Quick Answer: Yes, PhilHealth now covers preventive dental services for all members. Coverage includes mouth examination, oral prophylaxis (teeth cleaning), fluoride varnish application, pit and fissure sealants, and emergency tooth extraction. The maximum benefit is ₱1,000 per year, available at PhilHealth-accredited dental clinics.
Table of Contents
- What Dental Procedures Does PhilHealth Cover?
- PhilHealth Dental Coverage Amounts
- What's NOT Covered by PhilHealth
- How to Use Your PhilHealth Dental Benefits
- How to Find PhilHealth-Accredited Dental Clinics
- Maximizing Your PhilHealth Dental Benefits
- FAQs
Introduction
Many Filipinos don't realize that PhilHealth now includes dental coverage as part of its benefit package. The PhilHealth Board of Directors approved the Preventive Oral Health Services Package, making it the first time dental care has been covered under the national health insurance program.
This is part of the government's "Ngiting 70-20" vision, which aims to ensure that more Filipinos reach age 70 with at least 20 permanent teeth intact. Whether you're a PhilHealth member through employment, voluntary contribution, or as a dependent, you're entitled to use these benefits.
This guide explains exactly what's covered, how much you can save, and how to use your PhilHealth dental benefits in 2026.
What Dental Procedures Does PhilHealth Cover?
PhilHealth's Preventive Oral Health Services Package covers the following dental procedures:
Covered Procedures
| Procedure | Covered? | Details |
|---|---|---|
| Mouth Examination / Oral Screening | Yes | Included in visit package |
| Oral Prophylaxis (Teeth Cleaning) | Yes | Part of preventive visit |
| Fluoride Varnish Application | Yes | Applied after cleaning |
| Pit and Fissure Sealant | Yes | Max 2 teeth per year |
| Class V Procedure (Cervical Filling) | Yes | Max 2 teeth per year |
| Emergency Tooth Extraction | Yes | As needed |
| Dental Consultation | Yes | Included with services |
How Coverage Works
PhilHealth dental benefits are delivered through the Konsulta Package, which is PhilHealth's primary care program. You can avail of services from:
- Konsulta Package providers with dental services on-site
- Stand-alone dentists who receive referrals from Konsulta providers
The benefit is designed as preventive care. The focus is on keeping your teeth healthy through regular cleanings, early detection of dental issues, and protective treatments like fluoride and sealants.
What Each Procedure Involves
Oral Prophylaxis (Teeth Cleaning): Professional removal of plaque and tartar buildup that regular brushing can't address. Recommended at least once a year to prevent gum disease and cavities.
Fluoride Varnish Application: A protective coating applied to your teeth after cleaning. Fluoride strengthens enamel and helps prevent tooth decay. This is especially beneficial for children and those prone to cavities.
Pit and Fissure Sealant: A thin coating applied to the chewing surfaces of back teeth (molars) to prevent food and bacteria from getting trapped in the grooves. Most effective for children and adolescents.
Emergency Tooth Extraction: Removal of a tooth that is causing acute pain, infection, or other urgent dental problems. This covers emergency situations, not elective extractions.
PhilHealth Dental Coverage Amounts
PhilHealth pays a maximum of ₱1,000 per member per year for preventive oral health services. Here's how it breaks down:
| Visit / Service | PhilHealth Pays | When |
|---|---|---|
| 1st Visit (exam, cleaning, fluoride) | ₱300 | Anytime during the year |
| 2nd Visit (same services) | ₱300 | At least 4 months after 1st visit |
| Pit & Fissure Sealant or Class V (per tooth) | ₱200 | Max 2 teeth per year |
| Total Maximum per Year | ₱1,000 |
Co-Payment Rules
Your out-of-pocket costs depend on whether you visit a public or private dentist:
| Public Dentist | Private Dentist | |
|---|---|---|
| Exam + Oral Prophylaxis | No co-payment | Up to ₱1,500 co-pay per visit |
| Pit & Fissure Sealant / Class V | No co-payment | Up to ₱600 co-pay |
| Emergency Tooth Extraction | No co-payment | Up to ₱600 co-pay |
Key takeaway: If you visit a public dentist (government health center), the covered services are completely free. Private dentists may charge additional fees up to the maximum co-payment amounts listed above.
What's NOT Covered by PhilHealth
PhilHealth dental coverage focuses on preventive care. The following procedures are not covered:
- Braces and orthodontic treatment — All types of braces, retainers, and orthodontic appliances are excluded
- Teeth whitening — Considered a cosmetic procedure
- Dental implants — Not included in the preventive package
- Veneers and cosmetic crowns — Aesthetic dental work is not covered
- Dentures — Full and partial dentures are not included
- Root canal treatment — Endodontic procedures are not part of the package
- Non-emergency extractions — Only emergency extractions are covered
- Cosmetic procedures — Any dental work done primarily for appearance
For these procedures, you'll need to pay out of pocket or use HMO coverage if you have it. Many clinics offer installment plans for expensive treatments like braces. You can compare dental clinic prices on ClinicFinderPH to find affordable options.
How to Use Your PhilHealth Dental Benefits
Follow these steps to use your PhilHealth dental coverage:
Step 1: Verify Your PhilHealth Membership
Make sure your PhilHealth membership is active and contributions are updated. You can check your status through:
- The PhilHealth website (philhealth.gov.ph) member portal
- The PhilHealth mobile app
- Any PhilHealth Local Health Insurance Office (LHIO)
- Your employer's HR department (if employed)
Step 2: Find a PhilHealth-Accredited Dental Clinic
Your dental benefits must be used at accredited facilities. You have two options:
- Visit a PhilHealth Konsulta Package provider that has dental services
- Get a referral from your Konsulta provider to a stand-alone accredited dentist
You can search for PhilHealth-accredited dental clinics on ClinicFinderPH using the PhilHealth filter.
Step 3: Bring the Required Documents
When visiting the clinic, bring:
- PhilHealth ID or Member Data Record (MDR) — proves your membership
- Valid government ID — for identity verification
- PhilHealth Claim Form 1 (CF1) — you can download this from the PhilHealth website or get it at the clinic
Step 4: Inform the Clinic You'll Use PhilHealth
Tell the receptionist or dental staff that you want to avail of your PhilHealth dental benefit before any treatment begins. The clinic will:
- Verify your PhilHealth eligibility
- Issue a PhilHealth Benefit Eligibility Form (PBEF)
- Proceed with the covered dental services
Step 5: Pay Any Remaining Balance
If you visit a private dentist, you may need to pay a co-payment. The clinic will handle the PhilHealth claim filing on your behalf. Keep your receipt for your records.
How to Find PhilHealth-Accredited Dental Clinics
Not all dental clinics accept PhilHealth. Here's how to find accredited providers:
Check on ClinicFinderPH
The easiest way is to use ClinicFinderPH's search with the PhilHealth filter. Browse PhilHealth-accredited dental clinics to see verified listings near your location with contact details, services, and patient reviews.
Verify on the PhilHealth Website
PhilHealth maintains official lists of accredited providers at philhealth.gov.ph under Partners > Accredited Health Facilities. You can download updated PDF lists for dental/oral health providers.
Call Before You Visit
Even if a clinic appears on accredited lists, always call ahead to confirm:
- Their PhilHealth accreditation is still active
- They accept walk-in PhilHealth patients (some require appointments)
- What documents you need to bring
- Whether there are any additional fees beyond what PhilHealth covers
Government Health Centers
City and municipal health offices typically have dental services that are PhilHealth-accredited. These are a good option if you want to avoid co-payments entirely, as public providers cannot charge additional fees for covered services.
Maximizing Your PhilHealth Dental Benefits
Here are practical tips to get the most value from your PhilHealth dental coverage:
Use Your Annual Cleaning Benefit Every Year
Don't let your benefit go to waste. Schedule at least one dental cleaning per year. Better yet, use both visits (spaced at least 4 months apart) to get two cleanings annually. Regular cleaning prevents more expensive dental problems down the road.
Combine PhilHealth with HMO Coverage
If you have both PhilHealth and an HMO (Maxicare, PhilCare, Medicard, etc.), you can maximize your coverage:
- Use PhilHealth for preventive care (cleanings, fluoride)
- Use your HMO for additional procedures (fillings, extractions, basic dental work)
- Pay out of pocket only for what neither covers
Keep All Receipts and Records
Maintain records of your PhilHealth dental visits, including:
- Receipts of co-payments made
- Treatment records from the dentist
- PhilHealth claim forms filed
These records are useful for tracking your annual benefit usage and for tax purposes if applicable.
Check if Your Employer Offers Additional Dental Benefits
Some employers provide supplementary dental coverage beyond PhilHealth. Check with your HR department about:
- Company-provided dental HMO plans
- Dental allowances or reimbursement programs
- Group dental insurance benefits
Frequently Asked Questions
How many times can I use PhilHealth dental benefits per year?
You can avail of the Preventive Oral Health Services Package twice per year, with visits spaced at least four months apart. Each visit covers mouth examination, oral prophylaxis (cleaning), and fluoride varnish application. Additionally, you can get pit and fissure sealants for up to two teeth per year.
Can my dependents use PhilHealth dental benefits?
Yes, PhilHealth dental benefits extend to qualified dependents. This includes your spouse and children under 21 years old (or older if they have disabilities). Each dependent has their own annual benefit allocation.
Do I need to pay anything out of pocket?
It depends on where you go. At public dental clinics (government health centers), covered services are free with no co-payment. At private dental clinics, you may pay a co-payment of up to ₱1,500 per visit for examination and cleaning, or up to ₱600 for sealants or emergency extraction.
Can I use PhilHealth at any dental clinic?
No, you must visit a PhilHealth-accredited dental clinic or a dentist referred through a Konsulta Package provider. Not all dental clinics are accredited. Search for accredited clinics on ClinicFinderPH or check the PhilHealth website for the official provider list.
How do I know if a clinic is PhilHealth-accredited?
You can check in three ways: (1) Use the PhilHealth filter on ClinicFinderPH, (2) Download the accredited facility list from philhealth.gov.ph, or (3) Call the clinic directly and ask about their accreditation status.
Is root canal covered by PhilHealth?
No, root canal treatment (endodontic therapy) is not covered under the current PhilHealth dental benefit package. The coverage focuses on preventive services. You would need to pay for root canal treatment out of pocket or through an HMO plan.
Can I use PhilHealth for dental emergencies?
Yes, emergency tooth extraction is covered under the PhilHealth Preventive Oral Health Services Package. However, other emergency dental treatments like emergency root canals or broken tooth repairs are not included. For serious dental emergencies, go to a hospital emergency department.
What if my PhilHealth contribution is not updated?
If your PhilHealth contributions are not current, you may not be eligible to avail of benefits. You can update your contributions at any PhilHealth office or through authorized payment channels (banks, GCash, PayMaya, 7-Eleven). Check your eligibility status through the PhilHealth member portal before your dental visit.
Conclusion
PhilHealth's dental coverage is a valuable benefit that many Filipinos underuse. While the coverage focuses on preventive care with a ₱1,000 annual cap, regular use of these benefits helps maintain your oral health and can prevent costly dental problems in the future.
Make it a habit to schedule your PhilHealth dental visits annually. Combined with an HMO plan or employer benefits, you can significantly reduce your dental care costs.
Find PhilHealth-accredited dental clinics in your area: Cebu City, Quezon City, Makati, or Davao City.
Ready to find a PhilHealth-accredited dental clinic near you? Browse accredited dental clinics on ClinicFinderPH and filter by PhilHealth accreditation, location, and services.