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

637 Comments

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  1. Hi Chayette, Urdaneta District Hospital (formerly Perez) is Level 1. Submit 2 claim form 1 (one for your maternity claim, and the other for your newborn care coverage). Use the birth certificate issued by the hospital to support your newborn care claim. Prepare money because many government hospitals ask you to buy meds or supplies outside, as they don’t have enough meds or supplies. Keep your ORs; they should be in your name.

  2. thank you so much po mam nora…marami po kau natutulungan na mga kagaya ko..kip up the gud work po….god bless

  3. Hi Maam Nora. Ask ko lang po, year 2011 po ako nag apply sa philhealth as Individual paying-self employed. May MDR po bngay skn..and ngayon ko lang po nahulugan ang philhealth ko, jan-dec 2014, and sept 2014 po ang EdC ko. Do I need to get another copy of MDR? Or ok na po ang nsa akin ngayon? Thanks po for the reply.

  4. Hi nora… Just would like to ask… I recently resigned from a private sector company last nov 2013… And since then i havent paid my voluntary philhealth contributions… From oct 2013 (which isthe last company credit to my contribution) , the nxt payment i made was just this april may june 2014 and my edd is on oct 25, 2014… Will this payment/contribution be enough to cover my maximum maternity benefits?

    Another, what are these pre natal care receipts? Are these the monthly receipts from my obgyne everytime i have my check up? Will medicine like vitamins and supplemets cover this or just the consultation?
    Thank you so much.. Hoping for your reply!!! :)

  5. Follow up lang po ms nora… Enough na po ba ung april may june 2014 ko for my due date this coming oct 2014? Pasok po ba sya sa at least 3mos within 6 mos? Thanks!

  6. Tanks for the reply ms nora… Very very helpful.
    Another question, is there any other way i can still claim my maternity benefits if my obgyne is not a philhealth certified doctor but my hospital is?

  7. Hi Michelle, sorry but it should be both. Both your ob-gyne and your hospital should be Philhealth-accredited. The alternative is to find a Philhealth-accredited ob-gyne in the same hospital. But weigh your options, specially if your ob-gyne is the best for you.

  8. Hello po, Ms. Nora!

    So far I have tried the Philhealth website and other sites on maternity benefits of individually paying members, but this one has been the most informative and updated that I came across. Thank you so much for your patient responses sa comment section.

    I’m a freelancer and not yet a Philhealth member (di po kasi ako naoospital kaya hindi ko na rin naisip magpa-member). But now am 13 weeks along and will deliver Feb 2015. I’ve been having my pre-natal check-ups at Quezon City Gen Hospital. I’d like to ask whether I can avail of philhealth benefits when I deliver if I pay at least one year contribution agad pag-nag-apply ako as individually paying member?

    I hope you can also help me on this. Medyo vague nga po ang nakalagay sa website ng philhealth. Though I haven’t tried calling their hotline. Susubukan ko rin po tumawag at mag-inquire sa hospital.

    Thank you in advance po at more power to you and your family!

    -Danelle

  9. Thanks for the quick reply, Ms. Nora.

    May sentence dito sa Philhealth website:
    “Payment of at least three monthly premiums within the immediate six months prior to the month of confinement. For pregnancy-related cases, dialysis (except those undergoing emergency dialysis service during confinement), chemotherapy, radiotherapy and selected surgical procedures, payment of nine (9) monthly premium contributions within the last 12 months shall be required except for those enrolled under the KASAPI program.”
    http://www.philhealth.gov.ph/members/individually_paying/condition.html

    Does that mean napapasok ako sa 9 over 12 months?

  10. hi po uli ms nora..my question po me uli….ospital na po b bahala magprocess sa lahat ng pilhelt reinbursment ko?ibibigay ko po ba s knila lahat ng mga resibo na nasakin including prenatal chek ups ko bago ako madischarge?
    maraming salamat po ms nora…very imformative po itong site nu…it really helps po sa amin….god bless po ms nora and more power …

  11. Hi…po September po ung due date ko if sa lying in po ako manganganak..philhealth accrideted nmn po ung midwife,,dun db po php 6,500 ung ibabayad ng philheatlh sa knila…e php 5,000 lng po ung bayad sa kanila kapg walang philhealth,,san kanila din po ba ung php 1,500 na excess…at tanong ko n rin po kung makukuha ko po ba ng buong php 6,500 benefits ko if july 2014 lng ang mapost ng employer ko..almost 2 years n po ako sa employer ko..tnx po

  12. hi po ulit…incase nmn po na macaesarian ako makukuha ko po ba ung buong 19 k benefits,,ko po at estimated na hulog sa kin ng employer ko 12 months kasma August 2014. kso late posted nga lng po cla,, tnx po

  13. Hi Aisliin, go to Philhealth and get your MDR so you can check the payments made by your employer. If they paid only July and Aug, you will not qualify. They should remit June payment. The rule is payment of 3 of the 6 months before confinement. About CS, you should be in a hospital, not a lying-in. If initially, you’re in a lying-in, you’ll be transferred (you’ll pay the lying-in and you’ll use Philhealth at the hospital. About lying-in, both midwife and lying-in should be Philhealth-accredited. About excess coverage, no, you’ll not get the excess.

  14. Hi Chayette, yes, submit your prenatal ORs together with your Philhealth documents 1 day before discharge.

  15. Hi, ms. Nora. Ask ko lng po. Last 2 years pa po kasi ung hulog ko s philhealth. At since then, ndi npo ako nakapaghulog dhl unemployed po ako. And I’m giving birth this Sept2014 na po. Ask ko lng po pede pa po ba or qualified pa po b ako for philhealth benefit? Panu pa po kaya ako makakahabol para sa payment to avail the benefit? Nag-aacept po b sila ng payment for past months?
    Tska my nagsabi po kasi na I cant avail the Prenatal care benefit if less than 4times lng ung visit/check up ko sa panganganakan ko?
    Pls, also reply to my email add: sexyleyde00atgmail.com or jmctesiornaatyahoo.com.ph
    Para mabasa ko po reply niu po. You can also send me pm sa fb. Pa-search nlng po Joannmae Sarah Tesiorna
    THANK YOU SO MUCH! GODBLESS! :)

  16. Hi Joannmae, this August, you can pay July and Aug, not enough for the 3-month payment requirement. You can no longer pay for past quarters. If you like, go to Philhealth and ask if you can avail in Sep if you pay for 1 year in advance. At lying-in facilities, you can avail of Philhealth only if you had at least 4 prenatal care visits with them. God bless too

  17. Hello po.. Ask ko po sana, magagamit po ba ng husband ko yung philhealth niya sakin kasi manganganak po ako ngayon end of august kaya lang binayaran lang po niya is april to september. Kaya lang my OB said dapat 9months before ng due date ang bayad para magamit ang philhealth..
    Thank you po..

  18. Thank you po ms. Nora! Ok po. I’ll personally go to Philhealth to ask for possible solution para maka-avail po ako ng philhealth benefits. By Sept18 po kasi ang due date ko. Salamat po ng marami! :) God bless!

  19. Hi Abby, yes, you can use your husband’s Philhealth. The 9-month requirement has been reduced to 3 months. April to July is 4 months, so you’re eligible in Sept.

  20. Hi ms Nora, my edd is Oct 12 and I’m planning to pay my philhealth this month, I’m an individually payor since 2010 but I wasn’t able to pay it til now, would I still be able to pay the 3mos and avail the benefits of philhealth if ever bayaran ko yun or should I apply again for another MDR then pay. Thanks .. and 45 to 50k ang sabi ng doc ko for normal delivery sa mcm.. how much Lang dun any mkkaltas ng philhealth

  21. Hi Ms. Nora.
    If hindi ko po nabayaran yung 2nd quarter ko sa philhealth which is (april-June) pede ko pa po ba sya bayaran ngayon?
    Thankyou and Godbless!

  22. Hi Ms. Nora,

    I am currently 33 weeks pregnant the last time po na ng pachekup ak with my OB my DD would be is oct 5…Pero galing lng po ak dun yesterday and doctoc advise me na my due date may fall from sept 27-30 now i have paid my philhealth contributions from july to sept kc i was expecting na the duw date will be Oct now i am not sure po if i can pay retro payments for the month of june of this year para po mavocer ung sept..Please enlighten me what to do thanks po..

  23. Hi cookie, sad to say, you can no longer pay for June. If you like, you can go to Philhealth and ask if you can avail if you pay for 1 year in advance.

  24. hi po ms nora…septmber po ang edd ko..ngaun po sa lying in po ako manganganak..pero ang sabi po nung midwife na pinagtanungan ko hindi dw po ako eligible s maternity benefits dahil april dw po ako nag start ng payment as voluntary na dapat dw po january ako nag start na nagbayad…bayad na po ako hanggang september.
    nagtanong na din po ako s pilhelt office sabi eligible na dw po ako.
    ano po ang gagawin ko pag nanganak na ako at pinagpilitan nung midwife na d ako eligible for maternity benefits?
    help me po ms nora…ano po ang dapat kong gawin?salamat po

  25. Hi chayette, tell the midwife that the eligibility rule has changed. Is the lying-in really Philhealth-accredited? Why don’t they know the new rule? Ask the midwife if they make Philhealth deduction if you present a cert of eligibility from Philhealth. If yes, request this cert from Philhealth.

  26. Hi,

    I’m newly wed and pregnant. Ang edd ko is by end of oct. or 1st week ng November 2014. Magapply pa lang sana kami ng Philhealth [Individual paying] yung husband ko na lang para ako yung magiging beneficiary niya, makakaavail pa po ba kami ng benefits? Possible po kaya yung magbayad kami ng for 1 year tapos magamit namin sa panganganak ko? Thank you.

  27. Hi Ms. Nora,

    As an OFW, I have my monthly check-ups done outside PH but I will be giving birth in PH. Can I submit my prenatal care receipts from my clinic abroad to be able to claim my pre-natal care benefit?

    Thanks!

  28. Hi Sherryll, yes, submit your prenatal ORs together with your Philhealth documents. But prenatal care coverage is only 1,500 and it’s for normal delivery only.

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