You are on page 1of 5

Memorandum of Agreement

Know all men by these presents:

This Memorandum of Agreement is entered into for the Philippine Health Insurance Corporation’s
(PhilHealth) Maternity Care Package, this-----------------------in the----------------------------------------------------,
Philippines, by and between:

------------------------------------, of legal age, married/single, Filipino, a resident of-----------------------------------
-------------------and affiliated with-------------------------- hereinafter referred to as the MIDWIFE PROVIDER,


--------------------------------, of legal age, married/ single, Filipino, a resident of--------------------------------------
-------------- and affiliated with --------------------------------------------------------------hereinafter referred to as

WHEREAS, to ensure that quality care is provided to the patient, the MIDWIFE PROVIDER is required to
have a minimum of two (2) Philippine Health Insurance Corporation (PhilHealth) accredited PARTNER
PHYSICIANS for referral and further management of both mother and the newborn, needing higher
levels of maternal and neonatal care, respectively.

WHEREAS, each PARTNER PHYSICIAN, should be affiliated with a PhilHealth accredited secondary or
tertiary hospital;

WHEREAS, both parties have agreed that the PARTNER PHYSICIAN shall accept patients referred by the
MIDWIFE PROVIDER and provide appropriate necessary care to these patients.

NOW THEREFORE, for and in consideration of the foregoing provisions, the her in parties have agreed
to the following terms and conditions.

Article I

Definition of TERMS

1. The Maternity Care Package is a PhilHealth Outpatient Benefit Package that covers payment for the
following services for the first and second low risk pregnancies, prenatal care, normal birth , routine
newborn care, postpartum care, and family planning, all rendered by the provider in a PhilHealth-
accredited Outpatient Clinic.

2. Low-risk pregnancy is a pregnancy with no identified risk factors. Normal birth is defined as
spontaneous in onset, low risk at the start of the labor, and remaining so throughout labor and delivery.
The infant is born spontaneously in the vertex position between 37 and 40 completed weeks of
pregnancy. After birth, mother and infant are in good condition.

3. The PhilHealth-accredited PARTNER PHYSICIANS generally shall be Obstetrician and Pediatrician.
However, in provinces where there are no members of the Philippines Obstetrical and Gynecological
Society (POGS) and the Philippine Pediatric Society (PPS), General Physician who have undergone at
least six (6) months and service training in Obstetric or Pediatrics that prepares them to manage
obstetrics or newborn complications, respectively, may be allowed to serve as PARTNER PHYSICIANS
provided that they are dully accredited with PhilHealth- accredited secondary or tertiary hospital.

4. The OUTPATIENT CLINIC for the Maternity Package is a non- hospital outpatient facility with adequate
facilities and competently trained staff capable of providing all the maternal and neonatal services.

5. REFERRAL is the process by which the MIDWIFE PROVIDER directs the patient to the PARTNER
PHYSICIAN due to onset of risk for further management of patient’s care.

Article II


1. The MIDWIFE PROVIDER shall render prenatal, birth delivery, routine newborn care, and postpartum
services to female beneficiaries during their first and second low-risk pregnancies and normal deliveries.

2. The MIDWIFE PROVIDER shall be available to attend to all eligible patients at all times, especially
during intrapartum.

3. The MIDWIFE PROVIDER shall abide by/ comply with the prescribed clinical pathways and practice
guidelines for the maternity care package.

4. The MIDWIFE PROVIDER shall do a pregnancy risk assessment during the first prenatal visit of the
patient. Any patient who presents any of the following EXCLUSION CRITERIA shall be referred to the
PARTNER PHYSICIAN for Obstetric complication the soonest possible time.

4.1 History of previous major obstetric/ gynecologic operative intervention (e.g. Caesarian
Section, Salpingectomy for ectopic pregnancy, Oophorectomy)
4.2 History of three (3) or more miscarriage or one (1) stillbirth.
4.3 Maternal age under 19 years old.
4.4 Elderly primis with maternal age 35 years and older.
4.5 Multiple pregnancy (e.g. twins, triplets, etc.)
4.6 Abnormal fetal presentation (eg. Breech)
4.7 Placental abnormalities (e.g. low- lying placenta, placenta previa).
4.8 Uterine abnormalities (e.g. myoma uteri).
4.9 Ovarian abnormalities (e.g. ovarian cyst). History of Medical conditions (e.g. hypertension,
heart disease, diabetes, thyroid disorders, obesity, moderate-severe asthma, pre-eclampsia,
eclampsia, epilepsy, renal disease, bleeding disorders).
4.10 Other risk factors that may arise during present pregnancy (e.g. premature contraction,
vaginal bleeding), that the midwife perceives to warrant a referral to an obstetrician/ physician
for further management.

5. Should the patient develop risk factors during the course of the present pregnancy, or should the
patient require intrapartum referral for obstetric emergencies ( e.g. preterm labor, prolonged labor,
fetal distress, abruptio placenta) the MIDWIFE PROVIDER shall refer the patient immediately to the
PARTNER PHYSICIAN in Obstetrics for further management and/ or delivery.

6. In all cases of referrals, the MIDWIFE PROVIDER shall accurately accomplish the WFMC. Referral Form.
Moreover, the MIDWIFE PROVIDER shall be physically present when making intrapatum and postpartum
referrals to the PARTNER PHYSICIAN.

7. The MIDWIFE PROVIDER is autonomous and has direct responsibility and liability for his/her
judgement and actions.

8. The MIDWIFE PROVIDER shall not entertain phoned-in instructions from the PARTNER PHYSICIAN.

Article III


1. The PARTNER PHYSICIAN shall accept ALL patients properly referred by the MIDWIFE PROVIDER.

2. The PARTNER PHYSICIAN shall accept referral on a 24-hour basis for obstetric/gynecologic/neonatal
emergency cases.

3. The PARTNER PHYSICIAN shall be entitled to reimbursement of claims in accordance with existing
NHIP in-patient benefits but not under the MC Package.

4. The PARTNER PHYSICIAN shall pay to the MIDWIFE PROVIDER Referral Fees for Cesarean Sections and
other delivery cases referred. Both parties shall agree to the corresponding schedule of fees. A separate
Memorandum of Agreement shall be crafted for this purpose.

5. The PARTNER PHYSICIAN shall also assign SUSTITUTE PHYSICIAN for that particular case or for the
duration of his/her absence.

6. The PARTNER PHYSICIAN shall not entertain telephone consultations from MIDWIFE POVIDER.

Article IV


The herein PARTIES agree that their attendance to the patients shall be independent of each other,
hence, each PARTY shall be individually responsible for any incident that may occur during the time that
the patient is under his/her care. The determination of the liabilities of both PARTIES in the care of the
patient shall depend upon the specific factual circumstances of the cases.

IN WITNESS WHEREOF, the PARTIES have set their hands to this MEMORANDUM OF AGREEMENT at the
place and date written above.


-------------------------------------------- ---------------------------------------------
(Signature over Printed Name) (Signature over Printed Name)

Signed in the presence of

-------------------------------------------- ----------------------------------------------
(Signature over Printed Name) (Signature over Printed Name)

Subscribed and sworn to before me this----------day of---------------------------------------------------
The affiants/ exhibiting to me his/their respective-------------------------------------------

PTR No---------------------------------
Issued at---------------------------------
Issued on-------------------------------

Doc. No-----------------
Book No.---------------
Page No-----------------
Series of 20-------------