Can I Qualify for Philhealth Maternity Benefit?

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

ANSWER:  Meron na tayong Universal Health coverage, kaya kahit na-delay ka sa payment ng contributions mo, o kulang ang contributions mo, puede ka pang humabol. Basta meron kang Philhealth number, pababayaran lang sa iyo ang amount na dapat mong bayaran, at puede ka nang ma-cover.

Para sa malapit nang manganak at hindi pa Philhealth member, merong program available for you. Magtanong lang sa hospital o sa clinic kung saan kayo manganganak. Tanungin nio ang Women About to Give Birth program.


If you're EMPLOYED: You must have paid at least 9 monthly premiums or contributions within 12 months immediately prior to your delivery.  Your month of delivery is included in the 12-month count.

Example: You will give birth in December; you must have paid 9 monthly premiums within 11 months prior to December plus December.

If VOLUNTARY or INDIVIDUAL PAYOR:  The requirement is the same with that of Employed (since November 2013).  You must have paid 9 monthly premiums within 12 months immediately prior to your delivery.  Your month of delivery is included in the 12-month count.

Example: You will give birth in July; you should have paid 9 monthly premiums within 11 months prior to July plus July.

Nakakalito ba? Halimbawa, na-confine ka ngayong buwan -- magbilang ka ng 12 months magmula ngayong buwan pabalik. Sa 12 months na yan, dapat meron kang nabayaran na 9 months. Kapag meron, qualified ka to use Philhealth.

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.


How much is my Philhealth maternity benefit?


I am an Individual Payor. I have paid at least 9 of the 12 months BEFORE my month of delivery.
How much can I refund from Philhealth?

Answer: 

The benefit amount depends on the type of medical facility used.

For Normal Delivery:

--  5,000 pesos (for delivery at Level 2 to 4 hospitals)
         3,000 for hospital expenses
         2,000 for professional fee or PF or doctor's fee

--  6,500 pesos (for delivery at maternity clinics, lying-ins, birth centers, health centers or Level 1 hospitals)
         3,900 for clinic or hospital expenses
         2,600 for PF

For Cesarean Section or CS:

--  19,000 pesos  (covered only if CS is performed at Level 2 to 4 hospitals)
          11,400 pesos for hospital expenses
            7,600 pesos for PF         

Additional 1,500 Pesos for Prenatal Care ( for Normal Delivery Only )
 -  To be refunded by Philhealth through a check delivered by registered mail 
 -  Refunded only if member submits official receipts of prenatal care expenses worth at least 1,500 pesos   
     together with the maternity claim. Receipts must be in patient's name.

Additional 1,750 Pesos for Newborn Care Package ( for Normal Delivery and CS )
 -  Newborn care must be performed within 3 days of child birth
 -  If possible, gawin ito in the same facility para kasama na ang claim sa maternity benefit. Mahirap
     maghanap ng gagawa ng newborn screening na willing to fill up a lot of papers para lang sa newborn
     claim. 

What Prenatal Care procedures or supplies are covered? 

What Newborn Care procedures or supplies are covered? 

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

61 Comments

Nora said…
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
Nora said…
Hi maribel, yes, you can avail of Philhealth for your delivery in Oct.
Nora said…
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?
Nora said…
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
Nora said…
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.
Unknown said…
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
Nora said…
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,
Unknown said…
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?
Nora said…
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.
Unknown said…
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

Nora said…
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
Unknown said…
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!
Nora said…
Hi roa, your plan is good -- pay asap or in Feb for Jan to March, so you can avail in March.
Unknown said…
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!!
Unknown said…
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!!
Unknown said…
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
Nora said…
Hi Joyrence, yes, you can use Philhealth this July or August or Sep.
Unknown said…
Hi Nora i start work on Sept 2014 to sept 2015 can i avail my philhealth? my due date is on Feb 2015. Thanks
Unknown said…
Hi Nora i start work on Sept 2014 to sept 2015 can i avail my philhealth? my due date is on Feb 2015. Thanks
Unknown said…
Hi nora can I avail my philhealth this coming dec? I paid oct-dec
Nora said…
Hi Johna, yes, you can avail of Philhealth coverage this December. Keep your receipt and make sure your MDR copy is clear..
Unknown said…
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
Nora said…
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.
Mier said…
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.
Mier said…
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.
enna said…
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.
Nora said…
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.
Unknown said…
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.
Nora said…
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
Unknown said…
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..
Unknown said…
December 2016 po ung due ko.. Need ko pa po ba maghulog ?
Nora said…
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)
Unknown said…
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?
Ynah said…
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.
Nora said…
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.
Unknown said…
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
Unknown said…
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?
Unknown said…
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?
Nora said…
Hi Charisse: Yes, if you pay April May June, you can use it in June. Pay asap.
Unknown said…
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?
Unknown said…
This comment has been removed by the author.
Unknown said…
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.
Unknown said…
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
Unknown said…
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
Unknown said…
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.
Unknown said…
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?
Unknown said…
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?
Unknown said…
Hi po, just want to ask, what if 3k lng po yung total philhealth maternity contribution same lang po ba ang matanggap for normal delivery is P5,500? Thanks po.
Unknown said…
Hi i am giving birth next month Feb 2018. But my contributions as employed is Aug 2017 and as voluntary january 2018 to March 2018. Can i claim for benefits?
Nora said…
Hi Jane: Sorry, I think no. 3 monthly payments within 6 months prior to giving birth is required. Month of giving birth is counted in the count of 6. You should have paid at least 3 months within Sep Oct Nov Dec Jan Feb. But to be sure, ask the hospital or clinic.
Unknown said…
Hi ma'am. I belong to informal sector(Individual payor). I already paid my premium contribution for the months of Jan-March and even April-June. Im in my 38th weeks of pregnancy. If sakali po na manganak ako within this week, am I allowed or accepted to use my Philhealth Benefits? I have paid a total amount of 3,600 already pero madami namiss na mos kaya di ako pasok sa 9mos within 12mos. Yun kasi sabi ng tita ko na needed for me to avail my philhealth benefits. Please I need your response 😊
Nora said…
Hi Precious: Tama naman ang tita mo, kasi yan ang inannounce last January, pero nagpostpone ang Philhealth ng implementation ng 9-within-12. Puede pa up to Sept 30 yong 3-within-6, so kung manganak ka this March or April, covered ka. I hope alam mo ang total cost doon sa hospital where you will deliver, kasi 5k lang ang coverage for normal delivery. Minsan pa, 3k lang ang dinededuct at hindi nila dinededuct yong 2k na dapat madeduct from the PF of the OB. For CS, 19k (7,400 for PF and 11,600 for hosp).
Unknown said…
hi miss nora, i would like to ask po i was individual payor last APRL 2017 - SEPT 2017 and stop paying OCTOBER 2017 until April 2018, and now I'm already imployed and i start paying contribution may 2018 and my due date is SEPT. 2018 can i use po ba?
Unknown said…
Hi po! I will be giving birth to my 1st baby this coming month of November and new member palang po ako ng Philhealth, last August lang po. Will I be eligible for the maternity benefits/ can I use Philhealth sa hospital? Or should I pay first the 9-12 months contribution in advance?
Unknown said…
paano po Yun akin ma'am 2015 poako nakapag hulog may makukuha po ba ako???

Nora said…
Sorry, hindi mo magagamit ang Philhealth kung 2015 ang last contribution mo. Kung di ka pa nakapanganak, punta ka sa hospital kung saan ka manganganak at magtanong ka about Women About to give birth program.
Unknown said…
Hello po o will be giving birth sa 2nd baby ko this coming october bale cs po ako dun sa naunang baby ko bale nagbayad po kami ng 2400 to avail yung coverage ng oparation ko nung July 8 2015 after po nun i was employed in a call center company kung san nahuhulugan ko po yung philhealth ko 2016 up until april 19 2018 yun po yung last contribution ko nung nagresign ako after po nun hindi na po ulit ako nakapaghulog pwede prin po ba ako mkavail ng maternity coverage sa next na panganganak ko
Nora said…
Hello, ang alam ko is once lang na ibinibigay yong change to use the Women about to give birth program (payment of 2400). Pero it's great na Oct ka pa naman, and you still have time to accumulate 9 monthly premium payments to be eligible. So PAY ASAP for Jan to March (deadline for this is last business day of March), then April to Sep (puedeng every month or every quarter) or pay mo na agad Jan to Sep para hindi mo na makalimutan (9 months na yan). Then after Sep, continue paying para lagi kang eligible lalo na at meron ka uli new baby
Nora said…
I meant "chance," not "change"
Anonymous said…
Hi miss Nora. My employer paid my philhealth contribution until feb. I was admitted in the hospital last May. And nagamit ko nmn po ang philhealth ko. I will give birth this September pde ko pa ba bayaran ang philhealth ko kht unemployed na ako ngaun so I can use it po pag nanganak po ako? Thank you
Nora said…
Hi, yes, use the same Philhealth number as when you were employed. 300 per month. Since mag-iiba ka ng status from Employed to Self-earning, you need to go to Philhealth with your ID and change your status. Fill up the registration form, and check "Updating". Dapat meron kang 9 paid contributions within Oct 2019 to Sep 2020.
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