Can PhilHealth Benefits Lighten Your Pregnancy Cost?

Can PhilHealth Benefits Lighten Your Pregnancy Cost?

Pregnancy is truly a glorious time not just in a woman’s life, but also for her family. Aside from the emotional, physical, and mental investment that it entails, it can also be financially burdening if you are not prepared. Financial planning can be straining, especially if you don’t have the resources. Thankfully in the Philippines, PhilHealth provides financial assistance to pregnant women, during and after pregnancy. It is easily accessible to everyone and offers a good insurance coverage for pregnancy and delivery.

PhilHealth is easily available and has a very low monthly payment. They have a long list of health coverage, including the Maternity Care Package and Newborn Care Package. Most employed individuals are automatically enrolled in PhilHealth, since it’s compulsory for employers to enroll their employees to PhilHealth, SSS, and Pag-IBIG to provide them with the necessary benefits and insurance policies.

The following are two packages that PhilHealth provides to help pregnant women and their family cope with pregnancy financially.

Maternity care package

Members who are qualified and their dependents can take advantage of PhilHealth’s maternity package. However, there will be a required number of payments that the member must complete first before the benefits are extended to him or her. For those who are not a member yet, payment of the premium contribution with all the proper documentation such as, valid IDs with photo, birth certificates and your medical records during the pregnancy and etc. is needed.

Eligibility

  • Member must not be less than 19 years old
  • Should not have a history of 3 or more abortions/miscarriage
  • No history of medical conditions affecting the reproductive health such as ovarian abnormality, uterine abnormality and other maternal conditions that are considered as high risk based on PhilHealth’s Circulars 2008.

Documentary requirement

  • Claim form 1
  • Claim form 2
  • Claim form 3 (part II)
  • your most updated Member Data Record (MDR)
  • proof of eligibility
  • (a) sponsored ID, (b) OWP ID, (c) IPP – proof of premium payments

Maternity Care Package can only cover up to the fourth delivery, and it provides more specific packages according to the type of delivery: Normal Spontaneous Delivery Package (NSD) and Cesarean Package.

Normal Spontaneous Delivery Package (NSD)

This package will provide 5,000.00 for in-hospital availment and 6,500.00 if availed in any accredited birthing homes or maternity clinics.

This package is applicable to all PhilHealth accredited hospital or non-hospital facilities like maternity and lying-in clinics. It includes prenatal care, delivery, and postnatal care services such as the following:

  • 1,500.00 prenatal care free
  • 5,000.00 to 6,500.00 facility fee including professional fee
  • NO balance billing (applies to all)

Cesarean Package

Compared to the NSD, the Cesarean Package is dependent on the total amount billed to the patient, and will be computed by PhilHealth upon application. Thus, there is no exact breakdown of the actual benefit provided by this package.

Newborn care package

A woman’s responsibility does not end after giving birth, it is just the start of a lifetime responsibility. That is why PhilHealth also provides assistance for newborn, to make sure that after delivery, the child is well taken care of.

Who are eligible?

All qualified newborn of members are eligible for this package. Unlike the Maternity Package, it does not impose limits to the number of birth, members can apply for this even if they’re already on their fifth delivery and beyond.

This package is applicable to all PhilHealth accredited hospital or non-hospital facilities like maternity and lying-in clinics. The Newborn Care Package is worth 1,750.00 with NO billing balance. It includes prenatal care, delivery, and postnatal care services such as the following:

  • Screening test – newborn screening and hearing
  • Essential Intrapartum and Newborn Care (EINC) protocol
  • non-separation of mother/baby for early breastfeeding initiation
  • eye prophylaxis
  • weighing
  • BCG Vaccination
  • Hepatitis B Vaccination
  • Newborn Hearing Test
  • Newborn Screening Test
  • Professional fee

Documentary requirement

  • Claim form 1
  • Claim form 2 (all services must be enumerated)
  • Updated Member Data Record (MDR)
  • Proof of payments

Providing financial relief to every pregnancy

PhilHealth is mandated to provide financial risk protection to all, that’s why enrolling to their program is accessible and fairly easy. Enrolling will automatically qualify individuals for the benefit packages offered by this agency, it doesn’t require its member to have a long standing membership and contribution before they could  reap the benefits.

Pregnancy can be a major financial hurdle, while PhilHealth can help bring down medical expenditures, the compensation that it provides cannot cover the entire cost. This is why it isn’t practical to rely solely on the benefit packages of PhilHealth, especially if you want to have a more comfortable delivery.

It’s always best to save up a good sum of money on top of your PhilHealth benefits to ensure that all of your expenses will be fully covered. The amount that you should save up for will vary depending on the medical institution where you plan to have the delivery.

Alternatively, a medical insurance from private companies such as Sun Maiden Plus or Medicard will make the expenses less burdening. A medical insurance policy remains to be the most reliable for whatever illness or condition you are in, even in pregnancy. Thankfully, there are now private insurance companies that provide coverage for pregnancy and delivery. It will cover most of the expenses, from the hospital room to the doctor’s fee and medicine. Thus, it would be best to have these medical insurance on top of your PhilHealth coverage.

If you want to have peace of mind, the first step is by insuring yourself with a PhilHealth benefit package if you haven’t yet.

 

Image from huffingtonpost.com

Leave your comment