Can I Qualify for Philhealth Maternity Benefit?
QUESTION: I am a Philhealth member. I am giving birth to my baby next month. Can I qualify for Philhealth maternity coverage?ANSWER: Meron na tayong Universal Health coverage, kaya kahit na-delay ka sa payment ng contributions mo, o kulang ang contributions mo, puede ka pang humabol. Basta meron kang Philhealth number, pababayaran lang sa iyo ang amount na dapat mong bayaran, at puede ka nang ma-cover.
If you're EMPLOYED: You must have paid at least 9 monthly premiums or contributions within 12 months immediately prior to your delivery. Your month of delivery is included in the 12-month count.
Example: You will give birth in December; you must have paid 9 monthly premiums within 11 months prior to December plus December.
If VOLUNTARY or INDIVIDUAL PAYOR: The requirement is the same with that of Employed (since November 2013). You must have paid 9 monthly premiums within 12 months immediately prior to your delivery. Your month of delivery is included in the 12-month count.
Example: You will give birth in July; you should have paid 9 monthly premiums within 11 months prior to July plus July.
Nakakalito ba? Halimbawa, na-confine ka ngayong buwan -- magbilang ka ng 12 months magmula ngayong buwan pabalik. Sa 12 months na yan, dapat meron kang nabayaran na 9 months. Kapag meron, qualified ka to use Philhealth.
Para sa OFWs at Sponsored, walang pagbabago ang eligibility requirement. Pareho pa rin sa dati. Maco-cover kayo ng Philhealth kung ang dates of confinement ninyo ay within your Validity Dates na nakasulat sa Philhealth receipt ninyo (OFWs) o sa Philhealth card or Philhealth receipt ninyo (Sponsored).
If OFW: Your date of delivery should be within your Validity Dates written in your Philhealth premium payment receipt.
Example: You will give birth in August 8, 2017 -- this date should be within the Validity Dates in your receipt. For example, you will be covered if your validity dates are September 3, 2016 to September 3, 2017, or December 25, 2016 to December 25, 2017.
If your Validity Dates are August 1, 2016 to August 1, 2017, you will not be able to use Philhealth because August 8, 2017 is outside your validity dates.
If SPONSORED or INDIGENT member: Your date of delivery should be within the Validity Dates in the Philhealth ID card given to you.
Example: You will give birth in July 4, 2017; this date should be within the Validity Dates in your card. For example, September 3, 2016 to September 3, 2017, or December 25, 2016 to December 25, 2017.
If your Validity Dates are June 4, 2016 to June 4, 2017, you will not be able to use your Philhealth card because July 4, 2017 is outside your Validity Dates.
If LIFETIME or SENIOR CITIZEN member: Oh-uh... I think no Lifetime Member or Senior Citizen will ask about their maternity benefit eligibility hehe :)
But for other medical treatments, yes, you are qualified anytime. You just need to present your Lifetime Member ID and your MDR plus photocopies. Kapag ang hospital ay linked sa Philhealth member database, hindi na kailangan ang MDR.
How much is my Philhealth maternity benefit?
I am an Individual Payor. I have paid at least 9 of the 12 months BEFORE my month of delivery.
How much can I refund from Philhealth?
Answer:
The benefit amount depends on the type of medical facility used.
For Normal Delivery:
-- 5,000 pesos (for delivery at Level 2 to 4 hospitals)
3,000 for hospital expenses
2,000 for professional fee or PF or doctor's fee
-- 6,500 pesos (for delivery at maternity clinics, lying-ins, birth centers, health centers or Level 1 hospitals)
3,900 for clinic or hospital expenses
2,600 for PF
For Cesarean Section or CS:
-- 19,000 pesos (covered only if CS is performed at Level 2 to 4 hospitals)
11,400 pesos for hospital expenses
7,600 pesos for PF
Additional 1,500 Pesos for Prenatal Care ( for Normal Delivery Only )
- To be refunded by Philhealth through a check delivered by registered mail
- Refunded only if member submits official receipts of prenatal care expenses worth at least 1,500 pesos
together with the maternity claim. Receipts must be in patient's name.
Additional 1,750 Pesos for Newborn Care Package ( for Normal Delivery and CS )
- Newborn care must be performed within 3 days of child birth
- If possible, gawin ito in the same facility para kasama na ang claim sa maternity benefit. Mahirap
maghanap ng gagawa ng newborn screening na willing to fill up a lot of papers para lang sa newborn
claim.
What Prenatal Care procedures or supplies are covered?
What Newborn Care procedures or supplies are covered?
Related posts:
How Much is Philhealth Maternity Benefit?
How to Avail of Philhealth Benefit? Philhealth Registration
BUT I've read an announcement from Philhealth in the news the other day that it will consider 3 premium payments from the informal sector -- I don't know yet the details, and if "informal sector"includes all individual payors and when these will be effective, so we hope that this change will be implemented for individual payors soon, so that you will qualify. Check the news from time to time, or check philhealth.gov.ph or healthphilippines.net from time to time.
P.S. I've seen the new member form, and informal sector means tricycle drivers, vendors, etc. so if you're a professional, you might not be considered informal sector... but ask Philhealth, to be sure
Can I avail of philhealth benefit. My 24 contributions were with my former employer in 2011. Can I pay to avail? I'm now 8 weeks pregnant and my edd is may 2014.pls help
charm aldana said...October 10, 2013 at 8:14 AM
I'm 8 weeks pregnant. Can I avail of philhealth? My 24 months of contributions were paid when I was employed in 2010. Can I pay to to avail of maternity benefits?
Ms. nora, paid apr to dec 2014 -- this is also the advice of someone at Philhealth. But the midwife at the facility where I'm having my checkups said that I should have paid 9 months backward, meaning further back to Jan. I'm confused and I doubt if I can really use my Philhealth in Oct. Thanks
Hi maribel, the midwife might not know yet the new Philhealth policy for individual payors. Have you told her gently that the rules have been changed? Ask her if you can give her a cert of eligibility from Philhealth, then request for this cert from Philhealth.
Is she the only midwife there? If she'll be the one to help you deliver, and she insists on the old 9-month requirement, you might want to reconsider, or find another clinic. But ask the new clinic if they'll deduct your Philhealth coverage, because there's also a Philhealth-eligibility rule for clinics that you should have at least 4 prenatal checkups with them so you can use Philhealth. Ask others too
Hi maribel, you can avail this month. You've paid Apr to Dec. If you give birth this month, you have paid 5 months before this month (you've paid Apr May Jun July Aug) -- more than enough -- more than the 3-month requirement.
I'm so sad that the midwife is not giving you correct info. Pray that she has a change of heart.
We can understand that they need cash also for their families...that it takes months before they get their Philhealth payments. But they should also understand the situation of patients, and do the right thing.
Hi ms nora, January 2 , 2015 is my due date. Then last april to june I paid philhealth. Can I still pay for the months july to nov? Can I get benefits from philhealth? Thanks
Hi Cherry Mae, you can no longer pay for past quarters. Pay for Oct Nov and Dec 2014 asap, so you can avail of Philhealth in Jan 2015 for your delivery,
What if I give birth in Dec instead of january? Can I avail?
Cherry Mae Aquino 12/4/14
Hi ms nora i already paid oct to dec but according to my ob they required at least 9 months of contribution. What should I do?
REPLY:
Hi Cherry Mae, the 9-within 12-month requirement has been reduced to 3-within-6-month requirement. If you give birth in Jan 2015, you can avail. If you give birth in Dec, you can avail (you paid for June, Oct and Nov). You can go to Philhealth and ask for certification of eligibility. Bring your premium ORs.
Thank you,
Vilma
hi,good day, may i ask if I can avail of philhealth maternity benefits if cs operation? I'm a member and started my contributions last july 2015. my due date is on october. will wait for your reply. thanks
ANSWER:
Yes, CS is covered by Philhealth. Coverage is 19,000 pesos (7,600 for PF and 11,400 for hospital costs). Pay Apr to Sep 2016, so you can avail, or pay Jan to Dec 2016, so you're always covered. You can pay quarterly. Payment deadline for every quarter is the last day of the quarter.
Hi ms.nora. Will I be covered if my due date is august 2016 if I pay May June and July? I've been a member since 2014. Last payment was 2014 as employed.
ANSWER:
Hi enna, yes, if Philhealth allows you to pay for May to July. I think what they accept is April to June or April to Sep. You will be covered if you pay any of these. Update your data so you get a new MDR. Bring your ID.
Hi po. Pwede po magtnaong with regards sa refund, may natanggap po kasing letter si ate ko bout refund form of check po ba yon na marereceive?
Due date ko po this month of october 2017, and i paid from July-Sept and Oct-dec. Can i still avail maternity benefits?
Due date ko po this month of october 2017, and i paid from July-Sept and Oct-dec. Can i still avail maternity benefits?