PhilHealth Benefits and Voluntary Members Can Avail

What is PhilHealth and How Does it Work? 

Established in 1995, PhilHealth aims to financially help Filipinos with medical expenses. The agency can help cover medical bills or part of it. It works like an insurance company,^[1] except that it’s mandated by the government.

Member contributions and funding from both local and national governments enable PhilHealth to operate and aid its members. The government requires all employees to become PhilHealth members. Self-employed individuals (also called voluntary members) can also apply.

Read more: What is Universal Healthcare Act and How Will It Benefit Us?

How Much is the PhilHealth Contribution? 

To avail of PhilHealth coverage this 2024, you need to pay your contributions. If you’re employed, your contributions are already part of your mandatory government deductions. But if you’re a voluntary member, you can settle your contributions via PhilHealth offices, accredited banks, and select online platforms.

The cost of your contribution will depend on your salary. For 2024 to 2025, the contribution rate is 5%. Check out this table to see how much you’re supposed to cover:

What are the PhilHealth Benefits? 

Mainly, you get subsidies for your hospital bills. In other words, you can get a deduction in your hospital bill with PhilHealth.

Take note, though, that the agency implements a case rate payment system. With the said system, PhilHealth reimburses a fixed amount for a specific condition or procedure. The case rate amount is inclusive of hospital charges and the attending physician’s professional fees.

Use the following benefits of being a PhilHealth member in case of hospitalization or other medical procedures:

⚕️ Inpatient Benefits

If you are admitted to a hospital to receive care, you can get PhilHealth benefits. Part of your total bill will be shouldered by the agency, as long as the hospital you were admitted to is a PhilHealth partner.

⚕️ Outpatient Benefits

If you need medical care but do not need to be admitted, you can still enjoy PhilHealth benefits. The agency can cover part or the entire cost of the following procedures:

• Day surgeries – Non-emergency surgical procedures from minor to major operations; patients are sent home within the same day
• Radiotherapy – Covers treatments using cobalt and linear accelerators
• Hemodialysis – Includes inpatient and outpatient procedures; also covers emergency dialysis for acute renal failure
• Outpatient blood transfusion – Covers drugs, medicines, x-ray, laboratory, and operating room, among others

⚕️ Z Benefits

Launched during the term of President Benigno Aquino III, Z Benefits are designed for patients with serious medical conditions. You can avail of this benefit if your illness is covered by PhilHealth and you pass PhilHealth’s pre-authorization procedure.^[2]

The amount will depend on your condition. To give you an idea, here are some of the illnesses and the respective amounts covered by this benefit:

• Acute Lymphocytic / Lymphoblastic Leukemia (standard risk) – ₱500,000
• Breast Cancer (Stage 0 to IV) – ₱1.4 million
• Prostate Cancer (low to intermediate risk) – ₱100,000
• Cervical Cancer – ₱120,000 to ₱175,000
• Colon and Rectum Cancer – ₱150,000 to ₱400,000
• End-stage Renal Disease Eligible for Kidney Transplant (low risk) – ₱600,000
• Coronary Artery Bypass Graft Surgery – ₱550,000
• Surgery for Tetralogy of Fallot in Children – ₱320,000
• Surgery for Ventricular Septal Defect in Children – ₱250,000
• Select Orthopedic Implants – ₱48,740 to ₱169,400

⚕️ SDG-Related Benefits

Benefits under this category are in line with the United Nations Sustainable Development Goals (SDG). Here are some of the benefit packages:

• Outpatient Malaria Package – ₱600
• Outpatient HIV-AIDS Package – ₱30,000 per year or ₱7,500 per quarter
• Outpatient Anti-TB Treatment – ₱1,500 to ₱4,000
• Animal Bite Treatment Package  – ₱3,000
• Voluntary Surgical Contraception Procedures – ₱4,000

⚕️ Maternity Benefits

Expectant mothers can avail of PhilHealth’s maternity benefits, which include the following packages:

• Antenatal Care Package (ACP) – Covers procedures like prenatal check-ups and ultrasounds
• Normal Spontaneous Delivery Package (NSD) – Covers health services for low-risk vaginal delivery and postpartum period within the first 72 hours and one week after delivery
• Maternity Care Package (MCP) – Includes health services for the following: antenatal period, entire labor stages, normal delivery, and immediate postpartum period

Read more: PhilHealth and SSS Maternity Benefits Every Parent Needs to Know

⚕️ Mental Health Benefits 

PhilHealth’s mental health benefits cover the following outpatient services: consultations, diagnostic follow-ups, psychoeducation, and psychosocial support.^[3]

The subsidy for this benefit is categorized into two:

• General Mental Health Services Package – ₱9,000
• Specialty Mental Health Services Package – ₱16,000

Important note: This isn’t the complete list of covered procedures. Check PhilHealth’s official website for the complete list of accepted diseases and procedures. Take note that certain conditions apply when availing of each benefit.

How to Claim PhilHealth Benefits 

To apply for the benefits of PhilHealth, take note of the following:

Step 1: Check the PhilHealth Eligibility Requirements 

You need to meet certain conditions to avail of your PhilHealth benefits. These include the following:

• Payment of at least nine months’ worth of contributions within 12 months prior to the first day of confinement
• Hospital and medical professionals should be PhilHealth-accredited

Read more: How to Check If Your PhilHealth and Pag-IBIG Contributions are Posted

Step 2: Collate the Requirements 

The documents needed will depend on the benefit you’re availing of. But generally, you have to prepare the following:

• Member Data Record
• PhilHealth Eligibility Form or PBEF (for Inpatient Benefits)
• PhilHealth Claim Form 1
• Member Empowerment Form (for Z Benefits)
• PhilHealth ID
• Valid ID (e.g., passport, driver’s license, UMID, etc.)

Step 3: Submit the Requirements to the Hospital

On the day of your discharge, submit all the required documents to the hospital. The benefits will be deducted from your total hospital bill. Once you receive the final bill, settle it at the hospital’s cashier.

PhilHealth Benefits: FAQs

Still have questions about the benefits of PhilHealth? Check out the following to find answers:

1. How many times can I use my PhilHealth benefits in a month or year?

You can avail of PhilHealth benefits any time during the year as long as you fulfill the contribution requirements. However, note that certain procedures have benefit limits.

For instance, radiotherapy and outpatient blood transfusion have a 45-day benefit limit. Hemodialysis, meanwhile, has a 90-day benefit limit. One session is equal to a one-day deduction from the allowable days per year.

2. How much is covered by PhilHealth?

The agency covers part or all of your medical costs, but it depends on the medical case. Check out this list^[4] of medical rates covered by PhilHealth.

Related: Government Social Media Accounts Filipinos Need to Follow

3. Who can be my PhilHealth dependents?

The following PhilHealth dependents can avail of benefits without additional premiums:

• Legal spouse who is not a member
• Children below 21 years old
• Children over 21 years old who have a physical or mental disability
• Foster child
• Parents aged 60 years old and over
• Parents with permanent disability

4. Are X-Ray, MRI, and CT Scan covered by PhilHealth? 

Unfortunately, diagnostic procedures like x–ray, MRI, CT scan, 2D echo, and ultrasound aren’t covered by PhilHealth if they’re undertaken as outpatient services.

5. Can senior citizens apply as PhilHealth members?

PhilHealth automatically covers all senior citizens aged 60 and above. Those who want to enroll can visit their local office for senior citizens affairs or health insurance office.^[5]

Read more: Are Your Parents Enjoying These Benefits for Senior Citizens?

Final Thoughts

Now that you know the benefits you can get by being a PhilHealth member, you can minimize your medical expenses. Your qualified dependents can also enjoy the same PhilHealth benefits. Make sure to stay on top of your contribution to avoid any inconveniences when claiming your benefits.

💳 Use a Credit Card to Pay for Hospital Bills

With a credit card, you can pay in installments, get rebates, and more. Compare your options via Moneymax:

Credit Card	Hospital/Health-Related Benefits
HSBC Red Mastercard	0% interest installment plans Cash installment plans 6% rebate on your first Caltex fuel spend; 3% after
BPI Amore Cashback Card	1% cashback on drugstore and bills payment spend Special Installment Plan (SIP) to convert retail and online transactions into installments
RCBC Flex Visa	2x reward points on two preferred categories, including health and wellness Points redeemable for shopping vouchers or cash rebates
AUB Gold Mastercard	1 rewards point for every ₱50 spend Flexibility to choose exactly when to pay your bill

Sources:

• ^[1] PhilHealth website
• ^[2] Here’s How You Can Use PhilHealth’s Z Benefits Package (GMA Lifestyle, 2024)
• ^[3] PhilHealth Launches Outpatient Mental Health Benefits Package
• ^[4] PhilHealth Medical Case Rates
• ^[5] FAST FACTS: Avail yourself of PhilHealth Services Without Having to Pay Premiums (Rappler, 2023)