Some may argue that this is not a good time to conceive a child, considering the health risks and economic setbacks. However, this is not the way most Filipinos view it. For every two people that died as of March 2021, three babies were added to the population³.

Expectant mothers need to know the maternity benefits they are entitled to as citizens. One such benefit is the package provided by PhilHealth. Read on to learn more about its coverage, how to avail of the benefits, and the necessary documents to file for claims. 

Disclaimer: This article has been published for educational purposes only. Neither the author nor FilipiKnow is affiliated with PhilHealth, so specific queries about your membership and insurance benefits must be forwarded to the proper authority.

Related: How to Compute PhilHealth Contribution: A Complete Guide to Contribution Table and Payment

What Are the PhilHealth Maternity Benefits?

PhilHealth Maternity Benefits are health benefits packages the government provides to pregnant women, to cover their healthcare needs from prenatal to postpartum care. The benefits packages were formed with the help of health experts⁴ to ensure safe pregnancy while considering the costs of giving birth. This benefit covers deliveries in hospitals and non-hospital birthing facilities, but not home deliveries. 

It is advised that pregnant women avail of maternity services as early as possible in accredited hospitals, birthing homes, and maternity clinics to enjoy the services provided by PhilHealth.

Who Is Eligible for PhilHealth Maternity Benefits?

Every PhilHealth member about to give birth is immediately eligible for maternity benefits as per the Universal Health Care Act⁵, regardless of the number of contributions⁶. However, members are advised to continue paying their monthly premiums to avoid penalties.

PhilHealth Maternity Benefits Package for Women About to Give Birth

1. Maternity Care Package (MCP)

This is the benefits package available for mothers throughout the pregnancy. MCP covers prenatal checkups, normal delivery, and postpartum care. For accredited hospitals, the coverage is ₱6,500; for accredited birthing homes, lying in or maternity clinics, the coverage is ₱8,000.

MCP includes the following packages:

a. Antenatal Care Package

This package covers prenatal checkups such as laboratory tests and ultrasounds to check the patient’s status. 

b. Normal Spontaneous Delivery Package (including post-partum care)

This covers normal, low-risk vaginal deliveries, including the postnatal follow-up visits from 72 hours (3 days) up to 7 days after delivery. Hospital coverage is ₱5,000, then ₱6,500 for birthing homes and maternity clinics.

The following are other methods of delivery covered by PhilHealth:

• Cesarean section – ₱19,000
• Complicated vaginal delivery with or without episiotomy or forceps – ₱9,700
• Breech extraction/delivery – ₱12,120
• Vaginal delivery after cesarean section – ₱12,120

There are cases where the mother experiences common complications such as infection because of meconium or the baby’s first poop in the womb, high blood pressure, or high blood sugar. PhilHealth will still cover these complications but will fall under a separate coverage.

2. Expanded Newborn Care Package

The benefit under this package amounts to ₱2,950, and it covers the following:

• Provisions of essential newborn care such as immediate drying of the baby, early skin-to-skin contact, cord clumping, non-separation of mother and baby for early breastfeeding initiation, eye prophylaxis and vitamin K administration, weighing of the baby, and first doses of hepatitis and BCG vaccines.
• Newborn Screening Test screens the baby as early as possible for 28 genetic disorders that may cause mental retardation. The screening test must be done a few hours after delivery.
• Newborn Hearing Test is mandatory for all infants unless the parents or legal guardians of the newborn object to the screening due to cultural or religious beliefs.

Requirements in Filing for PhilHealth Maternity Benefits Claims

Secure the following documentary requirements to avail of PhilHealth maternity benefits:

1. The latest copy of your Member’s Data Record (MDR)
2. PhilHealth Claim Form (CF1) from your employer or your healthcare provider, if employed
3. PhilHealth CSF Form, if employed
4. Proof of Premium Payments 
5. PhilHealth ID and valid IDs
6. PhilHealth Claim Form 2 (CF2) from your healthcare provider

How To Avail of PhilHealth Maternity Benefits

1. If you are a PhilHealth member, the PhilHealth portal is available in PhilHealth-accredited facilities for them to check your records and process your claims.
2. For non-members, there are three ways to avail of the benefits: 

• Online. Download the PMRF or PhilHealth Membership Registration Form on the PhilHealth website and fill it out. Secure a copy of your valid ID, birth certificate, and other supporting documents (e.g., Declaration of legal dependents). Email these documents along with the PMRF to the official email address of the PhilHealth office near you. Related: How to Get or Retrieve Your PhilHealth Number: An Ultimate Guide.
• During Admission. If you are already admitted to the hospital or facility, they will be the ones to coordinate with PhilHealth to enroll you.
• Dropbox System. Since PhilHealth does not encourage pregnant women to go directly to the branch, you may enroll via an authorized representative. In an envelope, write your name, email, and contact number. Then, insert your filled-out PMRF, authorization letter allowing your representative to enroll you on your behalf, photocopy of your two valid IDs, and photocopy of the ID of the person you authorized.

3. For 4Ps members, coordinate with the local government unit to get a certificate of coverage validity.
4. For indigent members, coordinate with your municipal or city social welfare office for assistance. 
5. If you are not a 4Ps or indigent member but financially incapable, coordinate with the social welfare officer of the government hospital where you will give birth so they can enroll you in PhilHealth.

Tips and Warnings

• Be aware of your maternity benefits as a member. Visit the PhilHealth website or the official Facebook page to get updates.
• If you are employed, coordinate with your human resource (HR) department to obtain the requirements that your employer should fill out.
• Secure the requirements as soon as possible to avoid hassles in filing claims.
• If you’re not yet a member, enroll immediately to avail yourself of the benefits. Do not wait until you’re already laboring to process your PhilHealth.
• If you are having a low-risk pregnancy, it is advised that you deliver your baby to a non-hospital facility accredited by PhilHealth. You get higher health service coverage and are not exposed to a high-risk environment. This will also help hospitals to focus on more complicated medical cases.
• Do not go to a non-hospital facility if you’re experiencing a high-risk pregnancy⁷ because you will not be covered. High-risk cases include first-time pregnancy, the pregnant woman is below 19 years old at the delivery date, or the woman is 35 years old or older. If you’re any of these or have active complications, give birth at an accredited hospital. 
• Do not give birth at home if you want to avail yourself of maternity benefits.
• Keep in mind that your baby is covered. Your benefits do not stop at child delivery; take advantage of postpartum checkups.

Frequently Asked Questions

References

1. Philippine Health Insurance Corporation (PhilHealth). (2014). Tamang Sagot (PhilHealth Circular 22-2014) [PDF]. Retrieved from https://www.philhealth.gov.ph/circulars/2014/TS_circ22_2014.pdf
2. Philippine Health Insurance Corporation (PhilHealth). (2017). PhilHealth Circular No. 2017-0006: Strengthening the Implementation of the No Balance Billing Policy (Revision 1). Pasig City.
3. Vital Statistics 2021, January – March (Statistical Tables). (2021). Retrieved 12 October 2021, from https://psa.gov.ph/civilregistration/vital-statistics-2021-january-march-statistical-tables
4. Radyo5 92.3 News FM. (2020). Sakop ba ng PHILHEALTH ang mga BUNTIS? [Video]. Retrieved from https://www.youtube.com/watch?v=oxhwqckCFQs
5. Official Gazette of the Republic of the Philippines. (2019). Implementing Rules and Regulations of the Universal Health Care Act (Republic Act No. 11223) [PDF]. Retrieved from https://doh.gov.ph/sites/default/files/health_magazine/UHC-IRR-signed.pdf
6. PhilHealth Region III. (2021). Maternity Benefits and Newborn Screening Package [Video]. Retrieved from https://www.facebook.com/100068835595978/videos/445324786683936/
7. Padilla, A., PhilHealth Circular No. 025-2015: Social Health Insurance Coverage and Benefits for Women About to Give Birth Revision 1 (2015). Pasig City.