PhilHealth benefits: what PhilHealth pays for and how to use them

PhilHealth pays part of the cost of care for members and their declared dependents. Its benefits page groups them as inpatient benefits (hospital stays, paid as case rates), outpatient benefits such as day surgery, radiotherapy, hemodialysis and blood transfusion, the Z Benefits for serious and costly illnesses, public health packages such as TB and animal bites, and mental health care. Primary care is a separate package, YAKAP, and maternity care has its own packages. Every member is eligible from the start, and in a basic or ward room the law says no extra charge may be made.

Hospital stays

PhilHealth pays hospitals a fixed amount for each illness or procedure, called a case rate. Its benefits page says the case rate “shall be deducted by the Health Facility from the member’s total bill” before you leave, and covers both hospital charges and the doctor’s fees. Circular No. 2024-0037 raised many case rates by 50% for admissions from 1 January 2025; some packages, including stroke, high-risk pneumonia, severe dengue, cataract surgery and hemodialysis, were left out of that rise. The hospital files the claim with PhilHealth for you.

Recent changes, from PhilHealth’s circulars:

• The 45-day yearly limit on hospital days was lifted for members and dependents (Circular No. 2025-0007).
• The rule that blocked a second claim for the same illness within 90 days was lifted (Circular No. 2025-0015).
• Some stays of less than 24 hours are now covered, for example when a patient is transferred to another hospital (Circular No. 2026-0013).

PhilHealth’s benefits page still mentions the older day limits in places; the circulars are the current rule. See our guide to PhilHealth case rates.

Outpatient and primary care

YAKAP is PhilHealth’s primary care package: check-ups at a clinic you register with, set lab tests, some cancer screening and outpatient medicines. See PhilHealth YAKAP.

PhilHealth’s benefits page also lists outpatient packages for day surgeries, radiotherapy, hemodialysis, outpatient blood transfusion, outpatient malaria, HIV-AIDS, TB treatment (TB-DOTS), voluntary surgical contraception, animal bites and outpatient mental health care. The page is not dated, so check the amount for any package with PhilHealth or the clinic.

Z Benefits

The Z Benefits cover illnesses that PhilHealth calls “medically and economically catastrophic”. PhilHealth started them in 2012 (Circular No. 2021-0022). PhilHealth’s list of contracted facilities, updated as of 30 September 2026, shows these packages:

• Cancer: acute lymphocytic leukemia, breast, prostate, cervical, colon and rectal cancer.
• Open heart surgery: Tetralogy of Fallot, ventricular septal defect, coronary artery bypass graft, and heart valve repair or replacement.
• Prostheses and implants: ZMORPH, expanded ZMORPH and selected orthopedic implants.
• Kidney: kidney transplant, care after a transplant for adults and children, and peritoneal dialysis.
• Premature babies and children with disability: premature or small newborns, and children with developmental disability, hearing impairment, mobility disorder or visual disability.

How they work, according to PhilHealth:

• All members and their qualified dependents can use them if they meet each package’s criteria.
• Only contracted hospitals provide them, and each has a Z Benefits Coordinator. PhilHealth lists the hospitals for each package on its contracted facilities page.
• The hospital needs PhilHealth’s pre-authorization before treatment; PhilHealth says it processes it within seven working days.
• The patient signs a Member Empowerment form.

Each package has its own circular and amount. We don’t list amounts here because PhilHealth’s benefits page that shows them is not dated; ask the Z Benefits Coordinator at a contracted hospital.

Maternity and newborn care

PhilHealth issued new maternity circulars in 2026, on care in hospitals and in non-hospital and outpatient facilities. Our guide to the PhilHealth maternity benefit explains them.

Who can use the benefits

• Every member, from the start. RA 11223 Sec. 9: “Every member shall be granted immediate eligibility for health benefit package under the Program”, and a PhilHealth ID card “shall not be required”.
• Declared dependents use the same benefits. They must be listed on your Member Data Record. See PhilHealth dependents.
• Self-paying members who are behind on payments can still use their benefits. Circular No. 2026-0011 says “Failure to pay premiums shall not prevent the enjoyment of any Program benefits”, though missed premiums and interest must still be paid.

Using them at the hospital

• Use a hospital or clinic PhilHealth accredits. PhilHealth publishes its lists on philhealth.gov.ph.
• Documents: PhilHealth’s benefits page asks for a copy of your Member Data Record or the PhilHealth Benefit Eligibility Form (PBEF), and PhilHealth Claim Form 1. The hospital prints the PBEF; a PBEF that says “YES” means the patient is entitled to the benefit.
• No co-payment in the ward. RA 11223 Sec. 9 says “no co-payment shall be charged for services rendered in basic or ward accommodation”. A basic or ward room means a shared room, regular meals, a fan and a shared toilet (Sec. 4). Circular No. 2024-0037 says this applies in public and private hospitals. In a private or upgraded room, the hospital may charge you the difference.
• Discounts first. Circular No. 2024-0037 says PhilHealth and legal discounts, such as the senior citizen and PWD discounts, come off the bill first; private insurance or an HMO then adds to what PhilHealth pays.

What PhilHealth leaves to you

A case rate is a fixed amount. If you choose a room above ward level, or the care costs more than the case rate, Circular No. 2024-0037 says the extra may be paid from other sources or out of pocket. Families sometimes use private health insurance or an HMO to cover that gap. Our guide to HMOs and health insurance explains the difference. Everything else about PhilHealth for OFWs and their families is on our PhilHealth guide.