Health insurance Philippines guide: PhilHealth, HMOs, health cards and how to choose

When people talk about health insurance in the Philippines, they usually mean one of three things:

• PhilHealth, the government's national health insurance. Under the Universal Health Care (UHC) Act of 2019, all Filipinos are automatically included.
• An HMO, or health card. HMO stands for health maintenance organization: a private company that pays for your care at the doctors, clinics and hospitals in its network. Its membership card is what most people call a "health card".
• Private health insurance, a policy from an insurance company that pays the hospital or pays you cash.

These do not replace each other. PhilHealth is the base layer; an HMO or private plan is optional cover on top.

Studies using data from the 2010s found that only about 2 in every 100 Filipinos had an HMO or private health insurance. For most families, PhilHealth and free government services are the main protection.

Getting sick can cost a lot. In 2014, more than half of the country's health spending was paid by families themselves, one of the highest shares in the region. This is called out-of-pocket spending: money you pay yourself at the clinic, pharmacy or hospital.

In December 2024, PhilHealth wrote that it covered less than 40% of total hospital costs. It has since raised many of its case rates (see At the hospital). Worldwide, WHO says health costs caused money problems for about 2.1 billion people in 2022, and the poorest families were hit hardest.

PhilHealth members belong to one of two groups. Direct contributors pay premiums: employees, self-employed and self-earning workers, professionals, overseas Filipino workers (OFWs) and lifetime members. Indirect contributors, such as poor (indigent) families and senior citizens, are subsidized by the national government.

Main benefits, in short:

• Hospital stays. For each illness or procedure, PhilHealth pays a set amount called a case rate, which includes the attending doctor's fee. The hospital deducts it from your bill before discharge.
• Some outpatient care, such as day surgery and dialysis.
• Primary care through YAKAP: consultations, lab tests, cancer screening and selected medicines. See our PhilHealth YAKAP guide.
• Z Benefits for some serious and costly illnesses, such as breast cancer.

For the full list, see our guide to what PhilHealth covers.

Premiums (as of July 2026): direct contributors pay 5% of monthly income, from ₱500 a month (income of ₱10,000 or less) up to ₱5,000 a month (income of ₱100,000 or more). For employees, the employer computes the premium from the basic monthly salary. OFWs can pay monthly, quarterly, every six months or yearly through accredited collecting agents in the Philippines or abroad.

An HMO arranges and pays for your care through a network of accredited doctors, clinics and hospitals. You show your health card, and the HMO pays for covered care, up to your plan's limits. Depending on the plan, this can include consultations, hospital stays, surgery, lab tests, medicines and sometimes check-ups.

To keep costs down, HMOs set rules, such as:

• a limit on how much the plan pays
• procedures that are not covered
• co-payments or deductibles that you pay yourself
• little or no cover outside the network

Most HMO plans in the Philippines are bought by companies for their employees. Fewer people buy one on their own, but individual plans exist, including for self-employed people and freelancers.

A 2018 WHO review found that most Philippine HMOs require members to have PhilHealth first. Since late 2015, HMOs have been regulated by the Insurance Commission, which issues their licences to operate. Before that, weak oversight was linked to the closure of more than a dozen HMOs, so check that a company is licensed before you pay.

Health insurance from an insurance company can include hospital and surgery benefits, outpatient care, cash benefits if an illness or accident stops you from earning, and a lump sum for death or serious disability.

Many plans pay the hospital directly: you go to a hospital in the insurer's network, and the insurer settles the bill. You may only pay small charges for things the plan does not cover.

A cash benefit is a fixed amount that may not match your real hospital bill, so ask how much you would receive and when.

PhilHealth: every Filipino. Under the UHC Act, all Filipinos are automatically included. A member's qualified dependents share the cover at no extra premium: a legal spouse who is not a member, unmarried children below 21 who are not working (including adopted, step- and foster children), parents aged 60 or older with a low income who are not members themselves, and some children and parents with a disability who fully depend on the member. Dependents must be listed on the member's Member Data Record (MDR) to use their benefits without delay.

Senior citizens aged 60 or older who are not covered under any other PhilHealth group are members too; their premiums come from sin tax funds. Seniors who still work or have a regular income keep paying under their own group. Lifetime members are people aged 60 or older who have paid at least 120 monthly contributions.

HMO or private plan: anyone who buys one, or whose employer provides one. Before you sign, ask about age limits and about cover for health problems you already have.

For PhilHealth:

1. Get your PhilHealth Identification Number (PIN). Fill out the PhilHealth Member Registration Form (PMRF) and submit it at a PhilHealth Local Health Insurance Office (LHIO). Senior citizens can also register through the Office for Senior Citizens Affairs (OSCA) in their city or town.
2. Declare your dependents so they appear on your Member Data Record.
3. Pay your premiums if you are a direct contributor, through PhilHealth's accredited collecting agents.
4. Check that your payments are posted on the PhilHealth Member Portal or the eGovPH app, and keep your contact details up to date.
5. Register with a YAKAP clinic for primary care. You can find health centers and RHUs near you and ask whether they take YAKAP patients.

For an HMO or private plan:

1. If you are employed, ask your HR office what your company plan covers and whether you can add family members.
2. If you are buying on your own, compare offers from more than one licensed company using the questions below.
3. Read the contract before you pay, including the list of accredited hospitals, what is not covered and how to claim. Keep a copy.

Not sure where to start? Ask our free AI care navigator.

There is no single best health card. A cheaper plan may have a smaller network or a lower limit, so compare what you get, not only the price. Ask:

• Which hospitals and clinics near your home and work are accredited?
• How much will it pay? Is the limit per year, per illness or per person? Is it shared with family?
• What is not covered? Read the list of exclusions.
• What about health problems I already have? Ask whether pre-existing conditions, such as diabetes or high blood pressure, are covered, and from when.
• What room is included? Ask what happens if you choose a bigger room than the plan allows.
• What if I go to a hospital outside the network in an emergency? Ask how much the plan pays back.
• Has it joined PhilHealth's YAKAP agreement? (see the questions below)
• Is the company licensed by the Insurance Commission?

Be careful with offers that sound too good to be true, and never pay without an official receipt and a written contract.

When you are admitted, tell the staff about all your cover: PhilHealth, your HMO or insurance card, and your senior citizen or PWD (person with disability) ID if you have one. Under PhilHealth rules, your bill is paid in this order:

1. PhilHealth benefits and discounts required by law, such as the senior citizen and PWD discounts.
2. Your HMO, private insurance or employee benefits, up to their limits.
3. You pay what is left, if anything.

Ward or private room? For admissions from January 2025, PhilHealth beneficiaries in basic or ward accommodation (a room shared by three or more patients) at accredited public and private hospitals are entitled to no co-payment for covered care. A private room, upgrades or extra services cost extra unless your HMO or insurer covers them.

Asked to pay for covered care in a ward bed? Ask for your statement of account (itemized bill) and report it to PhilHealth's Corporate Action Center. If you cannot afford the rest of the bill, ask whether the hospital has a Malasakit Center for medical and financial assistance.

In an emergency, go to the nearest emergency room first and sort out your cover later. Know ahead of time where it is: find hospitals near you.

• "I have a health card from work, so I don't need PhilHealth." Many HMOs require PhilHealth, and PhilHealth is charged first. Without it, your HMO limit can run out faster.
• "PhilHealth is only for people with jobs." Every Filipino is included under the UHC Act. The national government subsidizes poor families and senior citizens.
• "My health card pays for everything." HMO plans have limits, exclusions and networks. Before a planned procedure, ask your HMO what is covered.