Philhealth Maternity Benefits
Requirements for Voluntary Members
Nora
May 31, 2012
philhealth
617 Comments
Philhealth Maternity Benefits Requirements for Voluntary Members or Individually
Paying Members and their Dependents
Ito ang mga documents na ibigay mo sa hospital or maternity clinic bago ma-compute
ang bill mo, or bago ka ma-discharge para maibawas agad ang Philhealth maternity
benefit mo sa total bill.
Mas maganda na maibawas agad ang Philhealth maternity benefit mo sa total bill mo,
kasi matagal ang processing ng Philhealth refund. Pareho lang ang amount ng benefit
ng nagpa-deduct agad at yong nagpa-refund.
1. Clear copy of Member Data Record (MDR) — Kunin mo ito from Philhealth
2. Philhealth Claim Form 1 — You can also get this form from Philhealth or from
some hospitals or clinics. Fill this up and sign. Ganito ang itsura ng
form: https://sites.google.com/site/informationphilippines/philhealth/philhealth-claim-
form-1
3. Clear copies of Official Receipts of Philhealth contribution payments
Dapat merong 9 monthly payments. Dapat itong 9 months na ito ay nasa loob ng 12-
month period bago buwan ng panganganak. Puedeng merong gap, basta merong 9
months na nabayaran sa loob ng 12-month period.
Example: Kung September 2012 ang buwan ng panganganak, dapat merong 9
months na nabayaran sa loob ng 12-month period mula September 2011 to August
2012.
4. If you are a dependent of your husband, at hindi pa nakasulat ang pangalan mo as
dependent sa MDR, submit a copy of your marriage certificate from NSO or from
local civil registrar
5. Official receipts of Prenatal Care Payments — Puede lang ang benefit na ito sa
Normal Delivery. Wala ito sa Cesarean Section o CS.
Submit at least 1,500 pesos worth of receipts, kasi 1,500 ang prenatal
care benefit. Anong prenatal care ang puede? Merong list
dito: http://www.healthphilippines.net/2011/11/philhealth-maternity-benefit-prenatal-
care/
6. Hindi naman sinabi ng Philhealth, pero dalhin mo na rin ang Philhealth ID mo or any
other ID, just in case hanapin sa iyo. Pero hindi ito dahilan para hindi mabawas agad
ang Philhealth benefit.
Additional Information:
1. Dapat Philhealth-accredited ang hospital o clinic at ang doctor.
2. Merong 1,750 pesos worth of Newborn Care — Dapat Philhealth-accredited ang
pediatrician. Puede ang benefit na ito sa Normal Delivery at sa CS. Ano itong newborn
care? Ito ang listahan: http://www.healthphilippines.net/2011/08/philhealth-maternity-
benefits-newborn-care/
3. How much is Philhealth maternity benefit?
Kapag Normal Delivery:
— 6,500 pesos pag maternity o lying-in clinic o Level 1 or small hospital
(2,600 pesos for doctor at 3,900 pesos for hospital)
— 5,000 pesos pag Level 2 to 4 or bigger hospital
(2,000 pesos for doctor at 3,000 pesos for hospital)
Ang 1,500 pesos ay marerefund lang kapag merong mai-submit na Official Receipts of
Prenatal Care Payments.
Kapag Indicated Cesarean Section o CS:
19,000 pesos — Dapat sa Level 2 to 4 hospital. 7,600 pesos for doctor at 11,400 for
hospital
Philhealth Maternity Benefits
Nora
January 13, 2011
philhealth
816 Comments
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.
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
