What PhilHealth Covers (and Doesn’t)
PhilHealth is the government’s health insurance program for all Filipinos. It provides basic coverage for hospital stays, certain surgeries, and procedures. However, it does not cover:
- Many private hospital fees
- Elective or specialized treatments
- Advanced diagnostic procedures
PhilHealth is essential, but for many families, it may not be enough to fully protect against high medical costs.
How HMO Works
An HMO (Health Maintenance Organization) is a prepaid medical plan usually offered by private companies. HMOs cover outpatient and inpatient care, depending on the network of hospitals and doctors.
Key points:
- HMO is network-based: You must go to accredited hospitals and clinics.
- Coverage is generally for hospitalization, doctor visits, and some medications.
- HMOs do not provide cash benefits. If you go out-of-network, costs may not be reimbursed.
HMOs are convenient for predictable medical visits but may not cover major unexpected emergencies outside the network.
What Health Insurance Is Designed For
Health insurance is a financial safety net designed to help pay for high-cost medical events, such as:
- Major surgeries
- Critical illnesses
- Extended hospital stays
Unlike HMOs, health insurance often reimburses actual expenses (or pays directly to the hospital) and can cover out-of-network hospitals. Policies vary, so understanding the terms is key.
Benefits of health insurance include:
- Protection against high medical bills
- Choice of hospital and doctor
- Financial peace of mind
Many Filipinos use health insurance in addition to PhilHealth to ensure coverage for unexpected medical emergencies.
Which One Fits You Best?
Choosing the right option depends on your situation:
Profile | Best Option |
| Young professional, few dependents | HMO or basic health insurance |
| Family with dependents | Health insurance + PhilHealth |
| Senior or chronic illness | Health insurance with higher coverage |
| Self-employed / OFW | Health insurance + PhilHealth, optional HMO |
Combination plans can also work—for example, PhilHealth for basic coverage + health insurance for high-cost events.
Realistic Cebu Hospital Cost Examples
- Minor surgery: PHP 30,000–50,000 (private hospital)
- Major surgery: PHP 150,000–500,000+
- Hospital stay (3–5 days): PHP 20,000–100,000+ depending on room type and procedure
These examples show why relying on PhilHealth alone may not be enough for many families in Cebu.
What to Do Next
Understanding your medical coverage is the first step toward financial preparedness. If you’re unsure which plan fits your family or business, start by comparing options and assessing real hospital costs.
You can reach out for a consultation to explore options that match your needs—no pressure, just clarity.