6 PhilHealth Benefits Available For Regular And Voluntary Members
6 PhilHealth Benefits Available For Regular And Voluntary Members. Unexpected medical emergencies, such as sudden hospitalization, can cause significant financial strain. In severe cases, costly treatments may force individuals to deplete their savings or even liquidate assets just to pay for healthcare.
Thankfully, Filipinos have access to a government backed solution PhilHealth. While many are registered members, not everyone is fully aware of the comprehensive PhilHealth benefits available to them.
What is PhilHealth and How Does it Work?
PhilHealth (Philippine Health Insurance Corporation) was established in 1995 with the core mission of easing the financial burden of healthcare costs for Filipino citizens. It operates similarly to a health insurance provider, with one major distinction—it is mandated and supported by the Philippine government.
The program is primarily funded through:
- Monthly contributions from members
- Shared contributions from employers
- Budget allocations from both local and national governments
Membership is compulsory for all employed individuals in the Philippines. Meanwhile, self-employed professionals, freelancers, and other non-salaried workers may enroll as voluntary members to access the same range of PhilHealth benefits.
This social health insurance scheme helps cover a portion—or in some cases, the entirety—of your hospital or outpatient expenses, depending on your case and eligibility.
How Much is the PhilHealth Contribution in 2024–2025?
To enjoy full access to your PhilHealth benefits in 2024 and beyond, members must ensure timely payment of their required contributions. For employed individuals, these contributions are automatically deducted as part of their monthly government-mandated withholdings. However, if you’re a self-employed or voluntary member, you have the option to make payments directly through PhilHealth branches, authorized banks, and accredited online payment platforms.
The exact amount of your PhilHealth contribution is determined by your monthly income. For the period covering 2024 to 2025, the contribution rate stands at 5% of your basic monthly salary. The table below outlines the applicable premium rates and expected monthly payments:
| Basic Monthly Salary | Premium Rate | Monthly Contribution |
|---|---|---|
| ₱10,000 | 5% | ₱500 |
| ₱10,000 – ₱99,999.99 | 5% | ₱500 to ₱5,000 |
| ₱100,000 and above | 5% (Maximum) | ₱5,000 |
Note: Contributions are shared equally between employer and employee for those formally employed.
What are the PhilHealth Benefits?
The primary advantage of being a PhilHealth member is access to substantial subsidies on your hospitalization and medical expenses. Essentially, the program allows members to receive discounts on hospital bills, significantly reducing the financial burden of treatment.
It’s important to understand that PhilHealth uses a case rate payment system, meaning each illness or procedure has a fixed reimbursement amount. This fixed rate includes:
- Hospital accommodation and treatment costs
- Professional fees of the attending medical specialists
Members can claim their PhilHealth benefits when undergoing hospital admission or certain outpatient procedures, as long as they are treated in PhilHealth accredited medical facilities
Inpatient Benefits
When you’re admitted to a hospital for medical treatment, you can take advantage of PhilHealth inpatient benefits. A significant portion of your hospital expenses can be covered by PhilHealth—provided the facility is PhilHealth-accredited.
These benefits may include:
- Hospital room and board charges
- Medical and surgical supplies
- Diagnostic services (e.g., laboratory and imaging)
- Professional fees of doctors and specialists
The actual amount covered depends on the medical case and falls under PhilHealth’s case rate payment system, where a fixed amount is applied for each illness or procedure.
Outpatient Benefits
You don’t have to be confined in a hospital to enjoy PhilHealth benefits. As a member, you can also receive coverage for selected outpatient procedures, which include:
- Day Surgeries: Non-emergency operations (both minor and major) where the patient is discharged on the same day.
- Radiotherapy: Includes cancer treatment sessions using advanced technologies such as cobalt machines and linear accelerators.
- Hemodialysis: Covers both inpatient and outpatient sessions, including emergency dialysis for patients with acute kidney failure.
- Outpatient Blood Transfusion: Includes costs for blood, related medicines, x-rays, laboratory exams, and even operating room services when necessary.
These outpatient services are available in PhilHealth-accredited hospitals and clinics, ensuring financial assistance without the need for overnight admission.
Z Benefits – For Catastrophic Illnesses
Introduced during the administration of President Benigno Aquino III, the Z Benefits package is tailored for patients battling life-threatening and costly diseases. To access this benefit, patients must be diagnosed with a PhilHealth-covered illness and complete the pre-authorization process set by the agency.
Here’s a breakdown of conditions covered and their corresponding PhilHealth benefit amounts:
| Medical Condition | Coverage Amount |
|---|---|
| Acute Lymphocytic / Lymphoblastic Leukemia (Standard Risk) | ₱500,000 |
| Breast Cancer (Stages 0–IV) | ₱1.4 million |
| Prostate Cancer (Low to Intermediate Risk) | ₱100,000 |
| Cervical Cancer | ₱120,000 – ₱175,000 |
| Colon and Rectum Cancer | ₱150,000 – ₱400,000 |
| End-stage Renal Disease (Eligible for Kidney Transplant) | ₱600,000 |
| Coronary Artery Bypass Graft (CABG) Surgery | ₱550,000 |
| Tetralogy of Fallot Surgery (Pediatric) | ₱320,000 |
| Ventricular Septal Defect Surgery (Pediatric) | ₱250,000 |
| Selected Orthopedic Implants | ₱48,740 – ₱169,400 |
These PhilHealth Z Benefits aim to drastically reduce the financial pressure on Filipino families affected by serious health conditions, ensuring they receive quality care without the fear of incurring crippling debt.
SDG-Related PhilHealth Benefits
PhilHealth aligns several of its benefit programs with the United Nations Sustainable Development Goals (SDGs), reflecting its commitment to preventive care and global health standards. These PhilHealth benefits address common but critical health concerns, especially in underserved communities.
Below is a list of SDG-related benefit packages available to eligible PhilHealth members:
| Package | Coverage Amount |
|---|---|
| Outpatient Malaria Treatment | ₱600 |
| HIV-AIDS Treatment (Outpatient) | ₱30,000 annually (₱7,500/quarter) |
| Anti-Tuberculosis (TB) Outpatient Therapy | ₱1,500 – ₱4,000 |
| Animal Bite Treatment Package | ₱3,000 |
| Voluntary Surgical Contraception | ₱4,000 |
These PhilHealth benefits are designed to encourage early intervention, reduce the spread of infectious diseases, and promote long-term health sustainability.
PhilHealth Maternity Benefits for Expectant Mothers
PhilHealth also provides comprehensive maternity benefits to support Filipino mothers during pregnancy, delivery, and postpartum recovery. These benefit packages are particularly helpful for low to middle income households and are accessible at PhilHealth accredited healthcare facilities.
Here’s a breakdown of the PhilHealth maternity benefits available in 2025:
| Package | Description |
|---|---|
| Antenatal Care Package (ACP) | Covers essential prenatal services, including regular check-ups and ultrasounds |
| Normal Spontaneous Delivery (NSD) | Includes services for uncomplicated vaginal delivery and immediate postnatal care |
| Maternity Care Package (MCP) | Covers the entire maternity cycle—from prenatal to labor, delivery, and postpartum support |
These packages ensure mothers receive the necessary care during all stages of pregnancy, minimizing complications and improving maternal and infant health outcomes.
Mental Health Benefits under PhilHealth
Recognizing the growing importance of mental wellness, PhilHealth provides coverage for various outpatient mental health services. These include:
- Psychiatric consultations
- Diagnostic follow-ups
- Psychoeducation sessions
- Psychosocial support and interventions
PhilHealth categorizes its mental health benefits into two distinct financial packages:
| Mental Health Package | Subsidy Amount |
|---|---|
| General Mental Health Services Package | ₱9,000 |
| Specialty Mental Health Services Package | ₱16,000 |
Note: The above benefits represent only a portion of the services covered. For the most accurate and updated list of eligible conditions and procedures, visit the official PhilHealth website. Always check specific requirements applicable to each benefit.
Who is Regular and Voluntary Members?
Before diving into the benefits, let’s define these membership types:
| Membership Type | Description |
|---|---|
| Regular Members | Employees with formal jobs whose PhilHealth contributions are automatically deducted from their salaries. Employers also contribute a portion. |
| Voluntary Members | Includes self-employed individuals, freelancers, informal sector workers, and OFWs who pay their contributions directly. |
Both types of members are entitled to the same benefit packages, provided their contributions are updated and they meet eligibility requirements.
How to Claim PhilHealth Benefits
To receive any PhilHealth benefit, including mental health coverage, follow the steps outlined below:
Step 1: Verify Your Eligibility
Ensure you meet the basic requirements:
- You must have paid at least 9 months of PhilHealth contributions within the 12-month period prior to your hospital admission or outpatient procedure.
- The hospital and attending healthcare provider must be PhilHealth-accredited.
Step 2: Gather the Required Documents
The documentation varies by benefit type, but generally includes:
- Member Data Record (MDR)
- PhilHealth Benefit Eligibility Form (PBEF) – required for inpatient claims
- PhilHealth Claim Form 1
- Member Empowerment Form (MEF) – required for Z Benefits
- PhilHealth ID
- A valid government-issued ID (e.g., Passport, Driver’s License, UMID)
Step 3: Submit the Requirements at the Hospital
Before you’re discharged:
- Submit all your completed documents to the PhilHealth or billing section of the hospital.
- The eligible PhilHealth benefit amount will automatically be deducted from your final hospital bill.
- Settle any remaining charges with the hospital cashier before discharge.
Common Issues and Solutions
| Issue | Solution |
|---|---|
| Denied claims | Verify MDR accuracy and contribution record |
| Lack of knowledge about Konsulta | Visit PhilHealth’s website or call their hotline |
| Late contribution payment | Pay retroactively (check current guidelines) |
| Hospital doesn’t file claims | Request CF1 and CF2 forms to process manually |
FAQs About PhilHealth Benefits
How many times can I use PhilHealth in a year?
Ans: You can use PhilHealth benefits multiple times in a year, but certain treatments have limits:
- Hemodialysis – 90 sessions per year
- Radiotherapy/Blood transfusion – 45 days per calendar year
How much of my bill does PhilHealth cover?
Ans: Coverage depends on:
- The diagnosis or procedure
- Whether the facility and doctor are PhilHealth-accredited
- Your eligibility status
Use the official case rate list on the PhilHealth website for specifics.
Who are considered dependents under PhilHealth?
Ans: Dependents who can use benefits without paying extra contributions:
- Legal spouse not registered as a member
- Children below 21 years old
- Children above 21 with disability
- Foster children
- Parents aged 60 and above
- Permanently disabled parents
Conclusion
PhilHealth benefits offer a vital safety net for both regular and voluntary members. Whether it’s a sudden illness, maternal care, cancer treatment, or mental health support, PhilHealth reduces the burden on families and ensures that more Filipinos have access to affordable healthcare.
