Health insurance in the Philippines: the types of cover

Health cover in the Philippines comes in layers. PhilHealth is the base that every Filipino has. On top of it, people add an HMO plan, a health insurance policy, critical illness cover, or a mix. Each pays in a different way.

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PhilHealth as the base

Every Filipino citizen is automatically included in the National Health Insurance Program (RA 11223, Sec. 5). Members are either direct contributors, who pay premiums (employees, self-employed people, OFWs), or indirect contributors, whose premiums the government pays (Sec. 8). All senior citizens are covered (RA 10645). PhilHealth pays fixed amounts for each kind of treatment, so a bill is often larger than what PhilHealth pays. Private cover is used for the rest. See the PhilHealth guide.

HMO plans

An HMO is a company that provides health services to its members “for a fixed prepaid premium” (RA 11223, Sec. 4(m)). You get a card, use its network of hospitals and clinics, and the HMO pays them directly up to the plan’s yearly limit. Many plans include consultations, tests and a yearly check-up. See HMOs in the Philippines for how to compare plans.

Health insurance policies

Health insurance is sold by life and non-life insurance companies. The Insurance Code counts health, accident and disability insurance as part of both life and non-life insurance (Sec. 193). The main types:

• Reimbursement (medical) insurance. Pays back hospital and medical costs up to the policy’s limit, after you claim with receipts, or pays the hospital directly where the insurer allows it.
• Hospital cash (hospital income) insurance. Pays a fixed amount for each day you are in hospital, whatever the bill. You use the money as you need.
• International health plans. Cover care in more than one country. Some Filipinos working or living abroad look at these when their employer’s cover ends at the border.

For health insurance contracts that exclude pre-existing conditions, the Insurance Commission limits how those conditions are treated and requires a free look period to cancel after you receive the policy, which group contracts need not have (IC Circular Letter 2018-65).

Critical illness cover

Critical illness cover pays a lump sum when you are diagnosed with one of the serious illnesses the policy lists, such as some cancers, a heart attack or a stroke. The money is yours to use. See critical illness insurance.

By life stage

• A young family: check-ups, children’s illnesses and short hospital stays matter most.
• Pregnancy: many private plans have a waiting period before maternity care is covered, so cover is better arranged before a pregnancy. PhilHealth has its own maternity benefits.
• Parents over 60: age limits and pre-existing conditions narrow the choice. See cover for seniors.
• OFWs abroad: cover in the country of work comes first; Philippine plans matter for visits home and for family at home.

For all kinds of insurance, see types of insurance in the Philippines.

This page explains the kinds of health cover in general terms. It does not describe any company’s product, and each plan’s own terms decide what it pays.