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• Members and Qualified Dependents
• Up to 4th delivery only
Who can avail
• Non-hospital facilities
• Engaged Maternity and Lying-in Clinics
• Engaged physicians and midwives Who provides
• Prenatal care
• Delivery
• Post natal care What services
• P 1,500 pre-natal care fee
• P 6,500 facility fee including professional fee
• No balance billing
Important Features
Maternity Care Package
Maternity Care Package
Applicable to Normal spontaneous vaginal deliveries performed in a non-hospital facility (birthing homes, lying-in, midwife managed clinics)
Covers first 4 normal spontaneous deliveries
• Inclusion
– Normal (uncomplicated) vaginal deliveries
• Low risk at the start and throughout labor and delivery
• Infant in vertex position
• Infant in 37 to 42 weeks AOG
– 1st pre-natal check-up must not exceed 16 weeks AOG
Maternity Care Package
• Exclusion
– 5th and subsequent deliveries not covered
– Maternal conditions that are considered high risk as enumerated in Circular 20, s 2008
Maternity Care Package Excluded Maternal Conditions
1. Age less than 19y/o
2. First pregnancy at the age of 35 or greater
3. Multiple pregnancy
4. Ovarian abnornality (ovarian cyst)
5. Uterine abnormality (myoma uteri)
6.Placental abnormality (placenta previa)
7. Abnormal fetal presentation (ie breech)
8. History of 3 or more abortions/miscarriage
9. History of 1 stillbirth
10. History of major obstetric/gynecologic surgical operations (ie CS, uterine myomectomy)
11. History of medical conditions (hypertension, pre-eclampsia, thyroid disorder)
12. Other risk factors that warrant referral for further management (ie premature contractions, vaginal bleeding)
Maternity Care Package
• Eligibility
– Members and qualified dependents
– Contribution requirements
• Amount P 8,000 (as case rate)
– P 6,500 for the actual delivery including professional fee
– P 1,500 for the prenatal care fee
• No Balance Billing Policy
– Applies to all
Benefit Availment – Maternity Care Package
• Requirements:
– Claim form 1
– Claim form 2
– Claim form 3 (Part II)
– Member Data Record
– Proof of eligibility
• Sponsored – ID
• OWP – ID
• IPP – proof of premium payments
• File within 60 days after the delivery
• Qualified dependents (newborn) of members
• No limit as to number of births
Who can avail
• Non-hospital facilities
• Maternity and Lying-in Clinics
• Hospitals Who provides
• Newborn care
• Screening tests – newborn screening and hearing
• Vaccination – hepatitis B and BCG
• EINC protocol
What services
• P 1,750
• No balance billing
Important Features
Newborn Care Package
Components of Newborn Care Package
• Immediate drying of the newborn
• early skin-to-skin contact
• cord clamping
• non-separation of mother/baby for early breastfeeding initiation
• eye prophylaxis
• Vitamin K administration
• Weighing
• BCG Vaccination
• Hepatitis B Vaccination
• Newborn Hearing Test
• Newborn Screening Test
• Professional Fee
Components of Newborn Care Package
500 500 550 200
EINC and vaccines
Professional Fee
P 1750
Newborn Screening
Test
Hearing Test
Newborn Care
Benefit Availment – Newborn Care Package
• Eligibility
– 3/6 contribution
– Even if 5th delivery and beyond
• Requirements
– Claim Form 1
– Claim Form 2 all services must be enumerated
– Member Data Record
– Certificate of live birth
– Proof of contribution
• File within 60 days after delivery
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