Complete Guide to PhilHealth Benefits and Coverage (2026)

PhilHealth covers all Filipino citizens under the Universal Health Care Act. In 2026, the contribution rate remains at 5% of your monthly salary (₱500–₱5,000/month). Major benefits include inpatient case rates that were increased by 50% in January 2025, maternity packages up to ₱37,050, dialysis coverage for 156 sessions/year, dental benefits up to ₱1,000/year, and Z-Benefits covering catastrophic illnesses like cancer and kidney transplants worth over ₱1 million.

PhilHealth has undergone massive changes in 2025 and early 2026 — benefit increases, lifted restrictions, new outpatient coverage, and the transition to the YAKAP platform. This guide breaks down everything you need to know as a member, dependent, or OFW.

Who Is Covered by PhilHealth?

Under Republic Act 11223 (Universal Health Care Act), all Filipino citizens are entitled to PhilHealth coverage. Members fall into these categories:

Direct Contributors (Mandatory):

• Employees in the formal sector (contribution split with employer)
• Self-employed individuals and freelancers
• Overseas Filipino Workers (OFWs)
• Kasambahays (household helpers)

Indirect Contributors:

• Indigent members (premiums paid by LGUs)
• Senior citizens (premiums paid by government)
• 4Ps/Pantawid Pamilya beneficiaries

Voluntary Members:

• Filipinos not currently employed can register at any PhilHealth Local Insurance or Express Office

Lifetime Members:

• Aged 60+ with at least 120 monthly contributions — no further payments needed

Who Are Your Dependents?

Your PhilHealth membership also covers:

• Your legal spouse
• Children under 21 years old (unmarried, unemployed)
• Parents aged 60 and above

How to Check Your Membership Status

Visit PhilHealth's Member Inquiry Portal to check your contributions, download your Member Data Record (MDR), and verify your benefit eligibility.

PhilHealth Contribution Rates (2026)

The premium rate stays at 5% of your Monthly Basic Salary for 2026 — no increase from 2025. This is the ceiling rate under the UHC Act.

For self-employed and voluntary members: You pay the full 5% yourself.

For OFWs: Land-based OFWs pay ₱6,000/year (₱500/month). Sea-based OFWs follow the salary-based rate, shared with their manning agency.

Inpatient Benefits

PhilHealth uses a case rate system — each medical condition has a fixed reimbursement amount that covers facility fees (room, medicines, labs) and professional fees (doctors, surgeons, anesthesiologists).

50% Case Rate Increase (January 2025)

PhilHealth implemented a 50% increase across approximately 9,000 benefit packages effective January 1, 2025 — effectively doubling the original rates that had been unchanged since 2014.

Two Major Restrictions Lifted

45-Day Limit — REMOVED (April 2025): There is no longer a 45-day annual cap on hospitalization. PhilHealth will now cover confinements beyond 45 days, subject to review.

Single Period of Confinement — REMOVED (October 2024): Members readmitted for the same illness within 90 days can now avail of benefits. Previously, this rule caused denial of 26,750 claims in 2023 alone.

Outpatient Benefits

YAKAP / Konsulta Package

The YAKAP program (replacing the old Konsulta system) provides primary care benefits at enrolled providers:

• Unlimited primary care visits
• 13 diagnostic tests including CBC, urinalysis, fasting blood sugar, lipid profile, and chest X-ray
• 75 essential medicines for chronic conditions (hypertension, diabetes, asthma, high cholesterol)
• 6 cancer screening tests
• Annual health screening

Outpatient Emergency Care Benefit (NEW — January 2025)

A brand-new benefit covering 342 outpatient emergency services, medicines, and supplies. This applies to emergency department visits where you are treated and discharged within 24 hours (no hospital admission). Land ambulance services are also being added.

Dialysis Coverage (Massively Expanded)

This is one of the biggest benefit expansions in PhilHealth history — annual dialysis coverage nearly tripled.

Maternity and Newborn Benefits

The Newborn Care Package covers newborn screening, hearing test, and essential newborn care. Prenatal and postnatal care (follow-up visits within 72 hours and 1 week after delivery) are included in the Maternity Care Package.

Dental Benefits

PhilHealth now covers preventive oral health services under YAKAP — a benefit many Filipinos are still unaware of.

Covered procedures:

• Mouth examination and oral screening
• Oral prophylaxis (teeth cleaning)
• Fluoride varnish application
• Pit and fissure sealant (max 2 teeth/year)
• Emergency tooth extractions

At public dental clinics, co-payments are prohibited — the service is free. At private clinics, maximum co-payments range from ₱600 to ₱1,500 depending on the procedure.

Not covered: Braces, teeth whitening, dental implants, veneers, dentures, root canal treatment, and cosmetic procedures. For more details, read our PhilHealth Dental Benefits Guide.

Z-Benefits (Catastrophic Illness Coverage)

Z-Benefits cover the most expensive medical conditions. They require pre-authorization and are available only at selected contracted hospitals.

Notable gap: Lung cancer is currently NOT covered under Z-Benefits. A nationwide patient petition was launched in early 2026 urging PhilHealth to add it.

Other Benefit Packages

Mental health benefits cover screening, diagnostics, psychotherapy, follow-up visits with psychiatrists or psychologists, and psychoeducation. Available at RHUs, city health offices, and DOH Mental Health Access Program sites.

How to File a PhilHealth Claim

At Accredited Facilities (Most Common)

1. Present your PhilHealth ID or Member Data Record (MDR) upon admission
2. The hospital verifies your membership and eligibility
3. Fill out Claim Form 1 (CF1) — your personal and medical data
4. The hospital fills out Claim Form 2 (CF2) — details of services rendered
5. Sign the Claim Signature Form (CSF)
6. PhilHealth benefit is deducted from your bill automatically
7. The hospital files the claim with PhilHealth on your behalf

For Reimbursement (Non-Accredited Facilities)

1. Pay the full hospital bill upfront
2. Gather required documents (CF1, CF2, CSF, valid ID, proof of contributions)
3. File for reimbursement at the nearest PhilHealth office
4. PhilHealth refunds the covered amount directly to you

Deadline: Claims must be filed within 60 calendar days from discharge. For OFWs hospitalized abroad: 180 days.

How to Find PhilHealth-Accredited Clinics

You can search for accredited hospitals, clinics, and YAKAP providers through:

• PhilHealth's official directory: philhealth.gov.ph/partners/providers/facilities/accredited/
• PhilHealth interactive map: philhealth.gov.ph/partners/providers/institutional/map/
• ClinicFinderPH: Search for PhilHealth-accredited clinics near you — filter by location, specialty, and PhilHealth accreditation status

The YAKAP Transition: What You Need to Know

PhilHealth is migrating from the old eKonsulta (eKon) system to YAKAP (Yaman ng Kalusugan Program) — a modernized primary care platform with Electronic Medical Records.

What this means for you: During the transition period, some clinics may experience temporary processing delays. If your regular clinic hasn't switched yet, ask if they have a timeline for their YAKAP migration. About 800 private hospitals are still at risk of being excluded from YAKAP if they don't install EMR systems by June 2026.

PhilHealth Finances: The ₱600 Billion Controversy

In 2025, PhilHealth received zero government subsidy — justified by its roughly ₱600 billion reserve fund. This sparked controversy:

• Medical experts documented a ₱356.6 billion shortfall from 2023–2025
• The Supreme Court ordered the return of ₱60 billion previously transferred to the National Treasury
• For 2026, PhilHealth received a ₱129.76 billion budget, including the restored ₱60 billion

The good news: more money flowing into PhilHealth means the benefit expansions described above are funded and sustainable for now.

Tips for Maximizing Your PhilHealth Benefits

1. Keep your contributions current. You need at least 3 monthly contributions within the last 6 months (or 9 within the last 12 months) before confinement to be eligible.
2. Always go to accredited facilities. You avoid the hassle of filing for reimbursement, and the PhilHealth deduction is applied automatically to your bill.
3. Know your case rate. Use PhilHealth's Case Rates Search Tool to check how much is covered for your condition before admission.
4. Don't forget outpatient benefits. The YAKAP/Konsulta package gives you free primary care visits, lab tests, and medicines — most members never use these.
5. Get your dental check-up. Free at public clinics, up to ₱1,000 coverage at private clinics. Many Filipinos don't know this benefit exists.
6. Avail Z-Benefits for serious illness. If diagnosed with cancer, kidney failure, or other catastrophic conditions, ask your doctor about Z-Benefit pre-authorization. Coverage can exceed ₱1 million.

Find a PhilHealth-Accredited Clinic Near You

Looking for a clinic that accepts PhilHealth? Search on ClinicFinderPH — we list over 19,000 clinics across the Philippines with PhilHealth accreditation status, services, operating hours, and contact details.

Frequently Asked Questions

How much is the PhilHealth contribution in 2026?

The premium rate is 5% of your Monthly Basic Salary, with a floor of ₱10,000 and ceiling of ₱100,000. This means monthly contributions range from ₱500 to ₱5,000. For employees, the cost is split equally between you and your employer (2.5% each). There is no rate increase for 2026.

What does PhilHealth cover for hospitalization?

PhilHealth uses a case rate system that covers both facility fees (room, medicines, labs) and professional fees (doctors). As of January 2025, case rates were increased by 50% across approximately 9,000 benefit packages. Common conditions like pneumonia (₱29,500), appendectomy (~₱24,000), and cesarean section (₱37,050) are covered. The 45-day annual hospitalization limit has been removed.

Does PhilHealth cover dental procedures?

Yes. PhilHealth now covers preventive oral health services including teeth cleaning, oral screening, fluoride application, pit and fissure sealants, and emergency extractions. Maximum coverage is ₱1,000 per year. Services are free at public dental clinics. Cosmetic procedures like braces, whitening, and implants are not covered.

How do I file a PhilHealth claim?

At accredited facilities, the process is automatic — present your PhilHealth ID or MDR upon admission, fill out the claim forms (CF1, CSF), and the hospital deducts the benefit from your bill and files the claim directly. For non-accredited facilities, you pay upfront and file for reimbursement at a PhilHealth office within 60 days of discharge.

Are my dependents covered by PhilHealth?

Yes. Your PhilHealth membership covers your legal spouse, children under 21 (unmarried and unemployed), and parents aged 60 and above. Under the Universal Health Care Act, all Filipino citizens are entitled to coverage regardless of employment status.

Does PhilHealth cover cancer treatment?

Yes, through Z-Benefits for catastrophic conditions. Breast cancer coverage reaches up to ₱1.4 million, kidney transplants over ₱1 million (living donor) or ₱2.14 million (deceased donor), and childhood leukemia covers a full treatment course. Z-Benefits require pre-authorization and are available at selected contracted hospitals. Note that lung cancer is not yet covered under Z-Benefits as of 2026.

What is the YAKAP program?

YAKAP (Yaman ng Kalusugan Program) is PhilHealth's modernized primary care program replacing the old eKonsulta system. It provides unlimited primary care visits, 13 diagnostic tests, 75 essential medicines, cancer screening, dental services, and annual health assessments at enrolled clinics. The transition from eKonsulta to YAKAP will be completed by July 1, 2026.

Can OFWs use PhilHealth benefits?

Yes. OFWs can use PhilHealth benefits at accredited facilities in the Philippines. If hospitalized abroad, OFWs can file for reimbursement within 180 days of discharge. Qualified dependents in the Philippines can also avail of benefits while the principal member is working overseas. Land-based OFW premium is ₱6,000/year.

Last updated: March 2026. PhilHealth benefits and policies may change — visit philhealth.gov.ph for the latest information.