Philhealth Maternity Benefit Requirements for Voluntary Members

Updated June 1, 2016

Philhealth Maternity Benefit Requirements for Voluntary Members or Individually Paying Members and their Dependents

Submit the following documents to the hospital upon admission, or before your bill is computed.

Philhealth coverage should be deducted from your bill. You can no longer file for refund directly with Philhealth.

 

1.   Clear copy of your  Member Data Record (MDR) — Get this from Philhealth

If you are a dependent of your husband, and your name is not yet written as dependent in your husband’s MDR, your husband should update his MDR at any Philhealth branch. He brings his ID and your marriage certificate.

2.  Philhealth Claim Form 1 — You can also get this form from Philhealth or from the hospital or clinic.   Fill this up and sign.  This is how the form look likes:  https://sites.google.com/site/informationphilippines/philhealth/philhealth-claim-form-1

Submit 2 claim forms: one for you and one for your baby

3.   Clear copy of Official Receipt of Philhealth contribution payment 

Your receipt should show payment of at least 3 months within the last 6 months before admission. Month of admission is included in the 6-month counting.

Example 1: Your admission is June 2016. You should have paid for April May and June 2016, or any 3 months of these 6 months: January, February, March, April, May and June 2016.

Example 2:  Your admission is October 2016.  You should have paid for July August September 2016, or any 3 months of these 6 months: May, June, July, August, September, October 2016.

Example 3: Your admission is November 2016. You should have paid for July August September 2016, or any 3 months of these 6 months: June, July, August, September, October, November 2016.

5.  Official receipts of Prenatal Care Payments 

(Only for normal delivery)

You attach these ORs to your Philhealth papers to claim the prenatal care coverage worth 1,500 pesos. This benefit will be sent to you by Philhealth via postal mail. Submit at least 1,500 pesos worth of receipts. This is offered only for normal deliveries. Not offered for CS deliveries.

What prenatal care receipts are valid? There’s a list here:  http://www.healthphilippines.net/2011/11/philhealth-maternity-benefit-prenatal-care/

6.  Bring your Philhealth card or ID or any other ID, in case it is required to confirm your identity.

 

3.  How much is Philhealth maternity benefit?

 Normal Delivery:

6,500 pesos if maternity or lying-in clinic

(2,600 pesos for doctor and 3,900 pesos for clinic)

5,000 pesos if hospital

(2,000 pesos for doctor and 3,000 pesos for hospital)

The prenatal care benefit of 1,500 pesos is refunded by Philhealth only if you attach Official Receipts of Prenatal Care Payments.

Indicated Cesarean Section o CS:

  19,000 pesos —  7,600 pesos for doctor and 11,400 for hospital

(CS should be done in a hospital)

Remember: 

1.  The doctor and the hospital or lying-in or maternity clinic should both be Philhealth-accredited.

2.   There’s 1,750 pesos worth of Newborn Care Benefit — The pediatrician should be Philhealth-accredited. This benefit is offered for both Normal Delivery and CS.

What is newborn care?  This is a list of newborn care services: http://www.healthphilippines.net/2011/08/philhealth-maternity-benefits-newborn-care/

Philhealth Maternity Benefit for OFW Members and Dependents

How to Claim Philhealth Refunds

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