Monday, May 9, 2011

What PhilHealth is not...

This post is intended to clarify the misconceptions of some members with regard to the National Health Insurance Program (NHIP), PhilHealth as the administrator of the NHIP and benefits it offers.

  • PhilHealth does not provide a pension nor can you withdraw your contributions.
  • Contrary to the belief of some members, PhilHealth does not provide any financial benefits to members such as loans or pensions as compared to the other government institutions such as the Social Security System or the Government Service Insurance System. Moreover, unlike the GSIS or Pag-IBIG Fund where you are able to withdraw all or a portion of your contributions, the contributions you pay to PhilHealth cannot be withdrawn, unless in the case discussed here;

  • PhilHealth does not reimburse all expenses incurred when you are hospitalized.
  • At the present time, PhilHealth only covers or reimburses a portion of your hospitalization bills. As we see it, PhilHealth should eventually cover all of them, however, due to unavailable standards in the health industry such as standard professional fees, hospital room rates or prices of drugs and medicines, there is difficulty in setting the amount that may be reimbursed by PhilHealth, not to mention the fact that PhilHealth is maintaining the program's viability;

  • PhilHealth does not pay for all medical related services.
  • Unlike HMOs, PhilHealth does not cover preventive healthcare such as annual physical check-ups, counseling or routine immunization except those covered in the prenatal care package. The corporation also does not pay for oral health services, unless those requiring hospitalization;

  • PhilHealth does not provide different health coverage or packages.
  • Whether you are contributing more or less to the program, PhilHealth only offers a uniform or standard benefit service or rates. This means that no specific packages are available for those wanting to increase PhilHealth benefit rates or coverage;

  • PhilHealth only covers a limited number of out-patient benefits.
  • Among these benefits are day surgeries, dialysis and cancer treatments, treatment on tuberculosis through TB-DOTS health care facilities, normal spontaneous delivery up to the 4th child, new born care package, voluntary surgical contraception procedures, OPB malaria package, cataract package and the influenza AH1N1 package;

  • PhilHealth does not cover all drugs and medicines.
  • PhilHealth only covers the drugs and medicines as enumerated in the Philippine National Drug Formulary (PNDF) for the listing of compensable drugs and medicines click here. You may refer to this PhilHealth Advisory.

We will try to include additional information in relation to this post once we gather more data.


  1. No outpatient coverage? No coverage on check ups? Have they ever heard this quote -

    "An ounce of prevention is worth a pound of cure".

  2. where i could find the list of compensable drugs, medicine and supplies for hospital claims.. thanks.

    1. you can refer in this link:

  3. its just an advisory but the link returns an error or does not exist

  4. so nagbabayad lang pala ako ng philhealth ko para magkaroon lang ng discounts if ever lang na may mangyari pala sa akin?

    hindi na ako gagamit ng philhealth kahit kelan, di ko na sya gagamitin sa mga requirements ko