Philhealth Benefits — Case Rates Payments for Certain Medical and Surgical Cases

Updated June 2, 2014:

Since January 2014, all hospitalizations and outpatient treatments eligible for Philhealth coverage are already being covered under the Philhealth Case Rate system.  Each medical or surgical case is covered by a fixed amount.

For medical cases, 30% of the fixed amount is for Doctors’ Professional Fees  (PF) and 70% is for hospital costs.

For surgical cases, it’s 40% for PF and 60% for hospital costs.

You can no longer file your Philhealth claims directly with Philhealth.

Submit your Philhealth documents to the hospital BEFORE DISCHARGE, so the hospital will deduct the Philhealth coverage from your bill.  It will be to the hospital that Philhealth will send the check.

If the hospital asks you to sign a waiver, READ the waiver.

You can see the coverage amounts here: Procedure Case Rates and Medical Case Rates.

The coverage amounts listed in the charts below, posted in August 2011, are still correct, but the list below includes only the first procedures and conditions covered under the Case Rate program.


Article below was posted on August 2011:

Last September 1, 2011, Philhealth started implementing its policy of paying fixed rates or fixed amounts to accredited hospitals and clinics for 11 medical cases and 11 surgical cases under its reimbursement scheme called Case Rates Payment.

If we count 9 case rates payment packages implemented since 2003, there are now 31 medical and surgical cases paid by Philhealth under its Case Rates Payment scheme. Other cases are paid under the regular Fee-for-Service scheme.

The fixed Philhealth payments are made directly to the hospitals or clinics. The fixed Philhealth payment is deducted from the total hospital bill and the balance will be paid by the patient.

Philhealth said that the Case Rates basis of payments for SURGICAL CASES  is applied to cases managed at Levels 2 to 4 hospitals (bigger hospitals), with certain exceptions.

For sponsored members and their dependents, the No Balance Billing Policy will apply when they are confined in government hospitals or clinics. It means the Philhealth payments will be adequate to cover their expenses for these 22 medical and surgical cases and they don’t need to pay anything. In cases where patients are asked to buy certain drugs or supplies, they will be reimbursed.

These are the selected medical and surgical cases and the fixed amounts that Philhealth is going to pay to hospitals or clinics, implemented for patients admitted starting September 1, 2011:


Medical cases Case Rates in Pesos
1.  Dengue 1
Dengue Fever and DHF Grades 1 and 2 8,000
2.  Dengue 2
DHF Grades 3 and 4 16,000
3.  Pneumonia 1 – Moderate Risk 15,000
4.  Pneumonia 2 – High Risk 32,000
5.  Essential hypertension 9,000
6.  Cerebral infarction (CVA I) 28,000
7.  Cerebro-vascular accident
hemorrhage (CVA II) 38,000
8.  Acute gastroenteritis (AGE) 6,000
9.  Asthma 9,000
10.  Typhoid fever 14,000
11.  Newborn care package (NCP) 1,750

Surgical Cases Case Rates in Pesos
1.  Radiotherapy 3,000
2.  Hemodialysis 4,000
3.  Maternity care package (MCP) 8,000
Normal spontaneous delivery (NSD)
in Level 1 Hospitals 8,000
NSD in Levels 2 to 4 Hospitals 6,500
4.  Delivery by caesarian section (CS) 19,000
5.  Appendectomy 24,000
6.  Cholecystectomy 31,000
7.  Dilatation and curettage 11,000
8.  Thyroidectomy 31,000
9.  Herniorrhapy 21,000
10.  Mastectomy 22,000
11.  Hysterectomy 30,000
PHILHEALTH PACKAGES launched from 1993 to 2010

Medical or Surgical Case Fixed Payments Year Implemented
TB-DOTS 6,500 2003
SARS 50 to 100k 2003
Avian Influenza 50 to 100k 2006
Bilateral Tubal Ligation (BTL) 4,000 2008
Vasectomy 4,000 2008
Cataract 16,000 2008
Malaria 600 2008
Normal Spontaneous Delivery
(NSD) with BTL 10,500 2009
Outpatient HIV/AIDS Treatment 30,000 per year 2010
Treatment for influenza A (H1N1) is now paid as Case Type A under the Fee-for-Service scheme. It was previously paid at a package rate of from 75k to 100k since 2009.


Add a Comment
  1. Hi jenny, ang total cost ay depende yan sa OB surgeon at sa hospital. Sorry wala akong estimate. Magtanung-tanong ka sa mga hindi expensive na hospitals. Yong OB na kausap mo, puede mong tanungin magkano po cash out ko if I use Philhealth? Philhealth coverage for ovarian cyst removal: 23,300 pesos ang total coverage for cystectomy (12,600 for PF and 10,700 for the hospital)

  2. Good pm po! Nahospitalize po asawa ko (cystectomy and appendectomy) kaya lang po tingin ko medyo maliit yung philhealth deduction nya about 23k po.. nagtataka ako bakit classified sya as indigent even though employed sya at working for 8 yrs.. malaki naging hospital bill nag range ng mga 170-180k.. may mali po ba don? thanks!

  3. Hi Ms. Nora! chineck ko ung hospital bill, 23300 ung nacover ng philhealth.. sa pgkakaalam ko un ay pra dun sa cystectomy tama po ba?kasi nga po my appendectomy pa sya listed dn nmn dun sa medical abstract.. pa help nmn po ano dpat nmin gwin.. my mrerefund pa po ba kmi? thanks sa mgging responce!

  4. Hi glenn, sad to say, kapag more than one procedures or illnesses within the same confinement, isa lang ang kino-cover ng Philhealth, usually yong mas expensive. Ang exceptions lang dito ay yong dialysis, chemo and other surgeries na puedeng second-case rate. Wala sa second-case rate list yong cystectomy at appendectomy.
    Yong whether indigent or employed, pareho-pareho lang ang benefit, kahit anong member category, ke dependent or OFW or non-working wife. Kung yong claim form at MDF ng spouse nio ay employed ang category niya at pumirma ang employer sa claim form at nagbigay kayo ng employer’s cert of Philhealth premium contributions, dapat employed ang category niya. Para sure and clear, puede kayong magtanong sa billing kung bakit isang Philhealth deduction lang. Dapat naman ma-explain nila.

  5. Thank you po Ms. Nora! Itatanong ko ndn po sa billing pra po ms mging clear dn smin.. Salamat po ult!

  6. Hi po ask q lang po anu ano po marerefund namin sa philhealth my son was hospitalized last august 17,2016 and diagnosed as blood sepsis.wala po kami binayaran hospital bill dahil nacover po cia ng philhealth q.

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