11/21/2012

Am I Qualified for Philhealth Maternity Coverage?

Updated March 8, 2018

QUESTION: I am a Philhealth member. I am giving birth to my baby next month. Can I qualify for Philhealth maternity coverage?

ANSWER:  It depends on your membership category, and the number of monthly premiums you have paid.

For Employed, Voluntary or Self-Employed Members

Starting October 1, 2018, hindi na lang 3 monthly payments ang required. Nine monthly payments na ang required para ma-cover ka ng Philhealth. Dapat meron kang nabayaran na 9 months sa nakaraang 12 months. Kasama sa bilang ng 12 months ang current month.


If you're EMPLOYED: You must have paid at least 3 monthly premiums or contributions within 6 months immediately prior to your delivery.  Your month of delivery is included in the 6-month count.

Example: You will give birth in December; you must have paid 3 monthly premiums within 5 months prior to December plus December (any 3 months within July to December)

If VOLUNTARY or INDIVIDUAL PAYOR:  The requirement is the same with that of Employed (since November 2013).  You must have paid 3 monthly premiums within 6 months immediately prior to your delivery.  Your month of delivery is included in the 6-month count.

Example: You will give birth in July; you should have paid 3 monthly premiums within 5 months prior to July plus July (any 3 months within February to July)

Para sa OFWs at Sponsored, walang pagbabago ang eligibility requirement. Pareho pa rin sa dati. Maco-cover kayo ng Philhealth kung ang dates of confinement ninyo ay within your Validity Dates na nakasulat sa Philhealth receipt ninyo (OFWs) o sa Philhealth card or Philhealth receipt ninyo (Sponsored).


If OFW: Your date of delivery should be within your Validity Dates written in your Philhealth premium payment receipt.

Example: You will give birth in August 8, 2017 -- this date should be within the Validity Dates in your receipt. For example, you will be covered if your validity dates are September 3, 2016 to September 3, 2017, or December 25, 2016 to December 25, 2017.

If your Validity Dates are August 1, 2016 to August 1, 2017, you will not be able to use Philhealth because August 8, 2017 is outside your validity dates.

If SPONSORED or INDIGENT member: Your date of delivery should be within the Validity Dates in the Philhealth ID card given to you.

Example: You will give birth in July 4, 2017; this date should be within the Validity Dates in your card. For example, September 3, 2016 to September 3, 2017, or December 25, 2016 to December 25, 2017.

If your Validity Dates are June 4, 2016 to June 4, 2017, you will not be able to use your Philhealth card because July 4, 2017 is outside your Validity Dates.

If LIFETIME or SENIOR CITIZEN member: Oh-uh... I think no Lifetime Member or Senior Citizen will ask about their maternity benefit eligibility hehe  :)
But for other medical treatments, yes, you are qualified anytime.  You just need to present your Lifetime Member ID and your MDR plus photocopies. Kapag ang hospital ay linked sa Philhealth member database, hindi na kailangan ang MDR.

Related posts:
How Much is Philhealth Maternity Benefit?
How to Avail of Philhealth Benefit? Philhealth Registration
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