How to Avail of PhilHealth Maternity Benefits: An Ultimate Guide for Pregnant Women

Last Updated on 10/12/2021 by FilipiKnow

Some people may argue that this is not a good time to conceive a child, considering the health risks and economic setbacks brought by the pandemic. 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 population1.

With the limitations to services due to ongoing health restrictions, it’s important for expectant mothers 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. 

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

 

Table of Contents

What are the PhilHealth Maternity Benefits?

PhilHealth Maternity Benefits are health benefits packages provided by the government to pregnant women, to cover their healthcare needs from prenatal to postpartum care. The benefits packages were formed with the help of health experts2 to ensure safe pregnancy while factoring in 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 Act3, regardless of the number of contributions4. 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).

philhealth maternity benefits 1
Source: Philippine Health Insurance Corporation Official Facebook Page.

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

MCP includes the following packages:

a. Antenatal Care Package.

This package covers prenatal checkups such as laboratory tests and ultrasound to check the status of the patient. 

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

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

The following are other methods of deliveries covered by PhilHealth:

  • Cesarean section – PHP 19,000
  • Complicated vaginal delivery with or without episiotomy or forceps – PHP 9,700
  • Breech extraction – PHP 12,120
  • Vaginal delivery after cesarean section – PHP 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. These complications will still be covered by PhilHealth but will fall under a separate coverage.

2. Expanded Newborn Care Package.

philhealth maternity benefits 2
Source: Philippine Health Insurance Corporation Official Facebook Page.

The benefit under this package amounts to PHP 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 which 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 which is mandatory for all infants, unless the parents or legal guardians of the newborn object to the screening due to cultural or religious beliefs5.
 

Requirements in Filing for PhilHealth Maternity Benefits Claims.

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

  1. 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. In the PhilHealth website, download the PMRF or PhilHealth Membership Registration Form 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 in the hospital or facility, they will be the one 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.
  1. For 4Ps members, coordinate with the local government unit to get a certificate of validity of coverage.
  2. For indigent members, coordinate with your municipal or city social welfare office for assistance. 
  3. 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 to 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 should be filled out by your employer.
  • Secure the requirements as soon as possible to avoid hassles in filing claims.
  • If you’re not yet a member, enroll as soon as possible to immediately avail 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 in a non-hospital facility accredited by PhilHealth. You get higher coverage for the health services, and you’re not exposed to a high-risk environment especially in the time of COVID-19 pandemic. 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 pregnancy6 because you will not be covered. High-risk cases include first-time pregnancy, the pregnant woman is below 19 years old at the date of delivery, or the woman is 35 years old or older. If you’re any of these or you have active complications, give birth at an accredited hospital. 
  • Do not give birth at home if you want to avail of maternity benefits.
  • Keep in mind that your baby is covered. Your benefits do not stop at child delivery so take advantage of postpartum checkups.
 

Frequently Asked Questions.

1. When can I file for PhilHealth maternity benefits?

As soon as you show early signs of pregnancy, you may already start to consult a PhilHealth-accredited hospital or birthing facility to avail of the prenatal services. It is advised to process the requirements as soon as possible to avoid hassles in the billing process.

2. How can I maximize the full benefits of the maternity packages?

Provided that you’re already a PhilHealth member, you can consult a PhilHealth-accredited healthcare provider during the early signs of pregnancy for you to avail of health services as early as possible. You should have a regular prenatal check-up to detect and manage any danger signs and avoid complications. Lastly, have your postpartum follow-up with your hospital or clinic because your maternity benefit extends to your baby.

3. How many contributions do I need to have to avail of PhilHealth maternity benefits?

Currently, PhilHealth no longer requires a minimum number of contributions for you to avail of the maternity benefits. However, you are advised to regularly pay your monthly premiums.

4. Why do services in non-hospital facilities have higher coverage than hospital services?

This is to encourage women experiencing low-risk pregnancies to have their deliveries in the safe environment of birthing facilities7. The more women with low-risk pregnancies avail of the PhilHealth maternity benefits at non-hospital facilities, the easier it will be for accredited hospitals to accommodate women with high-risk pregnancies.

5. I am not a PhilHealth member. Can I use my husband’s PhilHealth number instead?

Yes, you and your baby can avail of the PhilHealth maternity benefits as your husband’s legal dependents. However, it is advised that every Filipino should enroll as a PhilHealth member to assist you financially in availing of health services.

6. Can I directly file a claim to PhilHealth?

PhilHealth will only allow direct filing if the facility was not able to completely provide the necessary services, or the member was not able to secure the required documents because it fell on a weekend or holiday. In cases where the member paid for diagnostic procedures under MCP such as laboratories or ultrasound, the facility must reimburse the member up to a maximum amount of PHP 1,500.

7. Can I still apply for maternity benefits if I’m self-employed?

Yes, you can still apply for these benefits. Since you are self-employed, you can be a voluntary paying member.

8. What are the maternity benefits for indigent members?

Under the No Balance Billing Policy8, indigent members may avail of the Maternity Care Package, Antenatal Care Package, Normal Spontaneous Delivery Package, and the Newborn Care Package without paying beyond what PhilHealth covers when admitted in ward-type accommodation in public hospitals. 

9. Can I apply for PhilHealth maternity benefits if I’m a minor?

Yes. It is encouraged that you enroll as a PhilHealth member so that your baby will be covered by the Newborn Care Package. If you avail of the maternity benefits as a legal dependent of your parents, your baby will not be covered because he/she is not your parents’ dependent. Related: How to Be a PhilHealth Member as a Student: An Ultimate Guide

10. I am not a PhilHealth member and I’m not married to the father of my baby. Can I use his PhilHealth membership to avail of the benefits?

Yes, however only the newborn care package will be covered because the baby will fall as the father’s dependent. Legally, you cannot be his dependent because you’re not married, so your pregnancy and delivery will not be covered. With the ease of enrolment as a PhilHealth member, it is better for you to register to immediately avail of all the benefits.

11. I have several missed monthly contributions. Can I still avail myself of the maternity benefits?

Yes. As long as you are a PhilHealth member, you are automatically eligible for maternity benefits under the Universal Health Care Act. You should, however, pay those months that you missed paying your contributions.

12. I’m an inactive member and I’m no longer able to pay the premiums due to financial incapacity. Can I still avail of the PhilHealth maternity benefits?

Yes, you may still avail of the health benefits even if there was a gap in your contributions. Coordinate with your hospital’s social welfare office so you can be assessed for financial incapacity. 

13. How can I avail of the maternity benefits if I’m a single mother?

Regardless of marital status, you can avail of the benefits as long as you are a PhilHealth member.

14. Is the PhilHealth coverage the same for the second pregnancy?

Yes. There is no limit in the number of pregnancies covered by PhilHealth. However, for your safety and the safety of your child, it is advised to wait at least five years until the next pregnancy to give your body enough time to adjust. This will also ensure that you are focusing your attention on your child’s first few years of development.

15. If the mother had a miscarriage, is it still covered by PhilHealth?

Yes. Although miscarriages are not covered by the maternity package, the D&C Procedure or raspa which is done after a miscarriage is covered by PhilHealth. Like pregnancy, there is also no limit to the number of miscarriages that will be covered.

16. Can I receive the maternity benefits in the form of cash?

Unlike SSS maternity benefits, PhilHealth cannot give you a cash allowance. As a general rule, it must have been deducted already from your bill upon discharge and you will only be paying the amount in excess of what PhilHealth covered.

 

References.

  1. 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
  2. Radyo5 92.3 News FM. (2020). Sakop ba ng PHILHEALTH ang mga BUNTIS? [Video]. Retrieved from https://www.youtube.com/watch?v=oxhwqckCFQs
  3. 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
  4. PhilHealth Region III. (2021). Maternity Benefits and Newborn Screening Package [Video]. Retrieved from https://www.facebook.com/100068835595978/videos/445324786683936/
  5. Universal Newborn Hearing Screening and Intervention Act (2009).
  6. Philippine Health Insurance Corporation (PhilHealth). (2015). PhilHealth Circular No. 025-2015: Social Health Insurance Coverage and Benefits for Women About to Give Birth Revision 1. Pasig City.
  7. 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
  8. Philippine Health Insurance Corporation (PhilHealth). (2017). PhilHealth Circular No. 2017-0006: Strengthening the Implementation of the No Balance Billing Policy (Revision 1). Pasig City.

Miriam Burlaos

Miriam is addicted to learning new things and constantly looks for brand new knowledge to be obsessed about. She currently works full-time as an underwriting assistant while pursuing her passion for writing on the side. Nowadays, she’s also learning how to code because she wants to see her ideas come to life.

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