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FOR LIMITED DISTRIBUTION
PHILIPPINE HEALTH INSURANCE
CORPORATION MATERNITY HEALTH
CARE PROGRAM
PhilHealth is the country’s national insurance coverage program. One
major component is its Maternity Care Package. According to the News
Today 11/2/09 Iloilo city:
Following the unparalleled increase in PhilHealth benefits last April 5,
2009 up by 35 percent without a consequent increase in premium
contribution, PhilHealth in its continuous drive to provide its members with
their much needed medical protection attuned to the increasing costs of
hospitalization, has increased its Normal Spontaneous Delivery (NSD) and
Maternity Care Packages (MCP) with additional PHP2,000 from PHP4,500 to
PHP6,500.
This new case rate covers normal deliveries of the first four (4) births
availed through accredited hospital and non-hospital (lying-in clinics, birthing
homes or midwife-managed clinics) facilities.
Inclusive of the PHP6,500 are payment for the facility, prenatal care
and professional fee. For patients confined at the hospital, facility fee
component which covers room & board; drugs & medicines; laboratory,
supplies & other ancillary procedures; labor, delivery and recovery room and
other medically necessary charges will be paid at PHP2,500. The other
PHP2,500 is payment for the professional fee of the attending doctor for the
delivery, immediate post-partum care and counseling services rendered while
the remaining PHP1,500 is for re-imbursement of member’s prenatal
expenses for medicines, laboratory tests and ancillary procedures, tetanus
immunization and prenatal consultation prior to delivery provided these are
supported by official receipts.
However, for availment of Maternity Care Package (MCP) through nonhospital facilities will also cover PHP5,000 as payment for the facility and
professional fees while re-imbursement for member’s prenatal expenses will
be paid at PHP1,500 upon submission of valid official receipts.
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This case was written by Prof. Francisco L. Roman DBA, Asian Institute of Management. All case materials
are prepared solely for the purposes of class discussion. They are neither designed nor intended to
illustrate the correct or incorrect management of problems or issues contained in the case.
Copyright 2010, between Prof. Francisco L. Roman DBA and Asian Institute of Management, Makati City,
Philippines, http://www.aim.edu. No part of this publication may be reproduced, stored in a retrieval
system, used in a report or spreadsheet, or transmitted in any form or by any means - electronic,
mechanical, photocopying, recording, or otherwise - without the consent of the Asian Institute of
Management. To order copies, interested parties must secure a Site License Agreement from the
Knowledge Resource Center - Library Casebank, AIM, 123 Paseo de Roxas, Makati City 1260, Philippines,
Tel. No. (632) 892-4011 local 164/214/212; Telefax: (632) 817-2663 or e-mail krc@aim.edu.
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“The PHP6,500 case rate for normal delivery in non-hospital facilities
like maternity and mid-wife clinics is sufficient enough to cover all the
medical expenses of the patient,” said Dra. Bernadette Reynes, Head of the
Accreditation & Quality Assurance Section of PhilHealth Regional Office VI.
According to her, member will no longer need to pay for other expenses thus
ensuring PhilHealth patients 100 percent coverage of the package. “RHUs
accredited as Maternity Center as well as other birthing homes are expected
to provide such services to PhilHealth patients for free so that members
availing the MCP benefits will no longer incur out of the pocket expense,” she
added.
Aside from the NSD/MCP package, newly born babies are also entitled
to the routine newborn care (NCP) including newborn screening at a case
rate of PHP1,000 as an add-on to the benefits availed by the patient-mother.
In another report in the PIA Daily News Reader, 4/28/09 Legazpi City:
PhilHealth Bicol regional director Orlando Iñigo, Jr. bared that normal
spontaneous delivery (NSD) coverage extends to the first four births. He
explained that normal birth is characterized by spontaneous onset of labor;
low risk at the start of labor, throughout labor, and delivery; infant in vertex
position; and 37-42 weeks of completed pregnancy. He explained further
that this amendment applies only to normal (uncomplicated) vaginal
deliveries in both accredited hospitals and lying-in clinics. He added that for
non-hospital providers of the maternal care package, (e.g., lying-in clinics,
birthing homes, midwife-managed clinics), the first prenatal visit of patient
must not exceed the 16 weeks age of gestation. Patients who do not satisfy
this criterion should be referred to accredited hospitals to qualify for the
normal spontaneous delivery package.
"Excluded in this package are the 5th normal spontaneous deliveries
and subsequent births. Also excluded are those pregnancies resulting to
abortions since they are not covered by the limitation of coverage of NSD of
the first four births," he noted. "Those with history of medical conditions
(e.g., hypertension, pre-eclampsia, eclampsia, heart disease, diabetes,
thyroid disorder, morbid obesity, moderate to severe asthma, epilepsy, renal
disease, bleeding disorders) are also excluded as well as those with other risk
factors that may arise during present pregnancy (e.g. premature
contractions, vaginal bleeding) that should be referred for further
management," the director added.
Iñigo elaborated that the following conditions remain to be excluded in
PhilHealth accredited non-hospital facilities:
a. Maternal age under 19 years old;
b. First pregnancy of patients aged 35 years and older;
c. Multiple pregnancy;
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Asian Institute of Management
Copyright 2010
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FOR LIMITED DISTRIBUTION
Philippine Health Insurance Corporation Maternity Health Care Program
3
d.
e.
f.
g.
h.
Ovarian abnormality (ovarian cyst);
Uterine abnormality (myoma uteri);
Placental abnormality (placenta previa);
Abnormal fetal presentation (e.g. breech);
History of three or more miscarriages/abortion; one stillbirth;
major obstetric and/or gynecologic operation (e.g. cesarean
section, uterine myomectomy);
i. History of medical conditions (e.g. hypertension, pre-eclampsia,
eclampsia, heart disease, diabetes, thyroid disorder, morbid
obesity, moderate to severe asthma, epilepsy, renal disease,
bleeding disorders); and
j. Other risk factors that may arise during present pregnancy (e.g.
premature contractions, vaginal bleeding) that warrants a referral
for further management.
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Asian Institute of Management
Copyright 2010
AIM-X-XX-XXXX-XX
FOR LIMITED DISTRIBUTION
Philippine Health Insurance Corporation Maternity Health Care Program
4
___________________________________________________________________________
Asian Institute of Management
Copyright 2010
AIM-X-XX-XXXX-XX
FOR LIMITED DISTRIBUTION
Philippine Health Insurance Corporation Maternity Health Care Program
5
Please refer to the attachment “Guidelines” on Claim Forms
consisting of Pages 1 & 2 out of 7 pages that is required for the
voucher scheme.
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Asian Institute of Management
Copyright 2010