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.

 
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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

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  507. Nora May 31, 2015
  508. Jyc May 31, 2015
  509. patricia May 27, 2015
  510. odessa ann esparcia flores May 27, 2015
  511. Nora May 26, 2015
  512. kal May 25, 2015
  513. Nora May 24, 2015
  514. Nora May 24, 2015
  515. Nora May 24, 2015
  516. Nora May 24, 2015
  517. Lyaine May 21, 2015
  518. yang May 20, 2015
  519. anne May 20, 2015
  520. rosalyn May 18, 2015
  521. celine acesor May 15, 2015
  522. lexa May 8, 2015
  523. brenda May 7, 2015
  524. Anna May 7, 2015
  525. Nora May 2, 2015
  526. sarahjane April 30, 2015
  527. Nora April 29, 2015
  528. Nora April 29, 2015
  529. Nora April 29, 2015
  530. Nora April 29, 2015
  531. Justine April 29, 2015
  532. Analyn April 28, 2015
  533. jinky April 28, 2015
  534. jennylyn azuela April 27, 2015
  535. Nora April 26, 2015
  536. Nora April 26, 2015
  537. dana loraune April 26, 2015
  538. mariz April 25, 2015
  539. Nora April 21, 2015
  540. Nora April 21, 2015
  541. reena lauta April 20, 2015
  542. LYN FORTU April 19, 2015
  543. joyrenz April 16, 2015
  544. joyrenz April 15, 2015
  545. reena lauta April 14, 2015
  546. Nora April 11, 2015
  547. reez April 10, 2015
  548. Nora April 6, 2015
  549. dethsky April 5, 2015
  550. Nora April 5, 2015
  551. jackielyn juab March 30, 2015
  552. Nora March 27, 2015
  553. Nora March 27, 2015
  554. jackielyn juab March 26, 2015
  555. aprille grace March 26, 2015
  556. Nora March 24, 2015
  557. Nora March 24, 2015
  558. Nora March 24, 2015
  559. joycee March 24, 2015
  560. Roseane March 24, 2015
  561. Belle March 24, 2015
  562. Nora March 23, 2015
  563. Ana March 23, 2015
  564. maridel March 9, 2015
  565. Nora March 9, 2015
  566. Nora March 9, 2015
  567. jennielyn de leon March 9, 2015
  568. maridel March 8, 2015
  569. Nora March 8, 2015
  570. maridel March 8, 2015
  571. Nora March 3, 2015
  572. jenny March 3, 2015
  573. Marie February 25, 2015
  574. Nora February 10, 2015
  575. lezur February 10, 2015
  576. Nora January 31, 2015
  577. Mary Ann January 30, 2015
  578. Nora January 26, 2015
  579. danica January 26, 2015
  580. danica January 26, 2015
  581. Nora January 25, 2015
  582. Nora January 25, 2015
  583. angeline January 25, 2015
  584. Aubrey January 24, 2015
  585. claryz January 23, 2015
  586. Nora January 20, 2015
  587. claryz January 19, 2015
  588. Nora January 17, 2015
  589. mylene January 16, 2015
  590. Nora January 16, 2015
  591. Nora January 15, 2015
  592. CHRISTINE January 15, 2015
  593. smile evangelista January 15, 2015
  594. kath January 11, 2015
  595. Nora January 10, 2015
  596. kath January 10, 2015
  597. Nora January 9, 2015
  598. Joan Bae January 8, 2015
  599. Joan Bae January 8, 2015
  600. Nora January 7, 2015
  601. Nora January 7, 2015
  602. CHRISTINE January 7, 2015
  603. Lovella January 7, 2015
  604. Nora January 5, 2015
  605. Alaiza January 5, 2015
  606. Nora January 4, 2015
  607. mylene January 3, 2015
  608. Nora January 3, 2015
  609. Lovella January 3, 2015
  610. Nora December 29, 2014
  611. janet manuel December 29, 2014
  612. Nora December 28, 2014
  613. Richelle December 28, 2014
  614. Nora December 22, 2014
  615. ryan December 22, 2014
  616. Nora December 21, 2014
  617. erica December 21, 2014
  618. Nora December 4, 2014
  619. Nora December 4, 2014
  620. CHRISTINA December 3, 2014
  621. Franz December 3, 2014
  622. Nora December 3, 2014
  623. Aldrian December 2, 2014
  624. Nora December 2, 2014
  625. Reno December 2, 2014
  626. Nora November 30, 2014
  627. Rubie November 29, 2014
  628. Nora November 29, 2014
  629. erma November 28, 2014
  630. Nora November 25, 2014
  631. jenny November 25, 2014
  632. Nora November 23, 2014
  633. Nora November 23, 2014
  634. kiray November 23, 2014
  635. jo November 23, 2014
  636. Nora November 22, 2014
  637. nessa November 20, 2014
  638. Nora November 19, 2014
  639. Nora November 19, 2014
  640. Nora November 19, 2014
  641. Duday November 19, 2014
  642. Daryl November 18, 2014
  643. darr November 17, 2014
  644. Nora November 13, 2014
  645. Nora November 13, 2014
  646. darryl November 13, 2014
  647. clariz November 13, 2014
  648. Nora November 12, 2014
  649. Anjo November 12, 2014
  650. Nora November 9, 2014
  651. joyce gamez November 8, 2014
  652. Nora November 8, 2014
  653. Nora November 8, 2014
  654. ANNE November 8, 2014
  655. joyce gamez November 8, 2014
  656. Nora November 7, 2014
  657. Rich November 7, 2014
  658. Nora November 6, 2014
  659. Nora November 6, 2014
  660. riyolyn bernabe November 6, 2014
  661. Rhey November 4, 2014
  662. Nora October 31, 2014
  663. Nora October 31, 2014
  664. Nora October 31, 2014
  665. Nora October 31, 2014
  666. maritess laral October 30, 2014
  667. k-sel October 30, 2014
  668. jsen October 30, 2014
  669. SANDY October 29, 2014
  670. glorife salvador October 29, 2014
  671. Nora October 29, 2014
  672. cath October 28, 2014
  673. Nora October 25, 2014
  674. lorvi October 25, 2014
  675. Nora October 24, 2014
  676. Rachel October 23, 2014
  677. Nora October 23, 2014
  678. Rachel October 22, 2014
  679. Nora October 21, 2014
  680. Juliefer October 20, 2014
  681. Nora October 16, 2014
  682. kat October 15, 2014
  683. Nora October 14, 2014
  684. Clarisse October 14, 2014
  685. Nora October 14, 2014
  686. Chayette October 13, 2014
  687. Nora October 13, 2014
  688. marlyn October 12, 2014
  689. Nora October 11, 2014
  690. Nora October 10, 2014
  691. Nora October 10, 2014
  692. Kasei October 9, 2014
  693. cykies October 9, 2014
  694. Jannette Hernandez October 8, 2014
  695. cheena October 7, 2014
  696. Nora October 4, 2014
  697. rachel October 4, 2014
  698. Nora October 3, 2014
  699. joana October 2, 2014
  700. Nora October 2, 2014
  701. mayette October 1, 2014
  702. Nora September 28, 2014
  703. alona September 28, 2014
  704. Nora September 26, 2014
  705. Ruby September 26, 2014
  706. Nora September 26, 2014
  707. Nora September 26, 2014
  708. Kath September 25, 2014
  709. cris September 25, 2014
  710. Nora September 24, 2014
  711. maricor September 24, 2014
  712. Nora September 22, 2014
  713. Katty September 21, 2014
  714. Nora September 16, 2014
  715. Nhel September 16, 2014
  716. Nora September 15, 2014
  717. lisette September 14, 2014
  718. Nora September 13, 2014
  719. Gen September 12, 2014
  720. Nora September 12, 2014
  721. Nora September 12, 2014
  722. rachel September 11, 2014
  723. rachel September 11, 2014
  724. Nora September 11, 2014
  725. rachel September 11, 2014
  726. Kim September 10, 2014
  727. Nora September 10, 2014
  728. Joel September 9, 2014
  729. Nora September 9, 2014
  730. Nora September 9, 2014
  731. kim September 8, 2014
  732. Nora September 8, 2014
  733. remy September 8, 2014
  734. Kim September 7, 2014
  735. Nora September 6, 2014
  736. Nora September 5, 2014
  737. Rizza September 5, 2014
  738. Rizza September 5, 2014
  739. Nora September 5, 2014
  740. Jean September 5, 2014
  741. nadine September 5, 2014
  742. Nora September 5, 2014
  743. Elaine swing September 4, 2014
  744. Yrresor September 4, 2014
  745. Nora September 3, 2014
  746. Yrresor September 3, 2014
  747. Nora September 1, 2014
  748. Nora September 1, 2014
  749. Blaisey Equiz September 1, 2014
  750. Danelle September 1, 2014
  751. Nora August 31, 2014
  752. cindy August 30, 2014
  753. Nora August 30, 2014
  754. Jeanne August 30, 2014
  755. Nora August 22, 2014
  756. Sherryll August 22, 2014
  757. Nora August 19, 2014
  758. Joenha August 18, 2014
  759. Nora August 18, 2014
  760. chayette August 18, 2014
  761. Nora August 18, 2014
  762. cookie August 18, 2014
  763. Marie Bautista August 18, 2014
  764. Nora August 15, 2014
  765. marjorie August 14, 2014
  766. Nora August 14, 2014
  767. Joannmae Tesiorna August 13, 2014
  768. Abby Pura August 13, 2014
  769. Nora August 12, 2014
  770. Joannmae Tesiorna August 11, 2014
  771. Nora August 10, 2014
  772. Nora August 10, 2014
  773. Aisliin August 9, 2014
  774. Aisliin August 9, 2014
  775. chayette August 9, 2014
  776. Nora August 9, 2014
  777. Danelle August 8, 2014
  778. Nora August 8, 2014
  779. Danelle August 8, 2014
  780. Nora August 7, 2014
  781. Nora August 7, 2014
  782. chayette August 6, 2014
  783. Michelle Ilag August 6, 2014
  784. Nora August 6, 2014
  785. Michelle ilag August 5, 2014
  786. Michelle ilag August 5, 2014
  787. Che August 5, 2014
  788. Nora August 5, 2014
  789. Che August 4, 2014
  790. chayette July 31, 2014