11/21/2012

Am I Qualified for Philhealth Maternity Coverage?

By
Updated July 28, 2016
 
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.

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)

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.

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

47 comments:

  1. Hi charm, let's say you're able to pay for Oct 2013 to Apr 2014 -- these count to only 7 months, not enough for the 9-month requirement. Your 2010 and 2011 payments are no longer considered because they're long past.
    BUT I've read an announcement from Philhealth in the news the other day that it will consider 3 premium payments from the informal sector -- I don't know yet the details, and if "informal sector"includes all individual payors and when these will be effective, so we hope that this change will be implemented for individual payors soon, so that you will qualify. Check the news from time to time, or check philhealth.gov.ph or healthphilippines.net from time to time.
    P.S. I've seen the new member form, and informal sector means tricycle drivers, vendors, etc. so if you're a professional, you might not be considered informal sector... but ask Philhealth, to be sure

    ReplyDelete
  2. Hi maribel, yes, you can avail of Philhealth for your delivery in Oct.

    ReplyDelete
  3. charm aldana said... October 10, 2013 at 8:10 AM

    Can I avail of philhealth benefit. My 24 contributions were with my former employer in 2011. Can I pay to avail? I'm now 8 weeks pregnant and my edd is may 2014.pls help

    charm aldana said...October 10, 2013 at 8:14 AM

    I'm 8 weeks pregnant. Can I avail of philhealth? My 24 months of contributions were paid when I was employed in 2010. Can I pay to to avail of maternity benefits?

    ReplyDelete
  4. maribel deleon :
    Ms. nora, paid apr to dec 2014 -- this is also the advice of someone at Philhealth. But the midwife at the facility where I'm having my checkups said that I should have paid 9 months backward, meaning further back to Jan. I'm confused and I doubt if I can really use my Philhealth in Oct. Thanks

    Hi maribel, the midwife might not know yet the new Philhealth policy for individual payors. Have you told her gently that the rules have been changed? Ask her if you can give her a cert of eligibility from Philhealth, then request for this cert from Philhealth.
    Is she the only midwife there? If she'll be the one to help you deliver, and she insists on the old 9-month requirement, you might want to reconsider, or find another clinic. But ask the new clinic if they'll deduct your Philhealth coverage, because there's also a Philhealth-eligibility rule for clinics that you should have at least 4 prenatal checkups with them so you can use Philhealth. Ask others too

    ReplyDelete
  5. maribel deleon: My due date is Oct 3. But if I give birth earlier, in Sept., can I avail of my Philhealth? I had my checkup a while ago, and the midwife said that if I give birth in Oct, yes I can avail, but not if I give birth in Sept. Thanks.

    Hi maribel, you can avail this month. You've paid Apr to Dec. If you give birth this month, you have paid 5 months before this month (you've paid Apr May Jun July Aug) -- more than enough -- more than the 3-month requirement.
    I'm so sad that the midwife is not giving you correct info. Pray that she has a change of heart.
    We can understand that they need cash also for their families...that it takes months before they get their Philhealth payments. But they should also understand the situation of patients, and do the right thing.

    ReplyDelete
  6. Hi ms nora ask ko lang .. Sa january 2 , 2015 ang due date ko. Then last april to june naghulog ako sa philhealth. Pwede ko pa ba mahabol ung month ng july to nov??? Makakakuha ba ako ng benefits sa philhealth?? Thanks

    ReplyDelete
  7. Cherry Mae Aquino 11/7/14
    Hi ms nora, January 2 , 2015 is my due date. Then last april to june I paid philhealth. Can I still pay for the months july to nov? Can I get benefits from philhealth? Thanks

    Hi Cherry Mae, you can no longer pay for past quarters. Pay for Oct Nov and Dec 2014 asap, so you can avail of Philhealth in Jan 2015 for your delivery,

    ReplyDelete
    Replies
    1. Hi ms nora i already paid oct to dec but according to my ob they required at least 9 months of contribution.. Pano po ang gagawin ko?

      Delete
  8. Cherry Mae Aquino 11/7/14
    What if I give birth in Dec instead of january? Can I avail?

    Cherry Mae Aquino 12/4/14
    Hi ms nora i already paid oct to dec but according to my ob they required at least 9 months of contribution. What should I do?
    REPLY:
    Hi Cherry Mae, the 9-within 12-month requirement has been reduced to 3-within-6-month requirement. If you give birth in Jan 2015, you can avail. If you give birth in Dec, you can avail (you paid for June, Oct and Nov). You can go to Philhealth and ask for certification of eligibility. Bring your premium ORs.

    ReplyDelete
  9. Hi maam, ask ko lang po ,Up to how many giving birth was covered of Philhealth. before I know up to 4... My OB told me starting last Dec.its up to 6 giving birth was covered by Philhealth. is it true???
    Thank you,
    Vilma

    ReplyDelete
  10. Hi jenerose, the same with what you know, what I know is only up to 4 normal deliveries. I've tried looking if there's a new circular related to it, and I can't find any. I'll add to this, if I find something relevant

    ReplyDelete
  11. Hi ms.nora! Ask ko lang po,employed po ako last year and payed from April 2014-September 2014. Then nag-resign ako and changed to voluntary member noong October. I payed 600 for the last quarter(Oct-Dec). I'm 8mos.pregnant. I'm planning to pay the 1st quarter(Jan-March) this coming February. Due date ko last week of March. Can I avail the maternity benefits?Thanks!

    ReplyDelete
  12. Hi roa, your plan is good -- pay asap or in Feb for Jan to March, so you can avail in March.

    ReplyDelete
  13. Hi ms nora. I am about to gove birth this april. I was employed last july 2014 but resigned last dec 2014. Am i qualified for the philhealth maternity benefits? Thank you so much!!

    ReplyDelete
  14. Hi ms nora. I am about to gove birth this april. I was employed last july 2014 but resigned last dec 2014. Am i qualified for the philhealth maternity benefits? Thank you so much!!

    ReplyDelete
  15. hi ms nora. my due is on august. kakakuha ko lang po ng philhealth nung april so i paid for april-june july-august. am i qualified fot the philhealth marternity benefits? thank you

    ReplyDelete
  16. Hi Joyrence, yes, you can use Philhealth this July or August or Sep.

    ReplyDelete
  17. Hi Nora i start work on Sept 2014 to sept 2015 can i avail my philhealth? my due date is on Feb 2015. Thanks

    ReplyDelete
  18. Hi Nora i start work on Sept 2014 to sept 2015 can i avail my philhealth? my due date is on Feb 2015. Thanks

    ReplyDelete
  19. Hi nora can I avail my philhealth this coming dec? I paid oct-dec

    ReplyDelete
    Replies
    1. Hi Johna, yes, you can avail of Philhealth coverage this December. Keep your receipt and make sure your MDR copy is clear..

      Delete
  20. hi,good day, may i ask lng po kung pwede ako mg avail ng philhealth matenal benefits pg cs operation, member po and nag start lng po ako ng contribution ko last july 2015, my due date is on october po, will wait for you reply...thanks

    ReplyDelete
  21. jr junior 2/24/16
    hi,good day, may i ask if I can avail of philhealth maternity benefits if cs operation? I'm a member and started my contributions last july 2015. my due date is on october. will wait for your reply. thanks
    ANSWER:
    Yes, CS is covered by Philhealth. Coverage is 19,000 pesos (7,600 for PF and 11,400 for hospital costs). Pay Apr to Sep 2016, so you can avail, or pay Jan to Dec 2016, so you're always covered. You can pay quarterly. Payment deadline for every quarter is the last day of the quarter.

    ReplyDelete
  22. Hi Ms.Nora.can I avail maternity benefits if asawa ko lang may philhealth and I'm the beneficiary?.please I need your answer.thank u po.

    ReplyDelete
  23. Hi Ms.Nora.can I avail maternity benefits if asawa ko lang may philhealth and I'm the beneficiary?.please I need your answer.thank u po.

    ReplyDelete
  24. Hi ms.nora ask ko lang po qng ma cover pa po ba if due date ko is august 2016 , then binayaran ko po ung may june and july. member pa po ako 2014 last hulog po is march 2014 sa trabaho po.

    ReplyDelete
  25. enna 5/27/16
    Hi ms.nora. Will I be covered if my due date is august 2016 if I pay May June and July? I've been a member since 2014. Last payment was 2014 as employed.
    ANSWER:
    Hi enna, yes, if Philhealth allows you to pay for May to July. I think what they accept is April to June or April to Sep. You will be covered if you pay any of these. Update your data so you get a new MDR. Bring your ID.

    ReplyDelete
  26. Good day po!ask ko lg po august yung delivery ko anung bwan po dpat yung contribution of pay ko?oct to feb.yung wrk ko.

    ReplyDelete
    Replies
    1. Hi Admer, you should pay asap this month for Apr May June to avail in Aug. Get your MDR and Philhealth card from Philhealth. You can also pay for July to Sep for continuous coverage

      Delete
  27. Hi Ms. Nora.. Tatanong ko Lang po sana, na endo po kasi ako sa company na pinapasukan ko nung August, under po ako ng agency.. Tatanong ko Lang po sana kung makakaavail ako ng philhealth claim ko..

    ReplyDelete
  28. December 2016 po ung due ko.. Need ko pa po ba maghulog ?

    ReplyDelete
    Replies
    1. Hi edjulyn: Yes, pay for Oct Nov Dec asap. Pay at Philhealth so you can get your new MDR and maybe ID card if available. Before paying, fill up registration form. Check FOR UPDATING, and check Informal Sector--No Income (Member status)

      Delete
  29. Hi po ms. Nora i check online my latest contri is OCT 2016 due ko diz JAN 2017 as per my coop/agency late posting sila ng nov. Hulog since ngleave na rin ako.. cover na po b ang june 2016 to oct. 2016 ko for my january delivery? Thanks plsss answer po parq mkapaghilog pa ako?

    ReplyDelete
  30. Hi!My due is on June 2017, I havent updated my Philhealth Contri since May 2016 cos I resigned from work. Pag ng pay po ba ako this quarter, mkakaavail po ba ako ng maternity benefits? Thank you in advance.

    ReplyDelete
    Replies
    1. Hi Ynah: Yes, pay for Jan to March, and you can use Philhealth in June. Pay at Philhealth so you can get your new MDR as voluntary. Maganda rin na next quarter bayaran mo para may coverage just in case you need it.

      Delete
  31. Hi nanganak po misis ko ng march 2017, magagamit po b nya philhealth nya ang hulog nya po ay jan to march at april to june

    ReplyDelete
  32. Hi Ms.Nora, im paying philhealth voluntarily po. My due date is june. If i pay april,may,and june. Entitled p rin po b ako s benefits?

    ReplyDelete
  33. Hi Ms.Nora, im paying philhealth voluntarily po. My due date is june. If i pay april,may,and june. Entitled p rin po b ako s benefits?

    ReplyDelete
    Replies
    1. Hi Charisse: Yes, if you pay April May June, you can use it in June. Pay asap.

      Delete
  34. To whom it may concern:

    Hi po. Pwede po magtnaong with regards sa refund, may natanggap po kasing letter si ate ko bout refund form of check po ba yon na marereceive?

    ReplyDelete
  35. This comment has been removed by the author.

    ReplyDelete
  36. Hi po. Due date ko po this August. Tanong ko lang po kung makaka-avail pa rin ako ng benefits. Nitong May 2017 po ako nagpa-member sa Philhealth as employed at nagbigay na po ako ng contribution up to August.

    ReplyDelete
  37. Last hulog ko po ayjuly to dec2016 due date ko po ay oct.pag po b hinulugan ko ung jan up to advance in dec.macocovered npo aq para mkasve just in case mcs po aq

    ReplyDelete
  38. Last hulog ko po ayjuly to dec2016 due date ko po ay oct.pag po b hinulugan ko ung jan up to advance in dec.macocovered npo aq para mkasve just in case mcs po aq

    ReplyDelete
  39. hi ms nora :) due ko po jan2018. Ung una & 2nd payment ko po last 2012&2013 pa + ngyong nagbyad po ako july-dec2017 mkakakuha po ba ako ng benefits? Thank u po. Have a nice day.

    ReplyDelete
  40. Hello po Miss Nora Good day,.
    Due date ko po this month of october 2017, and i paid from July-Sept and Oct-dec. Can i still avail maternity benefits?

    ReplyDelete
  41. Hello po Miss Nora Good day,.
    Due date ko po this month of october 2017, and i paid from July-Sept and Oct-dec. Can i still avail maternity benefits?

    ReplyDelete

Please write your comment. Then click Publish. Login to Gmail. Click Publish again.
Your Gmail address will not be displayed online. It will not be seen by me.
If already logged in to Gmail, just click Publish after commenting, and your comment will be quickly published.