How coverage works here: Philippines.

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How coverage works here: Philippines

Handout · moraph.org/commons/sessions/reach/how-coverage-works-here

This sheet explains how health care gets paid for, in general and where you live. It is general information, not medical advice or advice on choosing a plan.

Four ways care gets paid for

A public system, paid for through taxes.
Public programs for particular groups.
Insurance, through work or bought yourself.
Paying yourself at the point of care.

The words

Premium: what you pay to be covered.
Deductible or excess: what you pay before cover starts.
Co-payment or coinsurance: your share of each visit or prescription.
Out-of-pocket cost: anything you pay yourself.

Before you get care, ask

Is this covered, and is anything not?
Do I need a referral or a particular provider?
What will I pay, and does anything need approval first?

Stay safe

If it might be an emergency, call the emergency number first.
Real programs don’t cold-call to sell cover or ask for your details.
Check anything you’re unsure about on the official sites below.

In the Philippines

Everyone is included. Under the Universal Health Care Act (Republic Act No. 11223), every Filipino citizen is automatically included in the National Health Insurance Program, run by PhilHealth. Every member has immediate eligibility for its benefit packages.
Members and premiums. Members are either direct contributors, who pay premiums, or indirect contributors, whose premiums are paid for them. Under the law, failing to pay premiums does not stop you from getting program benefits, though employers and self-employed direct contributors must later pay missed contributions with interest.
No ID needed, no co-payment in the ward. You don’t need a PhilHealth ID card to use a health service. No co-payment may be charged for services in basic or ward accommodation, meaning regular meals and a bed in a shared room with fan ventilation and a shared toilet and bath. Government hospitals must keep at least 90% of their beds as basic or ward beds.
How hospital benefits are paid. PhilHealth pays accredited facilities through case rates. The hospital deducts the case rate amount, which covers hospital charges and the attending doctor’s professional fees, from your total bill before you are discharged.
Primary care and medicines. Through PhilHealth YAKAP, members and their dependants choose a YAKAP clinic for check-ups and consultations, through the PhilHealth Member Portal or a PhilHealth Local Health Insurance Office. After a consultation, the PhilHealth GAMOT program gives free outpatient medicines from a set list at accredited pharmacies, up to a yearly limit.
Senior citizens and questions. Filipino citizens living in the Philippines aged 60 or over who are not covered under another category can enrol as senior citizen members, through the local Office for Senior Citizens Affairs (OSCA) or a PhilHealth office. PhilHealth’s 24/7 hotline is (02) 8662-2588.

Official places to check:

PhilHealth (Philippine Health Insurance Corporation): www.philhealth.gov.ph/about_us/RA11223_UHC.pdf
PhilHealth (Philippine Health Insurance Corporation): www.philhealth.gov.ph/benefits
PhilHealth (Philippine Health Insurance Corporation): www.philhealth.gov.ph/news/up/article/2026/news_6a193dac651d8.php
PhilHealth (Philippine Health Insurance Corporation): www.philhealth.gov.ph/members/senior
PhilHealth (Philippine Health Insurance Corporation): www.philhealth.gov.ph/about_us

More free official help in the Philippines: moraph.org/commons/help/health-access/ph

General information, not advice about your own situation. Checked 20 October 2026. If an official source says something different, it is right. Free to copy and adapt. moraph.org/commons/sessions/reach/how-coverage-works-here