PhilHealth benefits for members: what is covered
| Benefit | What PhilHealth pays | Source |
|---|---|---|
| Inpatient case rates | Fixed amount per condition, e.g. dengue ₱19,500, moderate-risk pneumonia ₱29,250, appendectomy ₱46,800 | PC 2024-0037 Annexes A–B (Jan 2025) |
| Maternity | Normal delivery ₱29,000; caesarean ₱58,000 | PC 2026-0005 (30 Apr 2026) |
| Hemodialysis | ₱6,350 per session, up to 156 sessions a year | PC 2024-0037 Annex C |
| Cataract (adult) | ₱20,200 per eye, up to ₱80,900 with a multifocal toric lens | PC 2025-0001 |
| YAKAP primary care | Free at public clinics; private clinics co-pay up to ₱900 a year | PA 2026-0003 |
| Ward accommodation | No co-payment in basic or ward rooms | RA 11223 Sec. 9 |
| Medicines, outpatient emergency, dental | Packages exist (GAMOT, OECB, oral health); check limits with PhilHealth | PhilHealth circulars 2024–2026 |
Sources: the PhilHealth circulars and advisories named. Case rates are split into a facility fee and a professional fee and are deducted from your hospital bill. As of November 2026.
Who is a member and who pays the premium
The premium is 5% of monthly income between ₱10,000 and ₱100,000. Work out yours with the PhilHealth contribution calculator, or all payroll deductions on the benefits hub.
| Member | Who pays | At ₱30,000 a month |
|---|---|---|
| Employee | Employee and employer, 50/50 | ₱750 + ₱750 |
| Self-employed, professional, voluntary, land-based OFW | The member, in full | ₱1,500 |
| Indigent, 4Ps, senior citizen, PWD and other indirect contributors | National government | ₱0 |
| Lifetime member (retirement age, 120 premiums) | No premium due | ₱0 |
Sources: RA 11223 Secs. 4, 10, 11; PhilHealth Circular 2026-0011; Advisory 2026-0042 (5%); Advisory 2025-0002 (₱10,000 floor, ₱100,000 ceiling). Amounts computed with the shared module. As of November 2026.
Monthly PhilHealth premium by income, 2026
Total premium; employees pay half
| Item | Monthly premium |
|---|---|
| ₱10,000 | ₱500 |
| ₱20,000 | ₱1,000 |
| ₱30,000 | ₱1,500 |
| ₱50,000 | ₱2,500 |
| ₱75,000 | ₱3,750 |
| ₱100,000 | ₱5,000 |
Can you use PhilHealth with unpaid premiums?
| Rule | Before UHC | Now |
|---|---|---|
| When you can use benefits | 3 months' premiums in the 6 months before (RA 10606) | Immediately on registration (RA 11223 Sec. 9) |
| Unpaid premiums | Could block benefits | Do not block benefits; arrears plus interest stay due |
| Self-paying members' arrears, Nov 2019–Dec 2025 | — | Interest waived and interest-free instalments of 12–60 months, on request, if you pay all premiums from 2026, empanel yourself and your dependents under YAKAP and update your records incl. declared income (PC 2026-0010 Sec. V.B.1); apply by 31 Dec 2027 (Sec. V.E.1). Principal stays due; seafarers excluded |
| Cannot afford to pay | — | Certificate of financial incapacity: reclassified as indirect |
Sources: RA 10606 Sec. 12; RA 11223 Sec. 9; PhilHealth Circular 2026-0011; PhilHealth Circular 2026-0010. Applications under PC 2026-0010 run to 31 December 2027 (PC 2026-0010 Sec. V.E.1). The "9 of 12 months" rule quoted online was not found in the law. As of November 2026.
Outside that waiver, late premiums still carry interest under RA 11223 Sec. 9: up to 1.5% a month, compounded, for self-earning members and at least 3% a month for employers.
PhilHealth services: what you can do online or at a branch
| Task | Where | Fee |
|---|---|---|
| Register | PhilHealth Member Portal, eGovPH app, or PMRF at a PhilHealth office | None |
| Update records or add dependents | PMRF marked Updating/Amendment, with proof | None |
| Get your Member Data Record | PhilHealth office with an ID, or the Member Portal | None |
| Get a PhilHealth ID | PhilHealth office with an ID | None |
| Check or pay premiums | Member Portal or eGov PH app; pay with the SPA | — |
| Use YAKAP | Register with an accredited YAKAP clinic | ₱0 public; up to ₱900 a year private |
| File a claim | Through the hospital, within 60 days of discharge (180 days abroad) | — |
Sources: PhilHealth Circular 2026-0011; Citizen's Charter 2024, Vol. 7; Advisories 2026-0003 and 2026-0042. As of November 2026.
Who can be your PhilHealth dependents?
| Dependent | Condition | Proof |
|---|---|---|
| Spouse | Legitimate spouse who is not a member | Marriage contract |
| Children | Unmarried, unemployed and under 21, including adopted, illegitimate, step- and foster children | Birth certificate or adoption papers |
| Children 21 and over | With a disability that makes them fully dependent | Medical proof |
| Parents | 60 or over below PhilHealth's income threshold, or permanently disabled | Member's and parent's birth certificates |
Sources: RA 7875 as amended by RA 9241 and RA 10606; PC 2024-0031 (foster children); Citizen's Charter 2024, Vol. 7. Senior citizens are covered in their own right under RA 10645. As of November 2026.
Common mistakes
| Mistake | What happens | Do this instead |
|---|---|---|
| Not using PhilHealth because of arrears | You pay the whole bill | Use it; settle arrears later |
| Choosing a private room without asking | Co-payment applies | Ask for basic or ward accommodation |
| Leaving dependents off your record | Delays at the hospital | Add them with a PMRF |
| Self-paying member skipping the year-end deadline | Interest up to 1.5% a month | Pay by 31 December |
Contributions and payroll
Your PhilHealth premium for any member type, and the other two payroll deductions.
Buod sa Tagalog
Lahat ng Pilipino ay miyembro ng PhilHealth sa ilalim ng Universal Health Care Act, at magagamit agad ang benepisyo. 5% ng buwanang kita ang premium ng mga direct contributor (₱500 hanggang ₱5,000), at gobyerno ang nagbabayad para sa mahihirap at senior citizen. Sagot ng PhilHealth ang bahagi ng bayarin sa ospital, ₱29,000 sa normal na panganganak, at libreng konsulta sa pampublikong YAKAP clinic.
Frequently asked questions
+How many times can I use my PhilHealth benefits in a year?
There is no longer a yearly day cap for most admissions: PhilHealth lifted the 45-day benefit limit from 4 April 2025 (PC 2025-0007), as long as each admission is medically necessary. Some packages keep their own limits, such as hemodialysis at up to 156 sessions a year.
+How much does PhilHealth cover in a hospital?
A fixed case rate per condition or procedure, deducted from your bill: for example ₱19,500 for dengue, ₱29,250 for moderate-risk pneumonia and ₱46,800 for an appendectomy (PC 2024-0037), or ₱29,000 for a normal delivery (PC 2026-0005). In basic or ward accommodation there is no co-payment under RA 11223.
+Can senior citizens be PhilHealth members?
Yes. Under RA 10645 every senior citizen is covered, with the premium paid by the national government as an indirect contributor. A senior who retired with at least 120 monthly premiums is a lifetime member and also pays nothing. Seniors who still work or earn may remain direct contributors.
+Can I use PhilHealth if I have unpaid contributions?
Yes. RA 11223 gives every member immediate eligibility, and failure to pay does not prevent you from using benefits. The unpaid premiums and interest remain due, but self-paying members can have the interest on November 2019 to December 2025 arrears waived and pay them in interest-free instalments (PC 2026-0010). If you genuinely cannot pay, a social worker's certificate of financial incapacity moves you to the government-paid indirect category.
+How much is the PhilHealth contribution in 2026?
5% of monthly income, from ₱500 to ₱5,000 a month, as confirmed by Advisory 2026-0042 in July 2026. Employees pay half and employers half; self-employed, voluntary and land-based OFW members pay all of it. No cut or suspension has been ordered.
+How do I claim PhilHealth benefits at the hospital?
Go to an accredited facility and show your PhilHealth number or ID. The hospital deducts the case rate from your bill and files the claim using the claim forms and signature form you sign. Local claims are due within 60 days of discharge; confinement abroad, within 180 days.
+What is PhilHealth YAKAP?
YAKAP (Yaman ng Kalusugan Program) is PhilHealth's primary care package, an evolution of the former Konsulta program (PC 2025-0017). You register with one accredited YAKAP clinic. Public clinics charge no fee, while private clinics may collect a co-payment of at most ₱900 per member per year (PA 2026-0003).
Sources and references
- RA 11223 — Universal Health Care Act — automatic membership, immediate eligibility, premiums, no co-payment in ward (checked November 12, 2026)
- PhilHealth Advisory 2026-0042 (21 July 2026) — 5% premium, ₱500 minimum, claims abroad (checked November 12, 2026)
- PhilHealth Circular 2026-0011 — self-paying members, registration channels, financial incapacity (checked November 12, 2026)
- PhilHealth Circular 2026-0010 — interest waiver and interest-free instalments on self-paying members' Nov 2019–Dec 2025 arrears (checked November 12, 2026)
- PhilHealth Advisory 2025-0002 — ₱10,000 floor and ₱100,000 ceiling (checked November 12, 2026)
- PC 2024-0037 Annex A — medical case rates — 50% adjustment from January 2025 (checked November 12, 2026)
- PC 2026-0005 — maternal case rates — ₱29,000 normal delivery, ₱58,000 caesarean (checked November 12, 2026)
- PhilHealth Advisory 2026-0003 — YAKAP: free at public clinics, ₱900 yearly cap at private clinics (checked November 12, 2026)
- PC 2025-0007 — lifting the 45-day limit — effective 4 April 2025 (checked November 12, 2026)
- PhilHealth Citizen's Charter 2024, Vol. 7 — registration, MDR, ID: no fee (checked November 12, 2026)
- PhilHealth Member Portal — official online services (checked November 12, 2026)
Back to the SSS, Pag-IBIG, PhilHealth and GSIS benefits hub for the combined contribution calculator and the other agencies.
Author and editorial review
Deepak Middha, Chartered Accountant
Chartered Accountant with 18 years in hedge funds; writes and maintains sulat.ph. Every rate, ceiling, deadline and fee on this page is taken from the law or the agency's own circulars and official announcements and was checked against that source on November 12, 2026. Where a figure could not be confirmed officially, the page says so.
Spotted an error or an outdated rule? Send a correction.
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