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PhilHealth Maternity Benefits 2023: Requirements and How To Avail

PhilHealth Maternity Benefits 2023: Requirements and How To Avail

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

Table of Contents

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)

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

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

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

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.
  1. For 4Ps members, coordinate with the local government unit to get a certificate of coverage validity.
  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 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

1. When can I file for PhilHealth maternity benefits?

As soon as you show early signs of pregnancy, you may already consult a PhilHealth-accredited hospital or birthing facility to avail of 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?

If you’re already a PhilHealth member, you can consult a PhilHealth-accredited healthcare provider during the early signs of pregnancy to avail of health services as early as possible. You should have a regular prenatal check-up to detect and manage 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?

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

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

This is to encourage women experiencing low-risk pregnancies to deliver their babies in the safe environment of birthing facilities8. 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 an ultrasound, the facility must reimburse the member up to a maximum of ₱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 PhilHealth voluntary-paying member.

8. What are the maternity benefits for indigent members?

Under the No Balance Billing Policy9, indigent members may avail of the Maternity Care Package, Antenatal Care Package, Normal Spontaneous Delivery Package, and Newborn Care Package without paying beyond what PhilHealth covers when admitted into a ward-type accommodation in public hospitals. 

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

Yes. You are encouraged to enroll as a PhilHealth member so that the Newborn Care Package will cover your baby. 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 yet, 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 yet, so your pregnancy and delivery will not be covered. With the ease of enrolment as a PhilHealth member, it is better to register to avail of all the benefits immediately.

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 who can no longer 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’s 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 to the number of pregnancies covered by PhilHealth. However, for your and the child’s safety, it is advised to wait at least five years until the subsequent pregnancy to give your body enough time to adjust. This will also ensure you focus on your child’s first few years of development.

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

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

16. Can I receive 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 from your bill upon discharge, and you will only be paying the amount over what PhilHealth covered.

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.
  8. 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
  9. Philippine Health Insurance Corporation (PhilHealth). (2017). PhilHealth Circular No. 2017-0006: Strengthening the Implementation of the No Balance Billing Policy (Revision 1). Pasig City.

Written by Miriam Burlaos

in Government Services, Juander How, PhilHealth

Last Updated

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.

Browse all articles written by Miriam Burlaos

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