Exclusions to Philhealth Benefits — Medical Cases Not Paid

What are the medical cases not covered by Philhealth?

The following are the exclusions, based on the Philhealth website:

– Fifth normal delivery of a child and subsequent normal deliveries
(Only four normal spontaneous deliveries are covered.)
– Non-prescription drugs and medical devices
– Treatment for alcohol abuse and dependency
– Cosmetic surgery
– Optometric services and devices such as eyeglasses and contact lenses
– Other medical procedures determined by Philhealth as cost-ineffective

Observations lang sa exclusions to Philhealth benefits:

Hindi rin covered ang dental services, di ba?
At saka yong mga outpatient services.
Yong mga kalimitan na nangyayari, such as pa-checkup sa doctor tapos bibilhin ang gamot, hindi covered.
Talagang yong mga hospitalization lang ang covered, and certain surgical procedures na puede kang umuwi after the procedure, kagaya ng cataract operation and simple cyst removal.

6 thoughts on “Exclusions to Philhealth Benefits — Medical Cases Not Paid”

  1. i consulted my dentist regarding my impacted wisdom tooth and he told me that i need to have a dental x-ray and undergo operation or extraction…can avail benefits from philhealth?thank you very much

    • Hi analyn, sorry, hindi ko sure kasi minor surgery ito at dental, at considered tooth extraction ito. Tooth extraction is not covered by Philhealth. Ask your dentist na lang, para malaman mo rin kung Philhealth-accredited siya.

  2. Hi, can Philhealth cover an eye surgery for my mother who is senior citizen? According to the specialist whom we’ve consulted, the problem is not severe, but she needs to be operated on immediately. Also, i was confined last January. I’m grateful that Philhealth covered it, but there were meds I bought outside. Can i claim refund for these meds? Tnanks

    • Hi Randy, your mother’s name should be listed in your MDR as your dependent. Find an eye surgeon who’s Philhealth accredited. If you’re in QC, if you like, you can consult with Dr. Lorena Ruth Capinpin at the Novaliches Gen Hospital. She has a Novagen eye clinic at SM Fairview.
      About the meds you bought outside, wait till you get your notice from Philhealth and see if Philhealth’s payment to the hospital is much more than your deduction. If much more, you can request for refund from the hospital (Bring your notice, bill and OR for meds and xerox copies).


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