PhilHealth Maternity Benefits for Mother and Child | Normal and Cesarean Delivery

Congratulations on your pregnancy! Do you know that PhilHealth have Maternity Benefits for Mother and Child? Know more about it!

Whether you will give birth via normal delivery or via cesarean operation, know that PhilHealth is able to assist from pre-natal to delivery to post-partum care as well as newborn screening.

The benefits that you may be able to get from PhilHealth is a welcome thing to defray some of the cost of pregnancy and in taking care of your newborn child.

If you are not an active member of PhilHealth, we recommend that you go to a branch now, update your records, pay your contributions, so that you can enjoy the several maternity benefits that PhilHealth provides.

What are these benefits? Is cesarean delivery included? Yes! It’s included! Get the details from this post and sharing by iSensey.

Have your child undergo newborn screening!

 

Newborn Care Package (NCP)

This is the benefit extended to take care of the newly born child. The amount that PhilHealth will give is P1,750 total for the following services:

• Essential newborn care
• Newborn screening test
• Newborn hearing screening tests

Info below about NCP are from the PhilHealth Circular No. 07, Series of 2009.

UPDATE: Philhealth has updated its NCP Benefit effective January 5, 2019.

NEWBORN CARE PACKAGE {Circular Nos. 24 s. 2006 and 20 s. 2007)

1) Newborn Care Package (NCP) may be availed by any qualified PhilHealth dependent delivered in accredited hospitals and non-hospital facilities for MCP that are certified as a newborn screening facility.

1. Qualified dependents include babies delivered via cesarean section, breech extraction, or vaginal deliveries.
2. Claim for NCP is independent from the mother’s claim for delivery.

i. Therefore, a claim can be filed for a baby’s NCP even if the mother’s delivery is not covered by PhilHealth. For this reason, babies of 5th and subsequent normal deliveries are also qualified for NCP.

ii. Baby’s claim need not be attached to mother’s claim for delivery.

iii. Moreover, the only required premium for dependents of Employed and Individually Paying members is three (3) months of contribution within the immediate six (6) months prior to delivery.

2) Newborn screening test, BCG and Hepatitis B immunization may be given on outpatient basis since normal newborn babies can be sent home as soon as possible.

1. The following are considered as incomplete provision of services: 1) Immunization done in private doctors’ clinics and 2) Newborn screening test done in another facility. In these cases, the member may be advised to file directly with PhilHealth.
2. The claims for NCP must only be submitted after completion of provision of said required services (newborn screening test, BCG and Hepatitis B immunization) if provided in RHU.

*Claims for NCP are exempted from the submission of Statement of Accounts.

*Since home deliveries are not covered for NSD, MCP or Newborn Care Package, members are advised to deliver only in PhilHealth-accredited facilities.

 

COMPLICATED and CESAREAN DELIVERY

These are the PhilhHealth cesarean coverage as of 2018:

PhilHealth Case Rate Benefit for Cesarean Section is P19,000.

Case Rate Benefit for Complicated Vaginal delivery is P9,700.

Case Rate Benefit for Breech Extraction is P12,120.

Case Rate Benefit for Vaginal Delivery after Cesarean Section is P12,120.

Make sure that you are an active member of PhilHealth to avail this benefit in case you will undergo cesarean delivery.

 

NORMAL DELIVERIES

For Normal deliveries, these are the Mother and Child Benefits provided for by Philippine Health Insurance as of 2018: ANTENATAL CARE PACKAGE, MATERNITY CARE PACKAGE, NORMAL SPONTANEOUS DELIVERY (NSD) PACKAGE.

For both Normal and Cesarean delivery, make sure to have your newborn undergo newborn screenings. This is for the health and benefit of your child.

Antenatal Care Package

This is the benefit for pregnant women (nagbubuntis na ina):

Pre-natal consultation and essential health services in the following accredited establishments: hospitals, birthing homes, lying-in clinics, maternity clinics, infirmary, dispensaries. PhilHealth case rate benefit is P1,500 for Antenatal Care Package.

The pregnant woman must be an active member of PhilHealth. Update your PhilHealth membership and consult with a health care provider during the early part of your pregnancy.

Make sure to undergo at least four pre-natal visits with 1 visit during the last trimester of pregnancy, also you must go to the same clinic or hospital for at least 4 pre-natal check-ups to enjoy this benefit.

If you will go to Clinic A, then Clinic B, back to Clinic A, then Hospital D, you will not get the Antenatal Care Package benefit. Dapat may 4 na pre-natal check-ups ka sa i-isang PhilHealth accredited establishment.

 

Maternity Care Package (MCP)

This is the PhilHealth benefit given to pregnant women until she gives birth. The benefit amount is P6,500 if services were done via hospital. The benefit amount is P8,000 if the procedures were done via birthing homes, lying-in clinics, maternity clinics, infirmary, and dispensaries. The MCP are for these services:

• Pre-natal consultation
• Essential health services
• Labor and delivery (normal delivery / panganganak na normal)
• Post-partum care

 

Normal Spontaneous Delivery (NSD) Package

This is the benefit extended to pregnant women for labor and delivery plus post-partum care or pagkatapos ng panganganak. The benefit amount is P5,000 if delivery was via hospital, it’s P6,500 if delivery is via birthing homes, lying-in clinics, maternity clinis, infirmary, and dispensaries.

• Normal delivery (normal na panganganak)
• Post-partum care

 

 

NSD versus MCP

What is the difference between Normal Spontaneous Delivery (NSD) Package at Maternity Care Package of Philhealth?

When it comes to Normal Spontaneous Delivery (NSD) Package, Philhealth covers the following services:

1. Labor and delivery (pagpapaanak)
2. Post-partum care – these are the services extended after giving birth

When it comes to Maternity Care Package, PhilHealth pays for the following services:

1. Labor and delivery (pagpapaanak)
2. Post-partum care – these are the services extended after giving birth
3. Prenatal care

As you see in the comparison, PhilHealth prenatal care service and benefit is not included in the Normal Spontaneous Delivery package.

 

You may also wonder why there are different rates of MCP and NSD Package in hospitals and non-hospitals? The non-hospital facilities have higher rates for MCP and NSD Package to encourage normal low risk deliveries in birthing homes/maternity clinics.

This is to allow mothers to experience normal natural birth in a safe environment of a birthing facility and also to decrease the caseloads of the normal deliveries in the hospitals for them to focus on management of more complicated cases.

 

Reminders for pregnant women who wants to avail of the PhilHealth benefits for Mothes and Newborns:

1. Make sure that your PhilHealth records are updated.
2. Prepare the needed documents like PhilHealth Claim Form 1 and your PhilHealth ID days before you will give birth.
3. Make sure that the benefit payment has been deducted from the total expenses related to giving birth BEFORE YOU LEAVE THE HOSPITAL / BIRTHING HOMES, LYING-IN CLINICS, ETC.
4. Undergo check-up in Philhealth accredited centers ideally on the first month of pregnancy or as soon as you notice the pregnancy symptoms and at least once on your last trimester.

Follow the regular check-up recommendations of our doctor or attending health officer.

Further advises by PhilHealth for pregnant women:

• Pregnant women should regularly consult their health care provider and have a record of these consults by keeping a mother’s book.
• Pregnant women should update their PhilHealth membership status and pay the premium contributions (if necessary) and prepare the documents needed for claims filing.
• Pregnant women should work closely with the health care provider in ensuring their good health and that of their baby.
• Pregnant women should give birth to an accredited health care institution.
• Pregnant women should have post-partum follow-up with their health professional.

5. Make sure to have your newly born child to undergo Essential Newborn Care, Newborn Screening Test, and Newborn Hearing Screening Test.

 

OTHER CONCERNS

SITUATION 1: Now, what if the pregnant woman is a member of PhilHealth BUT NOT AN ACTIVE MEMBER? She has missed contributions. Can she still apply for maternity and child benefits?

This is the procedure for those pregnant woment who are INACTIVE PhiHealth members:

Pregnant women with inactive membership shall be referred to a social worker to assess and enroll them through Point of Care or they can automatically be covered through the provision in 39b of the IRR for NHIA of 2013. For the latter case, pregnant women shall be given a medical certificate or alternative document and be referred to the PhilHealth LHIO/PRO for enrollment and payment of premium.

*These must be done prior to discharge of the mother from the facility.

* Provisions under 39b may only be availed once without penalties.

 

SITUATION 2: Now, what if the pregnant women is a PhilHealth dependent of her parents. Example: Minor pa yung babae at under sya ng PhilHealth ng magulang, tapos manganganak sya, can she avail the maternity benefits?

Since the pregnant woman is a qualified dependent of her parent who is a PhilHealth member, she is still eligible to receive PhilHealth benefits, however her newborn is not.

Hence to ensure that the baby will also have social health insurance coverage, women about to give birth who are still dependents of their parents shall be enrolled as principal member, voluntary membership to PhilHealth.

 

IMPORTANT:

Is pre-natal checkup required to avail of the Maternity Care Package? Kailangan ba talaga mag pa pre-natal ang ina para maka kuha ng MCP benefits?

Yes. Maternity Care Package covers the complete essential health care services for women about to give birth throughout their pregnancy and normal delivery (during antenatal, intrapartum and immediate postpartum periods) regardless of the type of health care institution where the services are rendered. Hence, for this benefit to be paid, there should be at least 4 pre-natal check-up from the same facility.

Kailangan ng at least apat na pre-natal check-up sa parehong establishmento ang isang ina para maka kuha ng benefit sa PhilHealth na Maternity Care Package. If nag pa pre-natal ka sa Maternity Clinic A ng 3 beses then isang beses sa Maternity Clinic B, di ka na qualified. Dapat apat na pre-natal check-up sa isang establishment.

Ginawa etong guideline para mas masundan ng maayos ang history ng iyong pagbubuntis.

Is pre-natal checkup required to avail of the Normal Spontaneous Delivery Package?

No. Normal Spontaneous Delivery Package covers health services during intrapartum, and immediate post-partum period for normal delivery regardless of the type of health care institution. 

What if the woman who is about to give birth have prenatal care from other facility and then gave birth in another facility?

In cases when the pregnant women receive 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. 

Can Antenatal Care Package and Maternity Care Package be claimed for the same person at the same period of pregnancy?

No. They cannot be claimed at the same time (whether by the same or different facilities). Antenatal Care Package covers pre-natal care while Maternity Care Package covers pre-natal care and delivery.

Kung sa Hospital A ka nag pa prenatal checkups ng at least 4X at dun ka din nag deliver, file a claim for PhilHealth Maternity Care Package.

Kung sa Clinic A ka nag pa prenatal check-ups ng at least 4 times, tapos sa Hospital A ka nanganak. You will file claim for Antenatal Care Package AND Normal Spontaneous Delivery (NSD) Package.

Contact PhilHealth for questions about the Maternity Benefits and Case Rates via call center at (02) 441 7442 or via trunkline (02) 441 7444 or visit the branch nearest you.

 

GET A COPY OF CLAIM FOR 1

You can go to Philhealth to get a copy of Claim Form 1 or download and print the Form 1 via online.

These benefits of Philhealth are for the mother and baby with the hope that the pregnancy as well as labor and delivery will go well.

Not a member of PhilHealth yet? Become a member of the Philippine Health Insurance. Apply for a Philhealth number and start paying premium contributions via online today.

Lastly, take care of yourself and your baby! Have a safe delivery!

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