What Your Coverage Includes
Every plan includes the same comprehensive coverage. The only difference between plans is how many family members are included. Here's exactly what's covered.
Coverage is used at accredited hospitals and clinics nationwide. Find one near you on the PhilCare accredited hospital list →
Annual Physical Exam
| Medical history & physical examination | Covered |
| Chest X-ray | Covered |
| Routine urinalysis & fecalysis | Covered |
| Complete blood count (CBC) | Covered |
| ECG (35+ or if indicated) | Covered |
| Pap smear (female, 35+ or if indicated) | Covered |
Preventive Health Care
| Health education & counseling on diet or exercise | Covered |
| Periodic monitoring of health problems | Covered |
| Family planning counseling | Covered |
Out-Patient Care
| Consultations during regular clinic hours (excl. prescribed medicines) | Covered |
| Pre- and post-natal consultations | Covered, excl. lab & diagnostics |
| EENT treatment by affiliated physician/specialist | Covered |
| Minor injuries (lacerations, mild burns, sprains, etc.) | Covered |
| Dressings, conventional casts & sutures | Covered |
| X-ray, lab, diagnostic & therapeutic procedures | Covered, up to a specified amount |
| Minor surgery not requiring confinement | Covered |
| Speech therapy (reimbursement only) | Up to ₱10,000 / year |
| Animal-bite treatment & vaccines | Covered; vaccines up to ₱20,000 / year |
| Allergy testing & screening | Up to ₱2,500 / year |
In-Patient Services
| Room & board (private room, per plan accommodation) | Covered |
| Operating room, ICU, isolation & recovery room | Covered, subject to MBL |
| Professional fees (physicians, surgeons, anesthesiologists) | Covered, subject to MBL |
| Standard nursing services | Covered |
| Medicines for in-patient use | Covered, subject to MBL |
| Blood products, transfusions & IV fluids | Covered, subject to MBL |
| X-ray, lab & diagnostics incidental to confinement | Covered, subject to MBL |
| Anesthesia, oxygen & their administration | Covered, subject to MBL |
| Standard admission kit & liaison-officer assistance | Covered |
Emergency Care
| In affiliated hospitals (ER fees, physician services, medicines, oxygen, IV, dressings, X-ray/lab) | Covered, subject to MBL |
| Room upgrade if a room is unavailable | Covered, subject to MBL |
| In non-affiliated hospitals | Reimbursed up to ₱30,000 / case / year |
| Outside the Philippines | Reimbursed up to ₱30,000 / case / year |
| Areas without an affiliated hospital (50-km radius) | Covered, subject to MBL |
| Ambulance (Metro Manila, coordinated via AeroMed) | Covered |
| Ambulance (provincial areas) | Up to ₱2,500 per conduction (reimbursement) |
Diagnostic & Therapeutic Procedures
A broad range of diagnostic and therapeutic procedures are covered, as prescribed by an affiliated physician and subject to the MBL, including:
- ECG & Holter monitoring
- EEG monitoring
- CT scans
- MRI & MRA
- Ultrasound (2D-echo, abdominal, etc.)
- Mammogram & sonomammogram
- Cardiac stress tests
- Endoscopic procedures
- Pulmonary function tests
- Radioisotope scans
- Dialysis
- Chemotherapy (IV & oral)
- Radiotherapy
- Physical & occupational therapy
Some procedures carry specific inner limits (e.g. certain special modalities up to ₱5,000 / procedure / year). Full schedule available on request.
Additional Benefits
| Work-related conditions (per ECC-covered conditions) | Covered |
| Motor vehicular accidents | Covered, subject to MBL |
| Congenital diseases (excl. PT & developmental disorders) | Up to ₱40,000 / year |
| Scoliosis (acquired cases only) | Up to ₱40,000 / year |
| Epilepsy / seizure disorder (if acquired) | Covered |
| Hepatitis B & C (if acquired, not STD-related) | Covered |
| Sports-related injuries (excl. extreme sports) | Covered |
| Unprovoked assault, incl. domestic violence | Covered |
| COVID-related care | Covered, subject to MBL |
| Maternity assistance (female, 280-day waiting period) | Up to ₱5,000 (reimbursement, once / year) |
Dental Benefits
Availed through Dental Network Co (DNC) accredited clinics. No reimbursement.
- Annual dental exam & consultation
- Oral prophylaxis (once a year)
- Simple tooth extractions
- Temporary fillings (as needed)
- Restorative & prosthodontic treatment planning
- Desensitization of hypersensitive teeth
- Simple denture adjustment
- Recementation of loose crowns, inlays, onlays
- Gum treatment (inflammation, bleeding)
- Emergency out-patient dental treatment
- Dental health education & counseling
- Two light-cure fillings per tooth
A ₱100,000 life insurance policy is also included for the covered VA. PhilHealth membership is required to cover the PhilHealth portion of any bill; non-PhilHealth members are responsible for paying that portion. Charges incurred by a newborn are not covered. Corrective eyewear is not covered, and medicines, vitamins, and eyeglasses are out-of-pocket expenses. This page is a summary; the full PhilCare schedule of benefits governs actual coverage. Benefits are subject to change at any time.
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