PhilCare covers hospital stays, emergency care, doctor consultations, tests and many treatments, up to PHP 200,000 for each illness or injury, per person, per plan year (1 July 2026 to 30 June 2027). Some benefits have a smaller limit. PhilCare does not cover some conditions and costs, such as pregnancy care (except pre-natal and post-natal consultations), medicines you take at home and cosmetic treatment.
Note: This is a plain-English summary of the 2026-27 PhilCare contract. If this summary and the contract differ, the contract applies.
What PhilCare covers
PhilCare covers the care below at PhilCare rates, up to your PHP 200,000 limit, when the care is medically necessary.
In hospital
Room and board in your PhilCare room type (Private Open)
Operating room, intensive care unit (ICU), isolation room and recovery room
Fees of doctors, surgeons and anaesthesiologists, at PhilCare rates
Nursing care and medicines used in hospital
Blood, blood products and IV fluids that you receive
X-rays, laboratory tests and other tests during your stay
Anaesthesia, oxygen, dressings, casts and stitches
In an emergency
At a PhilCare accredited hospital: emergency room fees, doctors' services, medicines for immediate relief, and tests and treatment for the emergency.
At a hospital that is not accredited, outside the Philippines, or where no accredited hospital is within 50 km: PhilCare pays you back at PhilCare rates, up to your limit.
For all emergencies: you or someone for you must tell PhilCare within 24 hours. See "Philippines: What to Do in a Medical Emergency (PhilCare)".
Out-patient care
Consultations with accredited doctors during clinic hours
Pre-natal and post-natal consultations
Treatment of minor injuries, such as cuts, mild burns and sprains
Minor surgery that does not need a hospital stay
X-rays, laboratory tests and other tests prescribed by an accredited doctor, up to a set amount
Laser eye treatment for a retinal tear, retinal hole, retinal detachment or glaucoma
Tests and treatments in any setting
MRI, CT scan, endoscopy, bone density scan and nuclear scans
Chemotherapy (including oral chemotherapy), dialysis and radiation therapy
Physical therapy
Speech therapy, which may be covered after a stroke
Preventive care
Health education and advice on diet and exercise
Family planning counselling (not infertility)
Regular monitoring of health problems
Benefits with a smaller limit
These PhilCare benefits have their own limit inside your PHP 200,000 limit:
PhilCare benefit | Limit in PHP (2026-27) |
Conditions present from birth (congenital) and their complications | 30,000 per member per year |
Congenital hernia | 30,000 per member per year |
Scoliosis, including when present from birth or before cover (not physical therapy sessions) | 30,000 per member per year |
Spinal stenosis | 30,000 per member per year |
Kidney stone surgery through the skin (percutaneous nephrolithotomy) | Up to 50% of the 200,000 limit |
HIV and AIDS | Up to 30% of the 200,000 limit, per member per year |
Chronic skin conditions, psoriasis and vitiligo | Consultation only |
Other laser eye procedures (not vision correction such as LASIK or PRK) | 20,000 per member per year |
Treatment of warts and similar skin growths (not on the genitals) | 2,000 per year |
Allergy tests (the allergens are not covered) | 2,500 per member per year |
Tuberculin (TB) skin test to diagnose, not to screen | 600 per member per year |
Ambulance from where the emergency happened to an accredited hospital | 3,500 per member per year |
Ambulance from one accredited hospital to another | Up to the 200,000 limit, per member per year |
First dose of anti-rabies, anti-venom or anti-tetanus vaccine, within 24 hours | Up to the 200,000 limit |
Later doses of these vaccines, after 24 hours | 18,000 |
Higher room in an emergency when your room type is full | First 24 hours only; never a suite |
Pre-existing conditions of a dependent added from 1 July 2026 | 20,000 in their first year of cover |
What PhilCare does not cover
These are the main things PhilCare does not cover. This list is not complete. Where there is an exception, it is in the same line.
Pregnancy and childbirth: pregnancy, childbirth, miscarriage, abortion and their complications. Pre-natal and post-natal consultations are covered.
Medicines at home: take-home and out-patient medicines, vitamins and supplements. Medicines given in emergency treatment, and chemotherapy, are covered.
Vaccines: all vaccines, except anti-rabies, anti-venom and anti-tetanus vaccines within the limits above.
Cosmetic treatment: procedures and surgery for appearance, such as liposuction. Reconstructive surgery to fix a problem caused by illness or an accident is covered.
Weight loss: weight-loss programs and surgery for obesity.
Fertility and sterilisation: infertility tests and treatment, artificial insemination, sterilisation or its reversal, circumcision and sex change.
Sexually transmitted diseases: not covered. HIV and AIDS are covered up to 30% of the limit.
Hepatitis C and D: not covered. Hepatitis B is covered if you catch it, but not vaccines or screening tests.
Vision correction: glasses, contact lenses, laser surgery to correct vision (such as LASIK), and treatment of short-sightedness or astigmatism.
Medical devices: hearing aids, braces, crutches, stents, pacemakers, pins, screws, plates, and medical equipment for use at home. Artificial limbs, joint replacements and heart valve replacements are covered up to your limit.
General dental care: not covered, except the PhilCare dental benefit and repair after an accidental injury. See "Philippines: PhilCare Dental, Annual Physical Exam and Life Insurance".
Check-ups for other purposes: medical exams for work, school, insurance, travel or a licence, executive check-ups, screening tests when you have no symptoms, and medical certificates. Your annual physical exam is a separate benefit.
Alternative and experimental treatment: experimental treatment, chiropractic, acupuncture and reflexology.
Mental health: mental health conditions, including psychiatric, behavioural and developmental disorders, are not covered in general. Before you book mental health care, ask your HR Manager what PhilCare covers.
Alcohol and drugs: injury or illness after taking alcohol or drugs, and illness from alcoholism or drug addiction.
Your own misconduct: injury from negligence, a crime, breaking the law, attempted suicide or self-harm, infections from tattoos or piercings, and self-inflicted firework injuries.
Dangerous sports: injuries from dangerous sports you choose to do, such as scuba diving, mountain climbing, surfing, boxing and martial arts, unless the activity is part of your declared job.
War and military service: injury or illness from military service or war.
Long-term care: custodial, home, convalescent and intermediate care.
Pain management: out-patient pain management, except in an emergency.
Complications: complications of treatment that PhilCare does not cover.
Organ donation: costs when you donate an organ.
Care outside the PhilCare network: for care that is not an emergency, PhilCare may not pay for doctors, clinics or hospitals it has not accredited, or may pay only up to PhilCare rates. Call PhilCare on (02) 8462-1800 before you use them.
Costs you pay yourself
Above your limit: amounts above your PHP 200,000 limit or a smaller limit.
Above PhilCare rates: the part of a doctor's or hospital's fee that is more than PhilCare rates.
PhilHealth's share: PhilCare does not pay the part of a bill that PhilHealth or another government program covers. Give your PhilHealth documents to the hospital before you leave, or you may have to pay that part yourself.
Extra hospital costs: a private nurse, extra bed, TV, extra food and toiletries, and costs after your doctor gives the discharge order.
A higher room you choose: the difference in room rates, plus at least 30% of your other covered hospital charges for a room one level higher, or at least 50% for a room two levels higher.
A higher room in an emergency after 24 hours: unless the hospital certifies that your room type is not available.
If PhilCare pays for something that is not covered, PhilCare can ask you to pay it back. If these excess charges are not paid, your cover can be suspended.
Who to contact
This article is general information, not the full PhilCare contract. For the full terms of your PhilCare cover, ask your HR Manager.
Whether a treatment is covered: call PhilCare on its 24/7 line, (02) 8462-1800.
Your cover, your dependents or your card details: contact your HR Manager through a support request in the Outstaffer AI platform.