PhilHealth Case Rate Finder
Circular 2024-0037 (50% Adjusted)
Senior / PWD (20% Off)
⚡ Multi-Case Rate Combined (ACR Rule)
1st Case Rate (100%)
None
₱0
2nd Case Rate (50% or 100%)
None
₱0
Total PhilHealth Deduction
₱0
Estimated Patient Balance
₱0
PhilHealth Coverage & Claim Guide
How does PhilHealth Case Rate deduction work?
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PhilHealth pays accredited hospitals via fixed All-Case-Rate (ACR) bundles. The full case rate amount is deducted directly from your Statement of Account (SOA) before discharge. You only settle the remaining out-of-pocket balance.
What is the difference between HCI Facility Fee and Professional Fee (PF)?
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Every case rate is divided between the health facility (room, board, diagnostics, medications) and the attending physician(s). For medical cases, the split is typically 70% HCI / 30% PF. For surgical procedures, it is 60% HCI / 40% PF.
What is the No Balance Billing (NBB) policy?
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Qualified members (Indigents, Sponsored, 4Ps, Senior Citizens, POS-financially incapable) admitted to ward-type accommodation in government hospitals pay ₱0.00 out of pocket. No additional charges beyond the PhilHealth case rate may be billed.
How are Second Case Rates calculated?
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If a patient has two distinct allowable medical conditions or surgical procedures during one admission, the higher case rate is reimbursed at 100% (1st Case Rate), and the secondary allowed condition is reimbursed at 50% (or 100% for specific maternity/special exemptions under PhilHealth Annex D).
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