PhilHealth Maternity Benefits for Women About to Give Birth

Aside from the SSS Maternity Benefit that I received when I gave birth to my child, I also received maternity benefits from PhilHealth amounting to Php 19,000 for my C-Section Delivery.

If you are a qualified member or beneficiary of PhilHealth, you too may also avail of the maternity benefits that the institution offers.

PhilHealth provides health insurance coverage and various types of benefits for women about to give birth. This is to enable all mothers and their newborns to have financial access to essential health services that will ensure their survival and well being.

Below are the benefits that PhilHealth provides for women about to give birth:

  1. Maternity Care Package (MCP)
  2. Normal Spontaneous Delivery (NSD) Package
  3. Antenatal Care Package (ANC01)
  4. Payment for Cases Referred to Hospitals
  5. Other Methods of Deliveries Covered by PhilHealth
  6. Newborn Care Package

To better understand these packages, we will explain the details per package.

1. Maternity Care Package (MCP)

This package covers the essential health services during the antenatal period, entire stages of labor, normal delivery and immediate post-partum period including follow-up visits within the first 72 hours and 1 week after delivery.

The Package Code is MCP01 and this may be availed in hospitals, infirmaries/dispensaries, and birthing homes/maternity clinics with the following rates:

Health Care Institution MCP Package Rate
Hospitals Php 6,500.00
Infirmaries/ dispensaries /Birthing homes/Maternity clinics Php 8,000.00

The professional fee shall be 40% of the package rate while the remaining 60% is for the facility fee.

The minimum stay of the mother in the facility shall be 24 hours.

PhilHealth shall require at least 4 pre-natal visits during the course of pregnancy.

Pregnant women are encouraged to have the first pre-natal check-up during the first trimester of pregnancy with at least 4 prenatal visits throughout the course of pregnancy. This is to detect and manage danger signs and complications of pregnancy and to reduce the risk of perinatal deaths.

2. Normal Spontaneous Delivery (NSD) Package

This package covers essential health services for normal low-risk vaginal deliveries and post-partum period within the first 72 hours and 7 days after delivery.

The package code shall be NSD01 and this package may be availed in hospitals, infirmaries/dispensaries, and birthing homes/maternity clinics with the following rates:

Health Care Institution MCP Package Rate
Hospitals Php 5,000.00
Infirmaries/ dispensaries /Birthing homes/Maternity clinics Php 6,500.00

The professional fee shall be 40% of the package rate while the remaining 60% is for the facility fee.

The minimum stay of the mother in the facility shall be 24 hours.

In cases when the pregnant women receives pre-natal care from another facility, the facility where pre-natal care is rendered may claim for Antenatal Care Package while the facility that will assist in normal delivery may claim for NSD Package.

3. Antenatal Care Package (ANC01) 

This package covers essential health services for women about to give birth during antenatal period regardless of method of delivery and pregnancy outcome (e.g., cesarian delivery, breech extraction)

The package code shall be ANC01.

The case rate for this package is Php 1,500.00.

The professional fee shall be 40% of the package rate while the remaining 60% is for the facility fee.

The requirements for this package are the following:

a. The facility is PhilHealth accredited as a hospital, birthing home/ maternity clinic, infirmary/ dispensary, or Tsekap/Primary Care Benefit 1 provider. Likewise, the healthcare professional shall also be PhilHealth accredited.

b. During the antenatal period (i.e., occurring before birth), the women should have qualifying
contributions or social health insurance coverage through different mechanisms.

c. There are at least 4 pre-natal check-ups/visits with the last one during the last trimester of pregnancy. For case/ s wherein pregnancy ended prematurely, all applicable prenatal checkups shall be documented. The number of required prenatal check-up is waived.

d. All the essential health services for the pre-natal care are provided.

e. The women about to give birth are referred appropriately to an accredited health care institution for management of labor and delivery.

f. Pre-natal visits and other services given, referrals and outcome of delivery are documented in the mother’s record and mother’s book or its equivalent.

maternity-benefits-philhealth

4. Payment for Cases Referred to Hospitals 

In cases when women in labor were initially managed in non-hospital facilities but eventually referred to hospitals for higher level of management and delivery, the referring facility shall be reimbursed 10% of the rate of NSD Package.

Facilities that provided Antenatal Care Package and initial management of pregnant women
who are in labor may claim for both services.

The package codes, rates and descriptions are the following:

Description Package Code Package Rate
Intrapartum monitoring or labor watch (without delivery) 59403 Php 650.00
Antenatal care services with intrapartum monitoring or labor watch (without delivery) ANC02 Php 2,150

*ANC Package (Php 1,500) plus Intrapartum  monitoring (Php 650)

The professional fee shall be 40% of the package rate while the remaining 60% is for the facility fee.

5. Other Methods of Deliveries Covered by PhilHealth

PhilHealth also covers the following methods of deliveries in accredited hospitals:

Procedure RVS/
Package
Code
Description Case Rate
(Php)
Cesarian Section (CS) 59513 Caesarian section, primary 19,000.00
59514 Cesarean delivery 19,000.00
59620 Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery; 19,000.00
Complicated Vaginal Delivery 59409 Vaginal delivery only (with or without episiotomy and/or forceps 9,700.00
Breech Extraction 59411 Breech extraction 12,120.00
Vaginal Delivery after Cesarian Section 59612 Vaginal delivery only, after previous cesarean delivery (w/ or w/o episiotomy) 12,120.00

Hospitals that provided Maternity Care Package or NSD Package and also performed bilateral tubal ligation may claim the procedure “Ligation or Transection of Fallopian Tube(s) abdominal or vaginal approach, unilateral or bilateral” (RVS Code 58600, Case Rate – Php 4,000) as second case rate paid in full.

For Example:

Services provided Claim Package/RVS Code Case Rate
Intrapartum care, normal delivery and post-partum care (no pre-natal care) 1st Case Rate NSD01 Php 5,000,00
Bilateral tubal ligation 2nd Case Rate 58600 Php 4,000.00

philhealth-maternity-benefits

6. Newborn Care Package

Pregnancy and childbirth involve both the mother and the newborn. The Newborn Care Package ensures that newborns have access to health care services within their first hours of life.

This package shall cover essential health services that newborns must receive within the first hours of life regardless of the method of their delivery and presence of comorbidities. This package may be availed from health care institutions that provide services for MCP, NSD Package and other methods of delivery.

The package code shall be 99432 and the amount of the package shall be Php 1,750.00 to be paid to the facility with the following components:

Services Amount (Php)
Essential Newborn Care:
• Immediate drying of the baby, early skin to skin contact, timely cord clamping, non-separation of mother/baby for early breastfeeding initiation, eye prophylaxis, vitamin K administration, weighing of the newborn, first dose of hepatitis B and BCG vaccine 500.00
• Professional fee 500.00
Newborn Screening Test (for metabolic diseases) 550.00
Newborn Hearing Screening Test 200.00
TOTAL Php 1,750.00

PhilHealth is a tax-exempt Government Corporation attached to the Department of Health whose main responsibility and mandate is to administer the National Health Insurance Program to provide health insurance coverage and ensure affordable, acceptable, available and accessible health care services for all citizens of the Philippines.

We all have the right to take advantage of this program with a corresponding responsibility either as a member or as a beneficiary. Members (myself included) have to pay my PhilHealth contributions or premiums so that in the event that I need their services, I can easily avail of the benefits.

Like what I mentioned at the beginning of this article, I received Php 19,000 from PhilHealth when I gave birth to my child via CS Delivery and it was really a huge help. I was able to avail of that benefit because I pay my PhilHealth contributions regularly.

Even now that my husband and I are already working from home (home-based), we make sure that we pay our contributions to PhilHealth regularly. It’s even more affordable for us now because we only pay for my husband’s PhilHealth account since I and our child are already his dependents and we can avail of the same benefits.

So, if you’re not a member of PhilHealth yet or you have stopped paying your contributions for whatever reason, go ahead and inquire now at the nearest PhilHealth office.

How to Contact PhilHealth

  • Head Office: Citystate Centre, 709 Shaw Blvd.,1603 Pasig City, Philippines
  • Trunkline: (02) 441-7444
  • Call Center: (02) 441-7442
  • Email Address: actioncenter@philhealth.gov.ph
  • Facebook Page: https://www.facebook.com/PhilHealth/
  • Website: https://www.philhealth.gov.ph

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Comments

  1. Michelle m.bersabal says:

    Pwede ko pa po bang bayaran ang contribution ko after ako manganak ,this month po kc ang duedate ko ..
    Nkabayad po ako july-dec.pero sbi ng Philhealth staff d na daw un magamit ..
    Slamat sa sagot .

    • hindi na po kc allowed ang retroactive payment or pagbayad sa previous months.
      pero tanong nyo pa din baka sakaling pumayag naman. kung hindi, eh ganun po talaga ang policy nila.

  2. Rosalie m brosas says:

    Wla Na Po ba tlga iba option for Phil health this coming June Na kc due date q nakapag bayad Na Rin aq sa Phil health .. pero sabe sa hospital d ko dw magagamit Yun kc cancel pa dw Phil health sa knila . So ano Po Yun sayang namn Po yung maleless ko sana malaking bagay Na Rin Yun .

    • punta na lang po kayo sa Philhealth office mismo para makapag-inquire kayo tungkol sa benefits na pwede nyong makuha.

  3. mary mae sususco says:

    maliban po ba sa mababawas sa bill ko after manganak,may makukuha pa akong financial assistance na manggagaling sa philhealth after manganak??

    • wala po, ibinabawas po yan sa hospital/medical bills.
      Sa SSS po, kung member kayo at qualified kayo, may matatanggap kang maternity benefit.
      Kung employed ka naman, itanong mo din sa employer or company nyo kung meron kayong maternity benefit bukod sa sss and philhealth benefits.
      Sa dati kong company, nagbibigay sila ng 10k for normal delivery at 15k for CS delivery.

  4. Honeh LEIGH PAngilinan says:

    Hello po ask ko lang po kung ano po benefit philheatlth ang mkukuha ko po if normal delivery po ako at kung sakaling ceasarian delivery po ako kasi po twin pregnancy po ako.4 years na po akong government employee

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