Most Filipinos pay PhilHealth every month and use a fraction of what it covers. Here is the 2026 contribution table, what the YAKAP (formerly Konsulta) package gives you for free, how case rates and No Balance Billing actually reduce a hospital bill, and how to claim.
PhilHealth is deducted from nearly every Filipino payslip, and most members could not say what it actually pays for. That gap costs money: an unclaimed YAKAP registration alone forfeits a free annual check-up and a set of laboratory tests every single year.
The short version: the 2026 premium rate is 5% of monthly basic salary, with a ₱10,000 floor and a ₱100,000 ceiling — so between ₱500 and ₱5,000 per month. In return you get outpatient primary care through YAKAP (formerly Konsulta), fixed case-rate payments on hospital admissions, and zero-balance treatment in government facilities if you qualify.
The 2026 Contribution Rate
The 5% rate is the final scheduled step under Republic Act No. 11223, the Universal Health Care Act, which raised premiums gradually over five years.
| Monthly basic salary | Premium rate | Monthly premium |
|---|---|---|
| ₱10,000 and below | Fixed floor | ₱500 |
| ₱10,000.01 – ₱99,999.99 | 5% | ₱500 – ₱5,000 |
| ₱100,000 and above | Fixed ceiling | ₱5,000 |
Who pays what:
- Employed members split the premium 50/50 with their employer. On a ₱30,000 salary the total is ₱1,500 — ₱750 from you, ₱750 from the employer.
- Self-employed, voluntary, and OFW members pay the full amount themselves.
- Indigent and sponsored members are subsidised by national or local government.
- Senior citizens are covered under the Expanded Senior Citizens Act without paying premiums.
Missed contributions do not cancel your benefits. Under the UHC Act every Filipino is automatically enrolled and granted immediate eligibility, and the law is explicit that failure to pay premiums must not prevent you from enjoying Program benefits. Unpaid premiums are collected from direct contributors as a debt with interest — they are a payment obligation, not a gate on your coverage. Always present your PhilHealth number at admission, even if you are in arrears.
YAKAP (Formerly Konsulta): The Benefit Almost Nobody Claims
YAKAP is PhilHealth's outpatient primary care programme, and it is the single most under-used benefit in the system. It replaced and expanded the former Konsulta (Konsultasyong Sulit at Tama) package when PhilHealth rebranded it in July 2025 — members already registered under Konsulta were carried over automatically, so if you enrolled before then you are already a YAKAP member.
You register once with an accredited YAKAP Clinic, and that provider becomes your assigned primary care doctor for the year. PhilHealth pays them a capitation fee directly; you pay nothing at the point of care.
What YAKAP covers:
- A free annual check-up and consultations with your assigned provider
- Laboratory and screening tests — the package expanded from 13 tests under Konsulta to 19, including screening for breast, lung, liver, and colorectal cancer
- Medicines for common conditions — expanded from 21 drugs to 75, with up to ₱20,000 per member per year for outpatient medicines
One important caveat: these are available tests, not an automatic annual panel. Which of them you actually receive depends on clinical indication and what your primary care team orders for your case. You are entitled to the assessment; you are not entitled to tick every box on the list.
Even so, the value is real. Paid privately, a check-up with a comparable panel typically runs ₱1,500–₱4,000 — see our annual physical exam guide for what those packages contain and cost.
How to register: choose an accredited YAKAP Clinic near you — usually a health centre, clinic, or hospital OPD — and enrol with your PhilHealth number and a valid ID. You can register with only one provider per year, so pick one you can realistically get to.
If you are managing hypertension or type 2 diabetes, YAKAP is built for exactly your situation: regular monitoring, routine bloodwork, and maintenance medication.
Inpatient Coverage: How Case Rates Work
For hospital admissions PhilHealth pays a fixed case rate per condition or procedure — a predetermined amount, split between a hospital charge portion and a professional fee portion, regardless of what the hospital actually billed.
This is the part members most often misunderstand. PhilHealth is a first payer that reduces the bill, not a plan that clears it. The sequence on a private hospital bill is:
- PhilHealth deducts its case rate from the total
- Your HMO covers the remainder, up to its Maximum Benefit Limit
- Anything still outstanding is out of pocket
Case rates exist for the conditions that fill Philippine wards — pneumonia, dengue, tuberculosis, stroke, appendectomy, caesarean delivery, and hemodialysis among them. In a government facility a case rate can cover most or all of an admission. In a private tertiary hospital it will cover a meaningful slice, not the whole thing.
No Balance Billing
No Balance Billing (NBB) means eligible members treated in the basic accommodation of a government hospital pay nothing beyond what PhilHealth covers — no top-up for the room, the drugs, or the professional fees.
Two conditions apply, and both matter:
- You must be in an accredited government facility
- You must be in basic or ward accommodation — the moment you upgrade the room, NBB no longer applies
NBB covers indigent, sponsored, senior citizen, lifetime, and other qualifying member categories. If cost is the binding constraint, this is the most powerful provision in the entire system, and it is forfeited by a room upgrade that feels minor at the time.
Other benefit packages
Beyond standard case rates, PhilHealth runs dedicated packages for high-cost care — the Z Benefit Packages for catastrophic conditions such as certain cancers, kidney transplant, and children's heart surgery, plus specific packages for hemodialysis sessions, maternity care, and TB treatment under DOTS.
How to Claim
For most employed members the process is close to automatic — but only if you supply the details at the right moment.
When you are admitted:
- Present your PhilHealth ID or PhilHealth Identification Number (PIN) at admission, not at discharge
- The hospital's billing section files the claim on your behalf
- Your Member Data Record (MDR) may be requested; you can print it from the PhilHealth Member Portal
- If you are a dependent, bring proof of relationship
- Confirm the PhilHealth deduction appears on the statement of account before you settle the bill
The single most expensive mistake is declaring PhilHealth late. Tell the admitting clerk at the start. Retroactive filing after discharge is possible in some circumstances but is far more work and sometimes fails outright.
Checking your contributions: log in to the PhilHealth Member Portal or use the PhilHealth mobile app to view your contribution history, print your MDR, and confirm you are in good standing.
Where PhilHealth Falls Short
Being clear-eyed about the gaps is how you decide whether you need supplementary coverage:
- Outpatient care outside YAKAP is largely uncovered — most specialist consults and diagnostics you arrange yourself
- Case rates rarely cover a full private hospital bill, particularly in tertiary Metro Manila hospitals
- Room upgrades void No Balance Billing
- Most medicines outside YAKAP and the inpatient package are self-funded
- Dental, optical, and elective procedures are generally excluded
This is precisely the gap an HMO exists to fill. The two are complementary, not competing — our HMO comparison guide covers how to size that second layer.
Frequently Asked Questions
How much is the PhilHealth contribution in 2026?
The premium rate is 5% of monthly basic salary, with an income floor of ₱10,000 and a ceiling of ₱100,000. That works out to between ₱500 and ₱5,000 per month. Employed members split the amount equally with their employer, while self-employed, voluntary, and OFW members pay it in full.
What does PhilHealth YAKAP (formerly Konsulta) cover?
YAKAP covers a free annual check-up and consultations with your assigned primary care provider, a panel of 19 laboratory and screening tests including screening for breast, lung, liver, and colorectal cancer, and 75 medicines with up to ₱20,000 per member per year for outpatient drugs. Which tests you actually receive depends on clinical indication and what your primary care team orders, so treat the list as what is available rather than an automatic annual panel.
Do I still need an HMO if I have PhilHealth?
They cover different things. PhilHealth pays fixed case rates on hospital admissions and provides outpatient primary care through YAKAP (formerly Konsulta). An HMO covers day-to-day consultations, diagnostics, and the balance of a hospital bill after PhilHealth pays. Most people with the means carry both, because PhilHealth alone rarely clears a private hospital bill.
Can I use PhilHealth if I missed contributions?
Yes. The Universal Health Care Act automatically enrols every Filipino and grants immediate eligibility, and it expressly provides that failure to pay premiums must not prevent you from enjoying Program benefits. Direct contributors still owe any missed premiums, which PhilHealth collects as a debt with interest, but arrears do not bar you from care. Always present your PhilHealth number at admission.
What is No Balance Billing?
No Balance Billing means eligible members treated in the basic or ward accommodation of an accredited government hospital pay nothing beyond what PhilHealth covers. It applies to indigent, sponsored, senior citizen, and other qualifying categories, and it is forfeited if you upgrade to a private room.
How do I check my PhilHealth contributions?
Log in to the PhilHealth Member Portal on the PhilHealth website or use the mobile app. You can view your full contribution history, confirm you are in good standing, and print your Member Data Record, which hospitals sometimes request at admission.
Are senior citizens covered by PhilHealth?
Yes. All Filipino senior citizens are covered under the Expanded Senior Citizens Act without paying premiums. They also qualify for No Balance Billing in the basic accommodation of accredited government hospitals.
Register with a Primary Care Doctor
YAKAP assigns you a primary care provider, and that relationship works best with a doctor you would see anyway. Browse general practitioners and family practice physicians near you, or read our guide on choosing between a GP and an internist.
This article summarises publicly available PhilHealth policy as of 2026 and is general information, not legal, financial, or medical advice. Contribution rates, packages, and case rates are revised periodically — confirm current details with PhilHealth directly.
doktor.ph Editorial Team
Health Systems DeskContributing writer at doktor.ph, dedicated to providing accurate and helpful health information for Filipinos.
