When a PhilCare-affiliated doctor says you need to stay in hospital, PhilCare covers your stay at a PhilCare-affiliated hospital, in a Private Open room. You do not pay an admission deposit at a PhilCare-affiliated hospital. This article is for employees in the Philippines with PhilCare, for the plan year 1 July 2026 to 30 June 2027.
Note: In an emergency, go to the nearest emergency room, or call 911. Then read "Philippines: What to Do in a Medical Emergency (PhilCare)".
How to be admitted to hospital
Get an admitting order from a PhilCare-affiliated doctor.
Go to the PhilCare Authorized LOA Issuer at a PhilCare-affiliated hospital. Show the admitting order and your PhilHealth MDR form.
Get your in-patient Letter of Authorization (LOA) or approval code.
Go to the hospital Admitting Section. Show your PhilCare card and your LOA.
Before you leave hospital, give your PhilHealth documents to the Billing Section. This means you do not pay the PhilHealth part of the bill.
Before you leave, sign the hospital Statement of Account. Pay for anything PhilCare does not cover.
PhilCare covers the stay when a PhilCare-affiliated doctor recommends it and PhilCare's representative at the hospital approves it before you are admitted. Your doctors must also be PhilCare-affiliated.
Your hospital room
Your room type is Private Open. You can choose a lower room type, but you get no refund for the difference.
If you stay in a higher room type for any reason other than an emergency, you pay extra, even if the hospital has no free room of your type. You pay the difference between the rate of your room and the average of the highest and lowest room rates for your room type. For other covered hospital charges, not counting room charges and doctors' fees, you also pay at least 30% for a room one level higher, or at least 50% for a room two levels higher.
Room type full in an emergency
If the PhilCare-affiliated hospital has no free room of your type, you can take the next room type up, but never a suite. PhilCare covers the extra cost for the first 24 hours only. After that you pay the extra cost, unless the hospital gives a certificate that no room of your type is available.
Your limit and what you pay
Your Maximum Benefit Limit is PHP 200,000 per illness or injury, per person, per plan year. An illness and its complications count as one. All injuries from the same event, or series of continuous events, count as one.
PhilCare issues an LOA only up to 80% of your remaining limit. PhilCare keeps the other 20% for reimbursements and claims it has not yet received.
You pay any charges above your limit, any charges above PhilCare rates, and anything PhilCare does not cover. If you stay in hospital after your doctor's discharge order, you pay all hospital costs from that time. If you do not pay the charges that are yours to pay, PhilCare can suspend your cover.
Important: If you stay after your doctor's discharge order, you pay all hospital costs from that time. If you do not pay charges that are yours to pay, your PhilCare cover can be suspended.
Who to contact
LOAs, hospitals and what PhilCare covers: PhilCare, 24/7 on (02) 8462-1800.
If you paid for covered care: read "Philippines: How to Claim a Reimbursement From PhilCare".
Your cover, your card or your dependents: your HR Manager.
This article is general information about your PhilCare plan for 1 July 2026 to 30 June 2027. It is not the full terms. You can see your benefits in the HeyPhil app or the PhilCare Member Gateway. For the full terms of your PhilCare cover, ask your HR Manager.