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PhilHealth Maternity Benefits: Who Are Qualified? How Much Is It?PhilHealth offers maternity care packages that can lower your birth medical expenses.by Rachel Perez .
Pregnancy and childbirth are not exactly cheap. Apart from prenatal checkups, consultation fees and the required tests throughout pregnancy, giving birth alone can cost from Php5,000 to Php200,000. (Here's a quick guide on childbirth costs.) It’s a good thing we have SSS maternity benefits for women working in private companies (GSIS for female workers in the public sector). Moms can now also receive financial assistance from the Philippine Health Insurance Corporation (PhilHealth) through its Maternity Care Package (MCP).
Philhealth’s maternity package or benefit covers essential health care services in any PhilHealth accredited healthcare facility for the following:
- Prenatal care, including checkups to screen and manage complications of pregnancy, maternal nutrition, immunization, and counseling for a healthy lifestyle
- All stages of childbirth including labor and delivery
- Postpartum care, including follow up visits within 72 hours and seven days after childbirth
Who can avail of the PhilHealth maternity benefit
You need to be a member of PhilHealth to avail of its maternity benefits. If you’re pregnant but not yet a PhilHealth member, register immediately via the agency’s online registration facility or by personally filing the application in one of its branches. To complete your registration, you’ll be required to pay the annual PhilHealth contribution of Php2,400.
If you are already a PhilHealth member, you should have paid at least nine months of premium contributions within the year before the first day of your confinement for the birth of your child. Of the nine monthly contributions, at least three contribution payments should fall within six months before the first day of confinement.ADVERTISEMENT - CONTINUE READING BELOW
Let us say you’re due to give birth in December. You should have paid your premium monthly contributions for at least nine months before your due date month — three of which should have been done between June to December or within six months before you are confined in the hospital to give birth.
New PhilHealth members or those who do not have nine months worth of membership contributions yet are required to pay at least three months of premium contributions within the six months before hospital confinement to qualify for the PhilHealth’s maternity benefit.
How much is the PhilHealth maternity benefit
Under PhilHealth's maternity benefits, members who give birth in hospitals are entitled to Php6,500. If they give birth in non-hospital facilities, such as health centers, lying-in clinics, birthing homes or midwife-managed clinics and in small hospitals, their Philhealth MCP increases to Php8,000.
Of the total Philhealth maternity benefit, Php1,500 is allotted for Antenatal Care Package. To qualify for this benefit, the pregnant women should have had at least four prenatal checkups in a PhilHealth-accredited healthcare provider (the last one during your third trimester). PhilHealth reimburses the amount directly to the member after she has given birth as long as she submits the original receipts for medication/vitamins and laboratory services done during her pregnancy.
Philhealth maternity benefits for normal delivery
If you give birth via natural spontaneous delivery or normal vaginal delivery, your PhilHealth maternity benefit is divided between the PhilHealth-accredited healthcare facility where you gave birth (Php3,900 to non-hospital facilities, and Php3,00o to hospitals) and the professional fee of the doctor or healthcare professional who attended to your birth: Php2,600 for those who gave birth in non-hospital facilities and Php2,000 for those who gave birth in hospitals.CONTINUE READING BELOWRecommended Videos
The SSS maternity benefits were updated to reflect the Expanded Maternity Leave Law and remove the limit to the number of births, and as does the MCP. "We do not have parity restrictions for normal deliveries, except that in the 1st, 5th and beyond pregnancies are not allowed to be done in birthing homes as directed by the Department of Health (DOH), clarified Dr. Shirley B. Domingo, PhilHealth's Vice President, Corporate Affairs Group., via email.
Philhealth maternity benefits for cesarean section
Women who give birth via cesarean setion are also covered by Philhealth maternity benefot. The PhilHealth MCP allots a total of Php19,000. The allotment for Philhealth maternity benefits for cesarean section are as follows: Php11,000 goes to the hospital and Php7,600 to the attending physician.
Other types of deliveries covered by PhilHealth maternity benefits
For complicated vaginal delivery, the PhilHealth maternity benefit is at Php9,700, and if you undergo breech extraction at Php12,120. For women who had a vaginal birth after C-section (VBAC), their PhilHealth maternity benefit is at P12,120.
For qualified members who had a miscarriage or pregnancy loss, PhilHealth covers the procedure dilatation and curettage (D&C), locally known as raspa, which amounts to Php11,000 (Php6,600 to the hospital and Php4,400 to the attending physician).
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Other PhilHealth benefits when giving birth
PhilHealth’s also offers benefits for women at risk of premature delivery and babies suffering complications due to preterm birth. The agency also offers Newborn Care Packages, which can further reduce your total childbirth expenses when combined with the MCP.ADVERTISEMENT - CONTINUE READING BELOW
Newborn Care Package
In 2019, PhilHealth started offering the enhanced Newborn Care Package, increasing the amount from Php1,750 to Php2,950. The amount covers both the original and expanded Newborn Screening (NBS) and hearing tests, BCG and Hepatitis B vaccinations, eye prophylaxis, weighing, and essential newborn care (ENC) protocol or Unang Yakap that includes skin-to-skin contact and breastfeeding, and fees for attending health professionals.
PH’s Newborn Screening Act of 2004 requires all newborns to undergo NBS to detect disorders that warrant early intervention. You can choose from the original test, which detects six genetic and metabolic conditions or the enhanced NBS test that screens for over 28 disorders. (Know more about the Newborn Screening here.)
Z Benefits for Premature and Small Newborns
The agency also provides Php600 to Php4,000 for women at risk of preterm delivery (Week 6 to Week 7 or within Week 24 to Week 36 of their pregnancy). It covers treatment for high blood pressure, corticosteroids to help develop the baby’s lungs, and transfer to a health facility that can provide the specialized care needed by the new mom and baby, among others.
Coverage for care for premature babies (those born at 24 weeks to less than 32 weeks and infants who have low birth weight or weigh less than 2,500 grams) ranges from Php24,00 to Php135,000. (Click here for a guide to Philhealth's Z Benefits.)
How to avail of PhilHealth maternity benefits
Unlike the GSIS or SSS maternity benefits, PhilHealth’s maternity benefits are not handed to the new mom after she has given birth. Instead, the amount covered is deducted from the member’s total hospital bill and professional fees of her doctor or healthcare professional.ADVERTISEMENT - CONTINUE READING BELOW
To avail of your PhilHealth benefits, you need the following:
- Latest copy of your PhilHealth Member Data Record (MDR)
- PhilHealth Claim Form 1 (CF1), filled out and signed by your employer. You can get this form at Philhealth branches, your chosen birth hospital or healthcare facility, or your employer.
- Proof of premium payment. Employees need to submit the Certificate of Premium Payments with OR numbers.
- PhilHealth ID and a valid ID.
- Claim Form 2 (CF2) filled out by your doctor or health care provider. The hospital usually provides this form.
Once you have all the documents on hand, submit them to the designated person in the hospital who will verify your PhilHealth documents. He will determine the maternity benefits you're eligible for and deduct them from your total bill.
If your chosen birth hospital cost higher than the maternity benefit covered by PhilHealth, you will have to pay for the additional hospital and professional fee charges.
This article was updated on September 25, 2019 at 6:38 p.m. to clarify MCP's coverage and restrictions on normal spontaneous births.
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