What does PhilHealth cover? Hospital, emergency, maternity and other benefits

PhilHealth stands for the Philippine Health Insurance Corporation, a government corporation attached to the Department of Health (DOH). It was created in 1995 by the National Health Insurance Act (Republic Act 7875).

PhilHealth is social health insurance. Members pay premiums into one shared fund, and the government pays for people who cannot. As the law puts it, the healthy help pay for the care of the sick.

PhilHealth does not run hospitals. It pays accredited hospitals, clinics and doctors for the care they give you. For most hospital stays it pays a fixed amount for each illness or operation, called a case rate. The hospital subtracts this from your bill before you go home.

Since the Universal Health Care (UHC) Act of 2019 (Republic Act 11223), every Filipino is automatically included. That year, WHO noted that about 55% of health spending in the Philippines came straight from people's pockets. Studies also show many members miss out on benefits because they don't know what is covered.

Under the UHC Act, every Filipino is a member. PhilHealth puts members in two groups:

• Direct contributors pay their own premiums: employees, self-employed people, professionals and overseas Filipino workers (OFWs).
• Indirect contributors have their premiums paid by the government: poor (indigent) families, senior citizens and, under a 2026 circular, persons with disability (PWDs) listed in the national PWD registry. For PWDs who are employed, the government pays the share the employee used to pay.

Your qualified dependents are covered at no extra cost once they are listed on your Member Data Record (MDR):

• a husband or wife who is not a member
• single, non-working children below 21, including adopted, step- and foster children, and older children fully dependent on you because of a disability
• a parent aged 60 or above with low income who is not a member, or a parent with a permanent disability who depends on you

Senior citizens aged 60 and up with no other PhilHealth category are members, paid for by the Sin Tax law. At hospitals linked to PhilHealth's system, a senior citizen ID is usually enough. Seniors who still work keep paying under their own category.

Not registered yet? In an emergency, you can be registered on the spot through the eGovPH app, the Member Portal or a form the hospital sends in.

When you are admitted to an accredited hospital, PhilHealth pays a case rate for your illness or operation. It covers your bed, medicines, lab tests, supplies and your doctor's fee. Recent changes:

• Higher case rates. A circular signed in December 2024 raised many case rates by 50%, to keep up with rising costs and lower what patients pay out of their own pockets.
• No co-payment in a ward bed. PhilHealth's no co-payment policy says a member admitted to a basic or ward bed should not have to pay for covered care on top of what PhilHealth pays. A ward bed is in a room shared by three or more patients, with regular meals, at least a fan, and a shared toilet and bath. Newer packages, such as the 2026 childbirth rates, spell out that this applies in both public and private accredited hospitals.
• No more 45-day limit. The old limit of 45 hospital days a year was removed in 2025, as long as the care is medically needed.
• Stays shorter than 24 hours can be covered since September 2026 if the admission was medically needed and the patient had to be moved to another hospital or died.

A semi-private or private room costs more. Before you are admitted, especially in a private hospital, ask the billing office what you may have to pay.

PhilHealth's Outpatient Emergency Care Benefit (OECB) pays for emergency room (ER) care when you are treated in the ER and sent home within 24 hours. It covers ER fees, lab tests, X-rays, scans and listed medicines at accredited hospitals.

• The amount should be taken off your bill at the ER. If it was not, you can still claim it later at a PhilHealth office (Local Health Insurance Office or LHIO) within the filing period.
• If the doctor orders your admission, the inpatient case rate applies instead.
• Under the Anti-Hospital Deposit Law (Republic Act 10932), a hospital must not ask for a deposit or advance payment before giving emergency care.

In an emergency, go to the nearest ER first and sort out papers later.

PhilHealth also pays for care that does not need a hospital stay:

• Primary care through YAKAP: consultations, basic lab tests and preventive care at one clinic you choose. See our PhilHealth YAKAP guide.
• Hemodialysis: up to 156 sessions a year for people with stage 5 chronic kidney disease, at ₱6,350 per session.
• Day surgery, radiotherapy for cancer and outpatient blood transfusion.
• TB treatment (DOTS) at accredited TB-DOTS centres: ₱7,800 for the whole course of standard treatment.
• Animal bite treatment at accredited animal bite treatment centres: ₱5,850 for high-risk exposures, such as bites that break the skin or scratches that bleed. It includes rabies vaccine and immune globulin, wound care, tetanus shots and antibiotics.
• HIV care at DOH treatment hubs: ₱58,500 a year.
• Outpatient mental health care at contracted facilities: up to ₱9,000 a year for general care or ₱16,000 a year for specialty care, including medicines.
• Malaria treatment and family planning surgery such as vasectomy or tubal ligation.

Amounts are from PhilHealth's benefits page as of October 2026.

Since April 30, 2026, the Expanded Maternity Care Benefit covers care from early pregnancy until after birth, at accredited lying-in clinics, YAKAP clinics, hospital outpatient clinics and labs. It includes:

• 8 prenatal check-ups: 1 in the first three months, 2 in the middle three months and 5 in the last three months
• iron, folic acid and calcium supplements, deworming, and tetanus vaccine if needed
• lab tests, including screening for hepatitis B, HIV, syphilis and diabetes in pregnancy, and ultrasound
• normal delivery, plus emergency care and transfer to a hospital if problems start during labor
• a check-up within 6 weeks after birth, family planning, breastfeeding and mental health support

A care coordinator guides each mother through her visits. Covered services are free if you give birth in basic accommodation. If you need more than 8 check-ups, a private clinic may charge for the extra visits, but no more than ₱900 in total.

For hospital births, PhilHealth's 2026 rates are ₱29,000 for a normal delivery and ₱58,000 for a cesarean section, with no co-payment in a ward bed. Start check-ups early: ask your barangay health station, RHU or YAKAP clinic where to go.

Z Benefits are packages for illnesses so costly they can drain a family's savings. They are given at contracted hospitals to patients who meet set medical criteria. Examples as of October 2026:

• breast cancer, all stages: up to ₱1.4 million
• childhood leukemia (standard-risk acute lymphoblastic leukemia): ₱500,000
• packages for cervical, prostate and colorectal cancer
• kidney transplant: from ₱865,000 to about ₱2.1 million, depending on the type of donor and surgery
• heart surgery: bypass surgery (₱660,000 to ₱960,000), heart valve surgery, and repair of some heart defects in children
• peritoneal dialysis at home, artificial limbs and braces (ZMORPH), and implants for hip and thigh-bone fractures
• care for premature and small newborns, and therapy, devices, glasses and hearing aids for children with disabilities

Ask your doctor whether your condition fits a package.

You pay the extra cost of room upgrades or services you choose. PhilHealth also does not pay for care that is not medically needed, or care at facilities that are not accredited.

Order of payment: PhilHealth and legal discounts (such as senior citizen and PWD discounts) come off your bill first, then your HMO or private insurance. If a balance is left that you cannot pay, ask the hospital's social worker or Malasakit Center about medical and financial assistance for patients who cannot pay. To compare PhilHealth with private plans, see our guide to HMOs and health insurance.

1. Know your PhilHealth number (PIN) and check that your dependents are listed, through the PhilHealth Member Portal, the eGovPH app or a PhilHealth office (LHIO).
2. Go to an accredited facility. You can find hospitals and health centres near you.
3. Tell the staff you are a PhilHealth member and show a valid ID, your MDR, or your senior citizen or PWD ID. The hospital prints a PhilHealth Benefit Eligibility Form (PBEF) or asks you to fill in Claim Form 1.
4. Check your bill before you pay. It should show the PhilHealth deduction.
5. Ask for help if something looks wrong. Talk to the hospital's PhilHealth coordinator or PhilHealth's P-CARES staff (Customer Assistance, Relations and Empowerment Staff). If PhilHealth was not deducted, file for reimbursement at an LHIO within the filing period. If you were charged for covered care in a ward bed, report it to the PhilHealth Action Center.

OFWs and their dependents confined abroad can claim within 180 days after discharge.

Not sure which benefit applies? Ask our free AI care navigator.

• Free for indirect contributors. The government pays the premiums of poor families, senior citizens with no other coverage, and registered PWDs.
• Direct contributors pay 5% of their monthly income, from ₱500 to ₱5,000 a month (since January 2025). For employees, the employer pays half. Self-paying members and OFWs can pay monthly, quarterly, every six months or yearly.
• The benefits are the same for every member.

Missed some payments? Self-paying members can still use their benefits, but must pay the missed months later, with interest of up to 1.5% a month. Pay the year's premiums by December 31, or by January 31 of the next year without interest. For months missed from November 2019 to December 2025, you can ask PhilHealth to waive the interest and let you pay in monthly instalments; apply at a PhilHealth office by December 31, 2027. If you truly cannot pay, ask a DSWD, LGU or hospital social worker to assess you, so the government may pay instead.

• "PhilHealth only pays a small part of the bill." This used to be closer to the truth, which is why case rates were raised. Under PhilHealth's rules, covered care in a ward bed should now cost you nothing extra; room upgrades and extras are what usually add to the bill.
• "You must stay in the hospital for at least 24 hours." Not always. ER care without admission has its own benefit, and shorter stays can be covered if the patient is transferred or dies.
• "I stopped paying, so my PhilHealth is useless." You can still use your benefits, and settle the missed months later.
• "It's rude to question the hospital bill." Asking what PhilHealth covers, and checking the deduction, is your right.