Philhealth Inpatient Benefits

PhilHealth‘s Inpatient Benefits offer a comprehensive range of support for members requiring hospital care. This program is designed to lighten the financial load of hospitalization by covering expenses such as room and board, medicines, laboratory tests, and medical procedures at accredited hospitals. It’s aimed at providing financial relief and access to necessary healthcare services for all registered PhilHealth members and their dependents. This includes those who are up to date with their contributions and are admitted to an accredited healthcare institution. The program ensures that members can receive the medical attention they need without the added stress of overwhelming hospital bills.

What sets this program apart is its direct payment assistance through All Case Rates, offering simplified billing processes for members and ensuring that a variety of medical and surgical cases are covered with predetermined case rates. Notable treatments such as radiotherapy and hemodialysis come with specific amounts to aid members further. By fulfilling straightforward requirements, like providing a copy of the Member Data Record or PhilHealth Benefit Eligibility Form (PBEF) and a completed PhilHealth Claim Form 1, members can easily avail themselves of these benefits. These not only underscore the significance of having a safety net in times of medical emergencies but also reflects the commitment of the Philippine government to secure the well-being of its citizens through accessible healthcare services.

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Credits: Philhealth / Facebook

What are PhilHealth Inpatient Benefits?

PhilHealth, the Philippines’ health insurance system, extends a helping hand to its members through its inpatient benefits. This coverage supports individuals by shouldering portions of hospitalization expenses. It includes payments for room and board, prescribed medicines, necessary laboratory tests, and specific medical procedures during confinement in a PhilHealth-accredited hospital.

Significance of this Benefit

PhilHealth Inpatient Benefits are significant because they provide financial security for Filipinos requiring hospital stays.  Statistics show PhilHealth covers a wide range of illnesses, with case rates set for various procedures. This, along with Republic Act No. 11223 or the “National Health Insurance Act of 2013”, ensures Filipinos can access essential medical services without facing financial burden. These services act as a safety net, reducing out-of-pocket hospital expenses and promoting better healthcare access for all.

Legal Basis

The provision of inpatient benefits by PhilHealth operates under the legal framework established by the Philippine government, ensuring that every member has access to healthcare services. This system of assistance is meticulously designed to alleviate the financial burden of medical care on individuals and families.


The inpatient benefits include:

  • Direct payment assistance to the healthcare institution through All Case Rates, simplifying the billing process for members.
  • Coverage of various medical and surgical cases with predetermined case rates.
  • Specific amounts allocated for certain treatments, such as:
    • Radiotherapy: P2,000 per session for cobalt and P3,000 per session for linear accelerator.
    • Hemodialysis: P2,600 per session, accommodating both inpatient and outpatient sessions.

Eligibility / Qualifications

All registered PhilHealth members and their dependents are eligible for inpatient benefits, given that their contributions are regularly updated and they are admitted to an accredited healthcare institution.


To avail of these benefits, members must prepare:

  • A copy of the Member Data Record or PhilHealth Benefit Eligibility Form (PBEF).
  • A duly accomplished PhilHealth Claim Form 1.

Step-by-Step Guide on How to Benefit from PhilHealth Inpatient Benefits

  1. Check Eligibility: Ensure your PhilHealth membership is active and contributions are up to date.
  2. Admission to an Accredited Hospital: Confirm that the hospital is PhilHealth-accredited.
  3. Prepare Necessary Documents: Gather your Member Data Record or PBEF and complete the PhilHealth Claim Form 1.
  4. Inform the Hospital’s Billing Section: Present your documents upon admission and inform them of your intention to use your PhilHealth benefits.
  5. Automatic Deduction: The hospital should automatically deduct the case rate amount from your total bill, including the professional fees of attending physicians, before discharge.
  6. Review and Clarify: Before discharge, review your bill to ensure that your PhilHealth benefits have been properly deducted.

Recent Updates

PhilHealth Inpatient Benefits: Understanding Your Coverage

Discover the comprehensive coverage provided by PhilHealth’s Case Rate for inpatient services. Whether you’re admitted or confined, rest assured that you’re covered for your medical expenses. Learn more about the benefits and peace of mind that PhilHealth offers.

PhilHealth Circular 2023-0025: Rationalizing Inpatient Case Rates for Improved Healthcare Coverage

In 2014, PhilHealth introduced the All Case Rates (ACR) to transition from fee-for-service to case-based payment and expedite claims processing. However, the published rates no longer align with actual hospitalization charges. To address this, PhilHealth is committed to rationalizing priority conditions in the ACR, enhancing financial coverage for quality healthcare delivery, and serving as an interim measure before implementing the diagnosis-related groups (DRG) provider payment mechanism. Additionally, Joint Circular No. 0001-2022, issued by the Department of Budget and Management, Department of Finance, Department of Health (DOH), PAGCOR, PCSO, and PhilHealth, outlines guidelines for utilizing funds from the national government share and Charity Fund to improve PhilHealth’s benefits packages in accordance with the Universal Health Care Act.

PhilHealth Benefits for COVID-19: Your Guide to Health Coverage

Discover the advantages of PhilHealth’s COVID-19 benefits. From testing packages to inpatient care and vaccine injury compensation, the agency provides comprehensive coverage to ensure your well-being during these challenging times. Stay informed and take advantage of the benefits you deserve.

Can inpatient benefits be used in all hospitals?

The PhilHealth inpatient benefit can be used in all PhilHealth-accredited hospitals nationwide, except for the Z Benefit Packages that can only be availed in selected contracted hospitals. This policy is effective until the agency releases the corresponding guidelines on this matter.



When admitted to a PhilHealth partner hospital, members can avail of inpatient benefits. PhilHealth will cover a portion of the total bill, providing financial assistance for necessary hospital care.



PhilHealth’s inpatient benefits are a cornerstone of the Philippines’ healthcare system, designed to support Filipinos during times of medical need. By understanding and utilizing these benefits, members can alleviate some of the financial stresses associated with hospitalization. Remember to check your eligibility, prepare the necessary documents, and communicate with your healthcare provider to ensure a smooth process. Health is a wealth worth investing in, and through PhilHealth, the government invests in the well-being of its people.

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