Last verified: October 5, 2026
Independent guide. We are not affiliated with PhilHealth. Benefit packages are set by PhilHealth circulars — confirm current coverage on philhealth.gov.ph.
Quick answer: Your PhilHealth membership pays for two big things: hospitalization (fixed case rates deducted from your bill) and YAKAP primary care — free annual checkups, 13 lab tests, 6 cancer screenings, and up to ₱20,000/year in free medicines at accredited clinics and GAMOT pharmacies. Senior citizens (60+) are covered free and automatically under RA 10645.
YAKAP: the primary-care package
YAKAP (Yaman ng Kalusugan Program), launched July 2025, is the expanded replacement for the old Konsulta program. It has four components:
| Component | What you get |
|---|---|
| KONSULTA | Free primary-care consultations with an accredited physician |
| GAMOT | 75 essential medicines free at accredited GAMOT pharmacies |
| LABORATORYO | 13 outpatient laboratory tests |
| SCREEN | 6 cancer screening tests |
The ₱20,000 medicine cap, explained: each member gets up to ₱20,000 per year in free GAMOT medicines — and each qualified dependent gets a separate ₱20,000. Of the 75 medicines, 21 essential ones are guaranteed continuously in stock at YAKAP clinics (PhilHealth Advisory 2026-0007).
The 6 cancer screenings: mammogram, breast ultrasound, low-dose chest CT scan, alpha fetoprotein (blood test), liver ultrasound, and colonoscopy.
How to enroll in YAKAP:
1. Pick an accredited YAKAP/Konsulta clinic near you (RHUs and accredited private clinics).
2. Register via the eGovPH app (Government Services → PhilHealth Portal → YAKAP), via the Member Portal’s Konsulta/YAKAP tab, or in person at the clinic — some clinics enroll you on the spot with your PhilHealth ID.
3. Complete your First Patient Encounter (FPE) — the initial checkup and health-risk assessment.
4. For medicines: only your YAKAP clinic doctor can prescribe through the GAMOT app (QR-code prescriptions). You cannot walk into a pharmacy directly.
Hospitalization benefits (case rates)
PhilHealth pays a fixed case rate per illness/procedure — deducted from your hospital bill, not reimbursed to you afterward. Examples from 2026 guides:
- Normal delivery: ₱29,000 case rate + ₱2,950 newborn care = ₱31,950 deducted. (A ₱45,000 bill leaves ~₱13,050 out of pocket.)
- Dependents use the same case rates at zero additional premium — present your MDR plus proof of relationship.
Zero Balance Billing: members admitted to a ward bed at DOH-retained hospitals pay ₱0 out of pocket — expanded to all PhilHealth members in August 2025. Ask the billing office whether ZBB applies to your admission.
What PhilHealth does NOT cover: cosmetic/elective procedures, eyeglasses and hearing aids, routine dental (outside YAKAP), private-suite upgrades above the case rate, and personal hospital items.
Senior citizens: free automatic coverage
Under RA 10645, every Filipino aged 60+ is automatically a PhilHealth member — premiums paid by the national government (sin-tax funding). No monthly payments, no enrollment fees.
- How to activate: register at your LGU’s OSCA (Office of Senior Citizen Affairs) or any PhilHealth LHIO — coverage is automatic by law, but your records must exist in the system.
- If you contributed 120+ months during your working years, you’re covered as a lifetime member; otherwise as a senior-citizen indirect contributor — either way, free.
- Zero Balance Billing applies to seniors in DOH-retained hospitals (ward beds).
- This runs alongside the 20% senior discount + VAT exemption under RA 9994 (Expanded Senior Citizens Act) — a separate benefit, not through PhilHealth.
Other covered groups
- Solo parents: may qualify for sponsored/indirect coverage under the Expanded Solo Parents Welfare Act (RA 11861) — confirm your category at your LGU social welfare office or PhilHealth branch, as implementing rules vary by locality.
- Indigents and 4Ps beneficiaries: covered as indirect contributors; check with your barangay or DSWD.
- PWDs: covered under their applicable member category; children with permanent disability qualify as dependents at any age.
Buod sa Tagalog
Sakop ng PhilHealth ang ospitalisasyon (case rates) at YAKAP primary care: libreng checkup, 13 lab tests, 6 cancer screening, at hanggang ₱20,000 kada taon na libreng gamot. Awtomatiko at libre ang senior citizens (60+) sa ilalim ng RA 10645. Magpa-rehistro sa YAKAP clinic — sa eGovPH app, Member Portal, o personal.
Troubleshooting
My YAKAP clinic says my registration isn’t found. Confirm you completed registration (eGovPH, portal, or in-clinic) and that your PIN is active. Re-register at the clinic if needed — in-person enrollment is immediate.
Pharmacy won’t honor my GAMOT prescription. Only accredited GAMOT pharmacies accept QR-code prescriptions, and only medicines on the 75-drug GAMOT list are free. Confirm both before going.
Hospital bill higher than expected after PhilHealth deduction. PhilHealth pays the fixed case rate, not your full bill. Ask for an itemized statement, check whether Zero Balance Billing applied (ward bed, DOH-retained hospital), and verify your MDR was presented at admission.
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Related guides: PhilHealth: Complete 2026 Guide · PhilHealth Online Registration · PhilHealth Contribution Table 2026 · PhilHealth MDR
Last verified: 2026-10-05. Official source: philhealth.gov.ph. YAKAP components (75 GAMOT medicines, 13 labs, 6 screenings, ₱20,000 cap) per PhilHealth Circular 2025-0017 and PIA reports; senior coverage per RA 10645; Zero Balance Billing expansion August 2025 per PIA.
Always confirm details on the official government portal:
Visit the official PhilHealth portalFrequently asked questions
Konsulta vs YAKAP — which do I sign up for?
YAKAP. It replaced Konsulta in 2025 and expanded it: 75 medicines (from 21), 6 cancer screenings (new), ₱20,000 annual medicine cap, and digital registration via eGovPH.
Do I need to pay anything at a YAKAP clinic?
No — consultations, covered labs, screenings, and GAMOT medicines are free at accredited providers, within the package limits. If you choose a branded medicine above PhilHealth's set price, you may pay the difference.
Can my dependents use YAKAP too?
Yes — registered dependents get their own consultations and their own separate ₱20,000 annual medicine limit.
I'm 62 and never registered — am I really covered?
Yes, by law (RA 10645). But visit OSCA or an LHIO to get your records into the system — hospitals can't find what was never recorded.
Does PhilHealth cover checkups at private hospitals?
YAKAP works through accredited clinics (public RHUs and accredited private clinics). Hospitalization case rates apply at accredited hospitals. Always confirm accreditation first.
What if my claim is denied?
Ask the hospital billing office for the denial reason in writing, verify your MDR details match your IDs, and follow up with PhilHealth. Most denials trace to record mismatches or lapsed employer remittances — see troubleshooting.
What are PhilHealth case rates?
A case rate is the fixed amount PhilHealth pays for a specific illness or procedure — deducted directly from your hospital bill, not reimbursed to you later. Example: normal delivery has a ₱29,000 case rate plus ₱2,950 newborn care (total ₱31,950 deducted). You pay whatever the bill exceeds the case rate — unless Zero Balance Billing applies (ward bed at a DOH-retained hospital, where you pay ₱0).
Is Konsulta still available, or is it YAKAP now?
It's YAKAP now. YAKAP (launched July 2025) replaced and expanded Konsulta — 75 free medicines instead of 21, plus 6 cancer screenings and a ₱20,000 annual medicine cap. If an old guide or clinic still says "Konsulta," they mean the same primary-care program; enroll through YAKAP via the eGovPH app, the Member Portal, or in person at an accredited clinic.
