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, good day! I was a contractor,individual payee for 1 year July 2014-Aug 2015. I didn’t pay for my contribution during those time. Now I am a full time employee, started in mid-August. My employer is sure paying my contribution for Aug and Sep of this year. My daughter will be scheduled for a cyst removal operation. When is the best time to schedule the operation, since it is not an emergency case, to avail Philhealth benefits? Is there any way I can cover my missed payments? Thanks in advance.

  2. Hi Ella, if your employer paid your premium for August and Sep and will pay for Oct, your daughter can use your Philhealth in Nov. This is because your employer can then certify that you have paid at least 3 contributions within 6 months prior to treatment. If your employer can pay for Oct immediately and can give the 3-month-payment certification, ask the hospital if you can use Philhealth this Oct.

  3. I’ve had goiter for 15 years. im 32 yrs old po, but my goiter is only small. Can I use philhealth for laborat0ries? I’ve been asking questions ever since about what to do. tnx

  4. Hi Mariel, sad to say, most outpatient laboratory procedures like scans and blood tests are not covered. I hope you find a hospital lab with cheaper rates.

  5. good pm po can my sister use her for her lupus. She’s currently confined at the national kidney hospital for her kidney problem. and for dialysis too, can she use Philhealth for this? How much is the coverage? thanks and god bless po.

  6. Hi cecille, yes, your sister can use Philhealth for her kidney problem, but the coverage is only around between 10k and 15k, depending on the specific diagnosis. Hemodialysis is covered — 90 hemodialysis per year at 2,500 pesos each.

  7. Hi mark, Philhealth’s coverage is only a small portion of the cost. Sorry I can’t give the exact amount because I can’t find this exact diagnosis on the list. There are lots in the list, ranging from 30k to 50k. It’s better if you ask the hospital’s billing department.

  8. hi po. Can I get something from philhealth even if I did not pay anything to the hospital. I received a BPN. I had operation for appendicitis.

  9. Hi kevin, no more from Philhealth because you already got your coverage; Philhealth already paid for your operation. That BPN is useful if you paid the hospital, or if you bought medicines outside the hospital.

  10. Hi good day i have goiter, already a bit big. I have not had lab exam.I’m willing to go on a surgery in case. if at a government hospital, is all covered? Do I have to pay something for thyroidectomy?

  11. Hi Princess, you need to consult with a doctor and have it examined at a government hospital. You might need to pay for the lab exam, but you can ask for discount at the social service dept. If thyroidectomy is advised, ask if it can be fully covered by philhealth. At many public hospitals, the patient needs to buy some meds/supplies outside the hospital, and will request for refund later on.

  12. My sister is 88 years old she will have laproscopic surgery I hope I spell it right but anyway the cost is 150,00 pesos I wanna know how much they will pay and she will stay 3 days in the hospital.

  13. Hi Evangeline, there are nearly 100 laparoscopy procedures on the list. What part of the body is being treated?

  14. Hi. My 92-yr old lolo is currently confined at a private hospital. His initial diagnosis is sepsis complicated by UTI. He’s been there for 3 nights alreadt. Would you know how much Philhealth will cover on his bill? Thank you.

  15. My son was hospitalized fir 7 days. The diagnosis was pnuemonia 1 mr. Upon discharge, the deduction from our bill was just 10,500. I still paid total amount of 6200. Akala q po ba 15,000 ang coverage ng pneumonia 1? Bkit po kya 10500 lng ang deduction?

  16. Hi Ann, 4,500 is allocated for the doctor. It’s sad but based on comments on our blogs, some doctors want cash, so they want patients to pay cash. Ask your hospital why the 4,500 PF coverage was not used to pay the doctor. Ask them if you can refund the 4,500 after you receive the benefit payment notice from Philhealth, and if not, ask them where the 4,500 will go — will it go to the doctor as additional PF?

  17. Hi Kathy, coverage for sepsis due to streptococcus is 32,000. Ask the billing department so you can prepare.

  18. I am a senior citizen with senior id and also lifetime member with Philhealth.
    I went for scanning and found out I have a small swelling on my right kidney
    Kindly advise what I should do and how much I have to pay. Also which hospital I should go. I stay at fort bonifacio ( st Luke global city)
    Kindly advise

  19. Hi Thomas, were you advised about what treatment to have? The coverage amount depends on the procedure that will be done. Since Philhealth coverage amounts are fixed, it’s advisable to have the treatment done at a more affordable hospital. If you’re a Makati resident, I think Makati has a special health card for its residents. If your doctor advises you to undergo a certain procedure, then you can ask several hospitals for their rates for that certain procedure. You can also ask for a second opinion about the advised treatment.

  20. Hi Nora, I’m diagnosed with ovarian neoplasm and my doctor advised me to have my left ovary and my uterus removed. How much will it cost me? I’m a philhealth member also. Thank you

  21. Hi AngeLee, sorry I think it’s not covered. I can’t see in the list. MRI is primarily a diagnostic procedure, so most likely it’s not covered. Ask the hospital.

  22. Hi BJ, based on those who have commented on our health blog, the cost ranges from 100k to 250k or more. Find a more affordable hospital. Or find a surgeon who works at the pay department of a government hospital, and ask about his/her cost package with Philhealth already considered.

  23. Hi Kiray, sad to say, you’ll get only one coverage, the costlier one. There are cases that can be covered as second case-rate, but these are procedures like dialysis or chemo.

  24. Hi Ms Nora.accdng s bpn ang bill ng ank q 35k plus s hospital.nagpay ng 38k ng p.hlth mployee ng ospital since nka leave un mag ayos ng papel w8 kami inform if ma refund un 3k excess n binayaran ng p.hlth s ospital ndi b refundable un ng member at nid p nila i check.after 9mos kundi p ko nagpakuha ng bpn s office ng p.hlth wala kmi n recieve s mail.nid magbayad on time ang member.service nmn ng refund ay ganynn kabagal.maraming salamat po s oras nu.godbless

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