PhilHealth All Case Rates (ACR)
Circular 2024-0037 (50% Increase) Updated
PhilHealth Case Rate Finder
Look up exact hospital benefits, ICD-10 medical codes, RVS surgical rates, and compute HCI vs. Professional Fee deductions instantly.
Apply No Balance Billing (NBB) Policy
For Indigents, 4Ps, Seniors, PWDs & Sponsored members in accredited public ward beds.
Hospital Fee (HCI)
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Doctor Fee (PF)
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Total PhilHealth Covered
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Estimated Patient Balance
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PhilHealth reimburses medical and surgical treatments through the All Case Rate (ACR) mechanism. Each case rate has a pre-determined lump sum that is split into:
- Health Care Institution (HCI) Fee: Covers hospital room, laboratory diagnostics, medical supplies, and prescribed medications.
- Professional Fee (PF): Covers the compensation for accredited attending physicians and surgeons.
When two surgical procedures or medical conditions occur within the same hospitalization period:
- First Case Rate (Highest Amount): Reimbursed at 100%.
- Second Case Rate: Reimbursed at 50% (unless explicitly exempted, such as Hemodialysis, Radiotherapy, or select Chemotherapy sessions).
- PhilHealth Claim Form 1 (CF1): Filled out by member or employer.
- Member Data Record (MDR): Updated copy showing qualified dependents.
- Valid Government-Issued ID: For identity verification upon admission/discharge.
- Claim Form 2 (CF2) & Form 4 (CF4): Accomplished directly by the hospital and attending physician.
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