PhilHealth Benefits Guide 2025: What Consultations Are Covered

PhilHealth is one of the most valuable benefits available to employed Filipinos — yet many members don't fully understand what's covered. This guide breaks down exactly what consultations and procedures PhilHealth covers in 2025, so you can maximize your benefits and reduce out-of-pocket expenses.

Who Is Covered by PhilHealth?

PhilHealth covers the following members and their qualified dependents (spouse, children, parents):

• Formal sector employees (private and government)
• Self-employed individuals who pay voluntary contributions
• Overseas Filipino Workers (OFWs)
• Senior citizens (automatic PhilHealth members)
• Indigent members (Listahanan/4Ps beneficiaries)
• Lifetime members who have paid at least 120 monthly contributions

Outpatient Benefit Package (OPB)

The PhilHealth Outpatient Benefit Package covers primary care consultations at accredited health facilities including:

• Consultation fee with a primary care physician
• Selected laboratory tests (CBC, urinalysis, fecalysis, X-ray)
• Selected medicines from the PhilHealth formulary

Coverage amount: Up to ₱500 per visit, with a maximum of 45 visits per year for the member and each dependent.

Maternity Care Package (MCP)

Pregnant PhilHealth members are entitled to the Maternity Care Package, which covers:

• Up to 4 prenatal visits with an accredited OB-GYN or midwife
• Normal spontaneous delivery: ₱6,500
• Caesarean section: ₱19,000
• Post-partum care

Z Benefits — Serious Illness Coverage

PhilHealth's Z Benefit packages cover the full cost of treatment for certain catastrophic illnesses, including:

• Breast cancer, prostate cancer, colorectal cancer
• Leukemia and lymphoma
• Coronary artery disease (CAD)
• Cerebrovascular disease (stroke)
• Kidney transplant and dialysis

These are covered in full at accredited specialty centers — no co-payment required for eligible members.

What PhilHealth Does NOT Cover

PhilHealth does not cover:

• Cosmetic procedures
• Dental services (except emergency extractions)
• Eyeglasses and optical consultations
• Maintenance medicines (except for covered packages)
• Private room charges beyond the standard accommodation allowance

How to Find PhilHealth-Accredited Doctors

To use your PhilHealth benefits, you must visit an accredited provider. Use MyDoktor.ph's PhilHealth filter to find accredited doctors in your city and specialty — no more guessing at the clinic door.