PhilHealth: what it covers, Konsulta, and how it pays your hospital bill

PhilHealth is the one benefit most families use, and the one they understand least. People find out how it works at the billing counter, at the worst possible moment. The short version: it pays a fixed amount per illness straight off your hospital bill, covers your family too, and gives you free check-ups through Konsulta if you register. Here's how to make sure you get all of it.

Who is covered

Under the Universal Health Care Act, every Filipino is a PhilHealth member. Direct contributors (employed, self-employed, OFWs, voluntary members) pay premiums; indirect contributors like indigent families, senior citizens and 4Ps members are covered by the government. In 2024 and 2025 the premium is 5% of basic monthly salary, on a salary floor of ₱10,000 and ceiling of ₱100,000. Employees pay half and the employer pays the other half; self-employed members pay the full amount.

Your membership also covers your qualified dependents: a legal spouse who isn't a member, children below 21 who are unmarried and unemployed, children with disability of any age, and parents aged 60 and above who aren't members themselves. List them in your records before you need them.

Case rates: how the bill gets smaller

PhilHealth pays through case rates: a fixed amount for each illness or procedure, deducted from your bill before you pay. For example, a package for pneumonia or a cesarean section has one set amount, whether your hospital charges a little or a lot. If the bill is higher, you pay the difference (that's where an HMO or savings comes in). If the bill is lower, the case rate still applies up to the actual charges. Many case rates were raised in 2025, so check the current amount for your condition on the PhilHealth website.

• Confinement must be in an accredited hospital, usually for at least 24 hours (some day surgeries and procedures are exceptions).
• You get 45 days of coverage per year, and your dependents share another 45 days.
• The same illness within 90 days of discharge counts as one confinement and can't be claimed twice.
• In government hospitals, patients in basic accommodation shouldn't be charged beyond the case rate for covered services.

Konsulta: free primary care

Konsulta is PhilHealth's primary care benefit. Register with an accredited Konsulta provider (a health center or clinic near you), and you get free consultations, selected lab tests like CBC, urinalysis, blood sugar and chest X-ray, and selected medicines for common conditions such as hypertension, diabetes and asthma. In 2025 PhilHealth began expanding this into a wider primary care program (YAKAP), so ask your provider what's covered today. Registration is free through the member portal, the app, or the provider itself.

Before you go to the hospital

1. Check that your premiums are updated. Direct contributors generally need recent paid months (for example, 3 of the last 6) for a claim to be honored.
2. Bring your PhilHealth ID or Member Data Record and a valid government ID; for a dependent, bring proof of relationship.
3. Tell admissions you're a PhilHealth member and sign the claim form before discharge. The hospital files the claim; you don't claim cash afterward.
4. Ask the billing section to show the PhilHealth deduction on the statement. If it's missing, ask why before you pay.

Emergency and you're not updated? You can still be admitted. Tell the hospital anyway and settle your premiums as soon as possible; some claims can still be honored, and a PhilHealth desk is in most big hospitals.

Z benefits and other packages

For very expensive conditions, Z benefits cover much larger packages in contracted hospitals: certain cancers, kidney transplant, some heart surgeries and more. Dialysis is covered for up to 156 sessions a year. There are also outpatient packages for TB treatment, some chemotherapy, and the maternity care package for normal delivery in accredited birthing homes. If you or a family member has a serious diagnosis, ask the hospital's PhilHealth desk which package applies before treatment starts.

How to do it in Iponista

1. Log hospital and clinic spending under Health, with a note of what PhilHealth deducted, so you know your real out-of-pocket cost each year.
2. Add your PhilHealth premium in Plan → Bills & payday if you pay it yourself, so a missed month never blocks a claim.
3. Build a 'Medical fund' goal for the part of the bill that case rates don't cover.

Remember this

PhilHealth pays a fixed case rate straight off the bill, covers your dependents, and gives free primary care through Konsulta. It only works if your premiums are updated and you tell the hospital before discharge.

Do this today

Log in to the PhilHealth member portal, check your premiums and listed dependents, and register with a Konsulta provider near you.