PhilHealth Benefit Calculator
Estimate All-Case-Rate hospital deductions, doctor fees, and out-of-pocket balance
| Total Gross Hospital Bill | ₱0.00 |
| Net Bill Before PhilHealth | ₱0.00 |
| PhilHealth Facility Deduction (HCI) | – ₱0.00 |
| PhilHealth Doctor Fee Deduction (PF) | – ₱0.00 |
| Final Patient Co-Payment | ₱0.00 |
Summary of commonly claimed All-Case-Rate (ACR) packages adjusted under recent PhilHealth circulars:
| Medical Condition / Procedure | Total Case Rate | Facility Fee (HCI) | Doctor’s Fee (PF) |
|---|---|---|---|
| Cesarean Section (C-Section) | ₱37,050 | ₱22,230 | ₱14,820 |
| Normal Spontaneous Delivery (Hospital) | ₱9,750 | ₱5,850 | ₱3,900 |
| Pneumonia (Moderate Risk) | ₱29,250 | ₱17,550 | ₱11,700 |
| Pneumonia (High Risk) | ₱48,000 – ₱90,100 | ₱33,600 | ₱14,400 |
| Appendectomy (Laparoscopic / Open) | ₱31,200 | ₱18,720 | ₱12,480 |
| Cholecystectomy (Gallbladder) | ₱40,300 | ₱24,180 | ₱16,120 |
| Ischemic Stroke (Acute CVA) | ₱76,000 | ₱53,200 | ₱22,800 |
| Hemorrhagic Stroke | ₱80,000 | ₱56,000 | ₱24,000 |
| Dengue Severe / Hemorrhagic | ₱20,800 | ₱14,560 | ₱6,240 |
| Hemodialysis (Per Session) | ₱4,000 | ₱2,600 | ₱1,400 |
| Cataract Surgery (Per Eye) | ₱20,800 | ₱12,480 | ₱8,320 |
- Check Member Eligibility: Ensure your premium contributions are updated (at least 3 monthly payments within the 6 months preceding confinement, unless indigent/senior/sponsored).
- Submit PhilHealth Claim Signature Form (CSF): Provided by the hospital’s billing section upon admission or 24 hours prior to discharge.
- Provide Member Data Record (MDR): Submit a copy of your updated MDR and 2 valid government-issued IDs. For dependents, submit supporting documents (e.g., Marriage Certificate for spouse, Birth Certificate for children).
- Automatic Deduction on Final Statement of Account (SOA): The hospital’s billing officer computes the case rate deduction and senior/PWD discounts directly before you settle your co-payment.
Q: What happens if my hospital bill is lower than the PhilHealth Case Rate?
A: PhilHealth covers up to 100% of actual eligible hospital charges. If the total bill is ₱15,000 and the case rate is ₱19,500, PhilHealth covers the full ₱15,000. There is no cash refund for the difference.
Q: Who is qualified for No Balance Billing (NBB)?
A: NBB applies to Indigents, Sponsored Members, 4Ps/Modified CCT beneficiaries, Senior Citizens, and POS (Point-of-Service) patients admitted in Ward (basic accommodation) in government hospitals.
Q: How does PhilHealth calculate two surgical procedures in one session?
A: The primary procedure is covered at 100% of the first case rate, and the second approved procedure is covered at 50% of its standard case rate.