po if mka avail ako ng NCP if ever breech talaga yung baby ko. Im currently 32 weekd pregnant and as per recent ultrasound result , breech parin po ang baby ko. If that’s the case, kung hindi talaga ako mkka avail ng NCP, does that mean na wala akong mkkuhang PhilHealth Benefits? Thank you po

  18. Hi Gen, you’re right, you cannot use Philhealth if it’s breech delivery and you give birth at a lying-in or maternity clinic. If you want to use Philhealth, give birth at a hospital. Consider the costs and your condition.

  19. .. hi ms. nora .. im lisette.. and im resining from work this oct 3. .. Can i avail my philhealth benefits already? im giving birth this november.. thanks

  20. Hi lisette, yes, you’re eligible. Request for a cert of premium payments with OR nos. (at least the past 4 months) from your employer. If they can give a copy of receipts, it would be great. Go to Philhealth, fill up member data (For Updating) and get your MDR and Philhealth card.

  21. Hello! I just want to ask if my previous confinement, polypectomy- december last year, will affect my maternity benifits. I am due in October. I was able to refund eight thousand plus for that said surgery.

    Thank you. You have a very helpful site. God bless.

  22. Hi Nhel, there’s no effect. You can use your Philhealth this October.
    Under the 90-day-rule, the subsequent confinements are not covered if confined for the same medical reasons within 90 days, except dialysis, chemo, and cataract surgery.

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