Updated June 2, 2016
Question: I am giving birth to my child next month. How much would be the Philhealth deduction from my my hospital bill?
Answer: The amount of your Philhealth maternity benefit depends on whether you give birth by Normal Delivery or by Cesarean Section, and the type of facility where you will deliver your baby.
NORMAL DELIVERY at a Hospital:
5,000 pesos = total benefit:
3,000 pesos — for hospital expenses
2,000 pesos — for the doctor
CESAREAN SECTION or CS at a Hospital:
19,000 pesos is the total benefit:
11,400 pesos — for hospital expenses
7,600 pesos — for doctors (professional fee)
Note: CS should be performed at a hospital, not at a clinic
NORMAL DELIVERY at a Lying-in or Maternity Clinic:
6,500 pesos = total benefit:
3,900 pesos — for clinic expenses
2,600 pesos — for midwife or doctor
REMEMBER that both the doctor/midwife and the hospital/clinic should be Philhealth-accredited.
If Normal Delivery, you can avail of Prenatal Care Benefit of
Up to 1,500 pesos if you submit prenatal care ORs together with your Philhealth papers.
You can get this in the form of a check from Philhealth, delivered by mail to your address. You need to give Official Receipts of prenatal care expenses together with your Philhealth papers to the hospital or clinic.
See this list of prenatal care expenses that are covered. If you’re able to submit ORs worth only 1,200 pesos, then you can refund only 1,200 pesos.
Submit your ORs together with your maternity benefit claim papers. The hospital or clinic will forward your prenatal ORs to Philhealth together with your maternity claim documents.
For lying-ins, they require that you had your prenatal check-ups with them.
Newborn Care Package for Baby Delivered through CS or Normal Delivery:
Up to 1,750 pesos
You can claim this separately from your maternity benefit. Submit another Claim Form 1 for this newborn care coverage. To sum up, submit 2 sheets of Claim Form 1 (one for your delivery and one for your baby).
The pediatrician should be Philhealth-accredited and the newborn care procedures should be done within a certain time period after birth, except for certain cases. You can avail of up to 1,750 worth of newborn care, depending on available newborn care procedures in the hospital or clinic and their costs.
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