PhilHealth maternity benefit: what it covers and how to claim

PhilHealth’s maternity benefit pays the clinic, birthing home or hospital for care from the first prenatal check-up to the weeks after the birth: at least eight prenatal check-ups and the routine prenatal tests, a normal delivery or a caesarean section, three postpartum visits, and the Newborn Care Package for the baby. New rates took effect on 30 April 2026. Every pregnant person enrolled in PhilHealth is eligible from the start, members and their qualified dependents alike, and there is no limit on the number of births.

The packages and what they include

PhilHealth issued two circulars in 2026: No. 2026-0006 (Revision 1) for care in birthing homes, lying-in clinics, primary care clinics such as YAKAP clinics, hospital outpatient departments and laboratories, and No. 2026-0005 for births in hospitals. The amounts below are what PhilHealth pays the facility, in Philippine pesos, as the circulars set them.

Before the birth (Circular No. 2026-0006):

Scroll the table sideways for more

The check-ups include the consultation, an examination, supplements such as iron and folic acid, health education and a written birth plan, and later fetal growth monitoring and a tetanus vaccine if needed. The circular says the routine prenatal tests “should be at no cost to the patient”. If a private provider sees you more than eight times, it may charge for the extra visits, but no more than PHP 900 for the whole pregnancy.

The birth:

Scroll the table sideways for more

A caesarean section is covered when it is medically needed, as the circular puts it, “obstetrically and medically indicated”. If a mother in labour is moved from a birthing home to a hospital, PhilHealth covers care in both places.

In the ward and in a semi-private room. In a basic or ward room, Circular No. 2026-0005 says hospitals “shall not balance bill patients in excess of the amount paid by PhilHealth” for anything the package covers, in public and private hospitals. For a normal delivery in a semi-private room, the same circular caps what the hospital can charge you on top at PHP 23,000. PhilHealth’s English Q&A on this circular says PHP 3,000, but its own table shows PHP 23,000; confirm with PhilHealth before you’re admitted. The Filipino Q&A also gives PHP 23,000.

After the birth: three postpartum visits, paid at PHP 1,350 in all, covering supplements, family planning, help with breastfeeding and nutrition, and mental health screening and support (Circular No. 2026-0006).

For the baby: the Expanded Newborn Care Package, PHP 5,752.50 since 1 January 2025 (Circular No. 2024-0037, Annex B). PhilHealth’s Q&A says it covers essential newborn care (such as drying the baby, skin-to-skin contact, timely cord clamping, eye care, vitamin K and the first doses of the hepatitis B and BCG vaccines), newborn screening and the hearing test. Circular No. 2026-0006 says newborns are covered automatically and that new newborn benefits will come in a separate circular. None had been published by 20 October 2026.

Who qualifies

• Every pregnant person enrolled in PhilHealth, from the start. Circular No. 2026-0006 says they “shall be immediately eligible to avail of PhilHealth benefits”, in line with the Universal Health Care Act.
• Members and their qualified dependents. PhilHealth’s Q&A on Circular No. 2026-0005 says “All PhilHealth members and their qualified dependents are eligible”. A wife covered as your dependent must be declared on your record. See PhilHealth dependents.
• Any number of births. Circular No. 025-2015 removed any limit on the number of births, covering deliveries “regardless of parity”, and the 2026 circulars set none.

How to use it

1. Choose PhilHealth-accredited providers for the check-ups, the tests and the birth. You can see different accredited providers for different trimesters, and move to another clinic with a referral letter from your current one.
2. Bring your prenatal record to every visit. Circular No. 2026-0006 accepts the Mother-Baby Book, Rekord ni Nanay or a similar DOH record as the prenatal record, and both you and the clinic keep a copy.
3. Bring a valid ID. Circular No. 2022-0013 says you may need one to prove who you are. No printed Member Data Record is needed: Circular No. 2026-0005 says claims “shall not require a printed copy of the member data record (MDR)”, and accredited facilities deduct PhilHealth’s share “any time or day of the week upon patient discharge”. PhilHealth’s benefits page still lists a copy of the MDR or the eligibility form (PBEF) and Claim Form 1, so a copy is a useful backup.
4. Sign the claim forms the facility prepares. The facility files the claim with PhilHealth.

If you are asked to buy medicines or supplies that the package covers, Circular No. 2026-0005 says you are entitled to a full refund from the provider. You can raise problems with PhilHealth’s Action Center at actioncenter@philhealth.gov.ph. For how case rates come off a hospital bill, see our guide to PhilHealth case rates.

Giving birth abroad. Circular No. 2026-0005 allows direct filing for a confinement abroad, and PhilHealth pays the part not covered by other insurance, up to its published rate. PhilHealth’s OFW brochure (as of August 2026) gives ofp@philhealth.gov.ph for overseas claims; ask there what to send.

PhilHealth and SSS maternity are different

They are two separate benefits. PhilHealth pays the clinic or hospital for the care. SSS pays a cash maternity benefit to the woman who is the SSS member. A family can use both. See our guide to the SSS maternity benefit.

Planning the other costs

PhilHealth’s Q&A on Circular No. 2026-0006 says there is “no payment required … for all services covered under this benefit as long as basic accommodation is used for delivery”. What can add to the bill: tests the package does not include, a semi-private or private room, and check-ups beyond the eight. Our guide to PhilHealth benefits covers the rest of what PhilHealth pays. Everything else about PhilHealth for OFWs and their families is on our PhilHealth guide.