Philhealth Maternity Benefits: Your benefits and how you can avail them

Philhealth Maternity Benefits: Your benefits and how you can avail them

Here's the lowdown on the Philhealth maternity benefits. Filipino moms should read this to know what they're entitled to and how to claim them.

Are you curious to know about Philhealth maternity benefits? Read on to know more.

They say that a baby is always a blessing, and so families often receive pregnancies with much excitement and infanticipation. At the same time, starting from day one of pregnancy, health and medical expenses are already present.

The best way to ease and address the financial burden that comes with carrying a child is to become fully aware of your benefits and entitlements and make the most out of them.

For its members, for example, PhilHealth Benefits include a Normal Spontaneous Delivery (NSD) and a Maternity Care Package. The NSD Package is applicable for births in accredited hospitals. The Maternity Care Package is for births in birthing homes, midwife clinics, and lying-in clinics.

What are the Philhealth maternity benefits?

Expectant moms may expect PhilHealth benefits of varied coverage, depending on the type of delivery, whether normal or caesarean. It also depends on the type of hospital or medical facility where the procedure takes place.

For women who give birth via normal delivery in a small (Level 1) hospital or other small birthing facilities such as a lying-in clinic or maternity clinic, the total coverage amounts to Php8,000. This will cover fees for the medical facility and professional handling the case, as well as prenatal care.

The amount break down is as follows:

P6,500 of the total amount can cover:

  • Professional fees for accredited doctors, and fees for facilities mothers use for delivery and postpartum care, and reproductive health, breastfeeding and newborn screening counselling.
  • Room and board at the hospital or medical facility
  • Necessary medicine
  • Laboratory fees, supplies, and other additional procedures
  • Labor, delivery, and recovery room fees

P1,500 of the total amount can cover prenatal care services including:

  • Necessary medicines
  • Lab tests and additional procedures
  • Immunization for tetanus
  • Doctors’ professional fees, as long as you have official receipts

For normal deliveries in hospitals ranked level 2 to 4, the Philhealth maternity benefits are the same as those stated above. The total receivable amount is only P6,500. However, this is broken down into two parts: P5,000 for the medical facility and professional fees, and P1,500 for prenatal care expenses.

PhilHealth maternity benefits cover mothers who give birth via caesarean section, with a total fixed amount of P19,000. PhilHealth divides this amount in two parts: P11,400 for hospital and medical fees and P7,600 for doctors’ fees. This benefit only covers the first four normal delivery births.

In the case of a caesarean section, PhilHealth covers primary and successive caesarean sections, as well as caesarean delivery resulting from an unsuccessful vaginal delivery for those who previously gave birth via c-section.

How to apply for Philhealth maternity benefits

To apply for these Philhealth maternity benefits, you must submit your updated PhilHealth Member Data Record and duly accomplished Claim Form to PhilHealth.

You can also check your PhilHealth contribution online so you won't need to visit the nearest PhilHealth office to check.

You will also need to include some necessary documentary attachments, such as official receipts, marriage certificates, and proof of identification. This must be done within 60 days from your hospital discharge date.

Requirements for Philhealth maternity benefits

In order to become eligible to avail of Philhealth maternity benefits, members should meet a required number of contributions prior to the month when this is to be availed.

1. For Employed members, the requirement is at least three months of contributions within the 6 months immediately before availment.

2. For Individually Paying members, a total of 9 months’ contributions must be made within the 12 months prior to availing it.

3. For sponsored and OFW members, this benefit may be enjoyed as long as the date of availment falls within the membership validity period.


You can also read: Maternity and paternity leaves 101

ABOUT THE AUTHOR: Patricia Cuyugan

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