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benefit coverage

inpatient coverage

PhilHealth provides subsidy for room and board, drugs and medicines, laboratory exam, use of operating room complex and professional fees for confinements of not less than 24 hours. Please refer to the table of rate ceilings/maximum allowances for inpatient coverage.

outpatient coverage

Day surgeries, dialysis and cancer treatment procedures such as chemotherapy and radiotherapy in accredited hospitals and free-standing clinics.

Special Benefit Packages

The following shall not be covered except when, after actuarial studies, PhilHealth recommends their inclusion subject to approval of its Board of Directors:

  • Fifth and subsequent normal obstetrical deliveries
  • Non-prescription drugs and devices
  • Alcohol abuse or dependency treatment
  • Cosmetic surgery
  • Optometric services
  • Other cost-ineffective procedures as defined by PhilHealth