PhilHealth Case Rates: How the Deduction Works
Philippine Health Insurance Corporation · benefits
Quick answer
PhilHealth pays accredited health facilities through All Case Rates. The case rate is deducted by the facility from your total bill before discharge, and is inclusive of hospital charges and the attending physician's professional fees. You bring your MDR or a PBEF plus Claim Form 1.
Last verified
Where these figures come from
About these figures: the numbers below come from PhilHealth's official published sources: PhilHealth | Benefits (https://www.philhealth.gov.ph/benefits/, retrieved 2026-09-01); PhilHealth | Online Services (https://www.philhealth.gov.ph/services/, retrieved 2026-09-01); PhilHealth | Advisory No. 2026-0042, Reimbursement Claims Abroad and Premium Contributions (https://www.philhealth.gov.ph/advisories/2026/PA2026-0042.pdf, retrieved 2026-09-01). Agencies change fees and rates without notice, so confirm with PhilHealth before you rely on them. Last verified: 2026-09-01.
The thing to understand about a PhilHealth case rate is when it applies: it comes off your bill before you pay, not as a refund afterwards.
How the deduction works
| Step | What PhilHealth publishes |
|---|---|
| 1 | Inpatient benefits are paid to accredited Health Facilities through All Case Rates |
| 2 | The case rate amount is deducted by the Health Facility from the member’s total bill |
| 3 | That total bill includes the professional fees of attending physicians |
| 4 | The deduction happens prior to discharge |
| 5 | The case rate amount is inclusive of hospital charges and the attending physician’s professional fees |
So the number you care about is not what PhilHealth pays you. It is what comes off the bill at the cashier.
What you bring
| # | Document |
|---|---|
| 1 | A copy of the Member Data Record, or a PhilHealth Benefit Eligibility Form (PBEF) |
| 2 | A duly accomplished PhilHealth Claim Form 1 |
The MDR guide covers printing the record, and the forms guide the claim form set.
Finding your amount
This guide does not reproduce case rate amounts. PhilHealth publishes them through a Case Rates Search tool, described as providing members with information on PhilHealth benefit packages, rather than as a table this guide could read and verify. Use the search.
| Tool | What PhilHealth says it does |
|---|---|
| Case Rates Search | Provides members with information on PhilHealth benefit packages |
| Claims Eligibility Checking | Enables providers to ascertain the benefit availment eligibility of members |
Where it applies
| Setting | Rule |
|---|---|
| All accredited Health Facilities | The general case |
| Primary Care facilities | Different case rate amounts apply for selected medical conditions, under PhilHealth Circular 0037, s-2024 |
| Admissibility | Only admissible cases shall be reimbursed |
Outpatient
| Benefit | Detail |
|---|---|
| Day surgeries | Ambulatory or outpatient surgeries, covering elective, that is non-emergency, surgical procedures ranging from minor to major operations |
PhilHealth publishes further outpatient benefits beyond day surgeries. This guide covers only what was read from its Benefits page.
Abroad
| Rule | Detail |
|---|---|
| Who | OFWs and dependents, wherever they are abroad |
| What | Reimbursement of confinements overseas at the applicable PhilHealth All Case Rate |
| Filing window | 180 days from the date of discharge |
| Back in the Philippines | Other benefits and services including YAKAP and the Z benefits from contracted providers |
Note the difference in mechanism: at home the case rate is deducted at the facility; abroad it is reimbursed to you afterwards, and only if you file within 180 days.
What the cover costs you
| Monthly income | Monthly premium | Annually |
|---|---|---|
| ₱10,000.00 and below | ₱500.00 | ₱6,000.00 |
| ₱20,000.00 | ₱1,000.00 | ₱12,000.00 |
| ₱30,000.00 | ₱1,500.00 | ₱18,000.00 |
| ₱50,000.00 | ₱2,500.00 | ₱30,000.00 |
| ₱100,000.00 and above | ₱5,000.00 | ₱60,000.00 |
Rate 5.0% effective January 2025, floor ₱10,000.00, ceiling ₱100,000.00. Dependents are covered at ₱0.00 extra. The contribution table and the dependents guide cover both.
Coverage does not wait for payment
| Rule | Detail |
|---|---|
| Eligibility | Immediate upon enrolment, under RA 11223 |
| Missed premiums | Failure to pay shall not prevent the enjoyment of any Program benefits |
| But | All missed contributions plus interest must be paid |
| Interest | Compounded monthly, not exceeding 1.5% |
| Deadline | December 31, grace to January 31 |
Where the other agencies pay cash instead
PhilHealth deducts from a bill. These pay you or your family directly.
| Agency | Benefit | Published amount |
|---|---|---|
| SSS | Sickness benefit | Covered in that guide |
| SSS | Disability pension | Minimum ₱1,000, ₱1,200 or ₱2,400 by credited years |
| SSS | Funeral benefit | ₱12,000 fixed, or ₱20,000 to ₱60,000 |
| OWWA | MEDPLUS supplementary medical assistance | Up to ₱50,000 per OFW-member |
| OWWA | Disability benefit | ₱2,500.00 to ₱100,000.00 |
| OWWA | Death benefit | ₱100,000.00 or ₱200,000.00, plus ₱20,000.00 burial |
An OFW member can hold PhilHealth, SSS and OWWA cover at once; they are separate systems with separate contributions. SSS for OFWs and OWWA membership cover the other two.
What this page does not cover
PhilHealth does not publish, on the pages read for this guide, case rate amounts as a readable table, the list of accredited health facilities, the criteria for an admissible case, the full outpatient benefit list beyond day surgeries, the Z benefit package amounts, or the claim filing deadline for a domestic confinement. None of those are stated here, and the Case Rates Search is PhilHealth’s own route to the amounts.
Related
The MDR guide covers the document a facility asks for, the forms guide Claim Form 1, and the YAKAP guide the primary care programme that aims to keep you out of the ward.
Frequently asked questions
- How does a PhilHealth case rate work?
- Inpatient benefits are paid to accredited health facilities through All Case Rates. PhilHealth states the case rate amount is deducted by the health facility from the member's total bill, which includes the professional fees of attending physicians, prior to discharge.
- Does it cover the doctor's fee?
- Yes. PhilHealth states the case rate amount is inclusive of hospital charges and the professional fees of the attending physician.
- How do I find the amount for my condition?
- PhilHealth publishes a Case Rates Search among its online services, which it describes as providing members with information on PhilHealth benefit packages. This guide does not reproduce case rate amounts, because PhilHealth publishes them through that search rather than as a page this guide could read.
- What do I bring to the hospital?
- A copy of your Member Data Record or a PhilHealth Benefit Eligibility Form, the PBEF, plus a duly accomplished PhilHealth Claim Form 1.
- Where can I use it?
- All accredited Health Facilities. PhilHealth notes that different case rate amounts apply for selected medical conditions when done in Primary Care facilities, under PhilHealth Circular 0037, s-2024.
- Is every admission covered?
- No. PhilHealth states plainly that only admissible cases shall be reimbursed.
- What about outpatient treatment?
- PhilHealth publishes outpatient benefits including day surgeries, that is ambulatory or outpatient surgeries covering elective non-emergency surgical procedures ranging from minor to major operations.
- What if I am confined abroad?
- OFWs and dependents, wherever they are abroad, are entitled to benefits through reimbursement of overseas confinements at the applicable PhilHealth All Case Rate, with claims filed within 180 days from the date of discharge.
More PhilHealth guides
Sources
- PhilHealth | Benefits, retrieved
- PhilHealth | Online Services, retrieved
- PhilHealth | Advisory No. 2026-0042, Reimbursement Claims Abroad and Premium Contributions, retrieved